‘Research waste’ as Cochrane Reviews ignored by guidelines

Clinical guidelines relating to paediatric respiratory disease have been heavily criticised for not using the high quality evidence available in systematic reviews from the Cochrane Collaboration.

The UK study published in Thorax identified 21 guidelines comprising 1,025 recommendations related to conditions such as childhood asthma, cystic fibrosis or respiratory infections.

They found relevant Cochrane Reviews for 96 of these recommendations however 28 of the recommendations (29%) did not cite any and 10 (10%) did not cite all the available Cochrane reviews.

While the majority of guideline recommendations were in agreement with Cochrane Review recommendations, 26% were not consistent.

There was only partial agreement in 9% of guideline recommendations, 4% were in disagreement, and 13% made a strong recommendation where the Cochrane review did not draw a conclusion.

Professor Anne Holland, chair of the TSANZ Clinical Care and Resources Sub-Committee and an editor of the Cochrane Airways Group, told the limbic that guideline development was an evolving field.

She said while some groups used very robust criteria and extensive search processes, not all were the same.

“The study highlights the fact that we need to move towards more standardised processes,” she said.

“Clinical guidelines are highly influential and have real implications for clinical decision-making and patients outcomes.”

The study noted that ‘few Cochrane Reviews in paediatric respiratory medicine were able to draw a strong conclusion’.

Professor Holland said the fact that only 96 of 1,025 guideline recommendations could be matched to a Cochrane Review also highlighted huge gaps in the evidence base.

She said Cochrane Reviews were focused on becoming more accessible to user groups – for example, increasingly providing short summaries, through more active dissemination of findings and a more efficient, compressed process so evidence could be made available in a timely fashion.

She said more attention was also being paid to improving the translation of guidelines into practice. Initiatives included the creation of decision aids for patients and guidelines formatted for accessibility via apps or mobile devices at the point of care.

“Guidelines are frequently referenced in scientific literature but their actual use in practice is not as often as expected.”

The authors said their findings were consistent with other evidence that guidelines do not make the best use of Cochrane Reviews in areas such as smoking cessation and neonatal medicine.

“A great deal of money, time and effort goes into creating and updating Cochrane Reviews. Not using such evidence in guidelines constitutes research waste,” they said.

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