Review priority areas
About the ARI Group’s priority-setting project
Cochrane’s policy and procedures have evolved to establish priority areas for reviews. We define priority setting as making informed decisions about review topics to ensure that concepts identified through consultation with health professionals, consumer representatives, and other stakeholders, are met. The purpose of the project was to identify priority topics of interest to our stakeholders for review.
Our priority-setting work involved three components: a stakeholder Delphi survey; a gap analysis of available randomised controlled trial (RCT) evidence that was compared with registered review titles; and analysis of topics searched via the Trip database.
We established a steering group to lead the priority-setting process:
- Professor Chris Del Mar, Cochrane ARI Group Co-ordinating Editor, Director of Centre for Research in Evidence-Based Practice (CREBP) (Bond University, Australia);
- Dr Mark Jones, Cochrane ARI Group Deputy Co-ordinating Editor (Bond University, Australia);
- Dr Anna Mae Scott, Senior Research Fellow/Assistant Professor, Centre for Research in Evidence-Based Practice (CREBP) (Bond University, Australia);
- Justin Clark, Cochrane ARI Group Information Specialist (at the time of the survey);
- Liz Dooley, Cochrane ARI Group Managing Editor; and
- Ann Jones, Cochrane ARI Group Managing Editor.
We are grateful for the support and interest of many external stakeholders who provided data, guidance and feedback. People from a wide range of organisations and agencies helped to promote stakeholder involvement to complete the Delphi survey:
- Centre for Health Communication and Participation, School of Psychology and Public Health, La Trobe University, Australia;
- Cochrane Knowledge Translation;
- Cochrane Membership, Learning and Support Services;
- Cystic fibrosis patient groups;
- European Patients' Academy (EUPATI) Facebook group;
- Health Consumers Alliance of South Australia Inc;
- Health Consumers Queensland, Australia;
- Health Technology Assessment International (HTAi) Patient/Consumer Interest Group;
- Institute of Health Economics, Canada; and
- Lung Cancer Canada.
We are indebted to the Delphi survey respondents. (Responses to the survey were anonymised). We also thank the director of the Trip database.
Priority-setting project components
We conducted two online surveys with the aim of identifying the top 20 priority systematic reviews from a list of 68 review topics derived from the gap analysis for which evidence was available from more than four RCTs.
We advertised the link to the first survey through a wide range of Cochrane portals, and to ensure a broad response from consumers and patients, we also contacted several consumer health groups in Australia who disseminated the request and survey link to their members.
A second survey asked respondents to choose 10 topics from a list of 25 topics that were identified in the first survey.
The top five priority topics derived from the survey were: vaccinations for acute respiratory infections; antivirals for acute respiratory infections; non-steroidal anti-inflammatories for acute respiratory infections; vitamins and supplements for acute respiratory infections; and infection control for influenza.
Research gaps analysis
We aimed to determine interventions and health conditions for which there are RCTs not systematically reviewed by Cochrane. We used a list of ARI-specific RCTs from our group’s trials register and compared this with a list of Cochrane Reviews specific to our group
The top five priority topics derived from the gap analysis were antibiotics for each pneumonia, acute bronchitis, sore throat, middle ear infection, and sinus infection.
Read our published report: Determining the gaps between Cochrane reviews and trials of effectiveness of interventions for acute respiratory infections: an audit. An interactive data graph is also available.
Trip database analysis
The Trip database is a clinical search engine which aims to help clinicians find the best available evidence to answer a clinical question. Our purpose was to identify topics that stakeholders had asked via this search engine and we extracted relevant searches containing at least one disease and one clinical management term.
The top five priority topics derived from the Trip database analysis were: vaccination for influenza; antibiotics for middle ear infection; vitamin C for the common cold; corticosteroids for meningitis; and treatments for pneumonia.
Analysis and evaluation
We derived five priority review topic areas from the Delphi survey:
- Interventions to prevent acute respiratory infections;
- Antivirals for acute respiratory infections;
- Nonsteroidal anti-inflammatory drugs for acute respiratory infections;
- Vitamins and supplements for acute respiratory infections; and
- Infection control and influenza.
We matched existing reviews to these topic areas and used the gap analysis findings to identify additional review topic areas that need to be addressed. We then invited the ARI Group Editors to provide feedback. The Editors provided valuable insights and their guidance has been applied to ensure topics are robust and clinically relevant.
Our priority setting exercise involved a broad range of stakeholders to ensure that topics were clinically and socially relevant, appropriate, and feasible. We experienced challenges: some suggested topics were outside the ARI Group’s scope (such as asthma); were not well defined and could not be matched to a specific health condition or intervention topic (e.g. “ARI non-specific”); or were concepts that did not relate to topics that could inform a population, intervention, comparator, outcomes (PICO) question or are generally treated as intervention review outcomes (e.g. mortality, adverse effects). These topics, and duplicated topics, were excluded from the analysis. We also faced challenges when interpreting feedback relating to complementary and alternative medicines which did not provide enough detail to enable comparison with current reviews, or those that were supportive, rather than complementary, therapies.
We made a post hoc decision to link priority topics to a standardised list of topics supported and managed by the Cochrane ARI Group.
Project time frame
The project was undertaken from 2017 to 2018. We plan to review the relevance of the priority review topics as time and resources permit. At a minimum, we will conduct another priority-setting exercise within five years.
Priority setting findings and review topics
We matched the five priority topics to current titles and used findings from the gaps analysis findings to validate need for possible new reviews. As a result, we will commission four new priority reviews.
Interventions to prevent acute respiratory infections
We considered commissioning two new reviews: one to investigate vaccination for polio and another on palivizumab to prevent respiratory syncytial virus (RSV) in children.
Following investigation, it was found that reviews were underway and were being managed by another review group. Therefore, we abandoned this review and have removed polio as a topic we will consider in reviews.
A review on palivizumab to prevent RSV in children is still being investigated.
Antivirals to treat acute respiratory infections
Assessment was undertaken to commission a new review to investigate antivirals (such as baloxivir and similar antiviral agents) to treat influenza and influenza-like illness. It was found that clinical study reports for this review were not widely available, and the credibility of a review based on limited evidence was questoned. It was decided to postpone commissioning a review on this topic indefinitely.
Nonsteroidal anti-inflammatory drugs (NSAIDs) for acute respiratory infections
A new review has been commissioned to investigate NSAIDs for sore throat (tonsillitis, pharyngitis). It is aimed that the review will be published in early 2021.
Vitamins and supplements for acute respiratory infections
A new author team is currently updating a review investigating Vitamin A for preventing acute lower respiratory tract infections in children up to seven years of age.
We are seeking new authors to undertake a review on Zinc for the common cold.
Infection control and influenza
A current review on this topic, Physical interventions to interrupt or reduce the spread of respiratory viruses, is being updated.
Other review topics
We welcome proposals for reviews, but potential author teams must ensure the topic is globally and clinically relevant, and there is recent or ongoing RCT evidence or research on the topic. We are unable to accept review proposals that investigate topics already covered. Please see Our reviews.