Skip to main content

Table 3 Overview of challenges encountered most frequently in evidence reviews

From: A scattered landscape: assessment of the evidence base for 71 patient decision aids developed in a hospital setting

Characteristics of the PtDA Challenges related to available evidence
Related to treatment alternatives  
Very different treatment alternatives being compared
(Extended) do-nothing compared to active treatments
No directly comparative evidence available: lack of evidence for one/some alternatives but comparative evidence for others
Different absolute/relative estimates from heterogeneous reviews/studies
Network meta-analysis not considered helpful if effect estimates different compared those of directly comparative evidence
Established treatments compared to innovations Older versus newer evidence, absolute numbers differ: interpretation/transferability to current setting difficult
Validity of estimates from older studies questionable
Treatments offered by competing clinical entities (e.g., cardio-surgeons vs. cardiologists)
Specific clinical expertise with certain alternatives greater than with others (e.g., laparoscopic vs. open surgery)
Intense but productive discussions with clinicians on best available evidence/evidence interpretation
Available evidence does not always seem to well reflect current clinical practice or clinical expertise at UKSH
Related to target population, subgroups
Focus on e.g., elderly patients, children
Effect modification/subgroups identified in evidence reviews
Transferability of results from evidence reviews to target group difficult,
Support of clinicians needed to interpret evidence and its relevance for target group
Need to provide relevant information for subgroups in the PtDA, e.g., for patients with diabetes
No separate searches of additional evidence for identified subgroups were usually conducted
Related to outcomes
Decision on framing of outcomes (e.g., mortality versus survival)
Specific outcomes (effectiveness/harms) considered very important by patients or physicians
Outcomes reported in the evidence (mortality) were framed differently in the evidence summarization/PtDA (e.g., as survival) to provide most appropriate information to patients in specific situations
Second/third round searches for evidence were conducted to fill data gaps
  1. PICO, Patients, Intervention, Comparison, Outcomes; PtDA, Evidence-based Patient Decision Aid