Systematic Reviews

Role of the librarian in this stage

Before you begin conducting a systematic review, a librarian can help you:

  • Develop and refine your research question framework 
  • Determine if any prior reviews have been published on the same or similar topics
  • Determine how much literature might be available on your topic

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Recruit team members

Keep these guidelines in mind when establishing your systematic review team:

  • Have a minimum of 3 reviewers, although a higher number will expedite the screening process.
    • Odd number simplifies tie-breaking process
    • Depending on the size of the literature, you may want to add additional team members. A team of up to ten or twelve people is not unusual for a large systematic review.
  • Choose experts in the field.
  • Collaborate with a librarian to develop a search strategy.
  • Work with a statistician if conducting a meta-analysis.
  • Define roles and expectations early in the review process.

Develop and refine research question

Systematic reviews aim to answer a specific research question. There are frameworks to help in question development and identification of search terms. PICO is the most popular framework utilized for clinical research topics.

Element Definition Questions to consider Example

 

P

Patient(s) / Population(s)

 

 

Who is the focus of my research question?

  • How would you describe this population (age, race, sex, health status, risk factors, previous or current ailments, current medications, etc.)?
  • How is the condition defined (symptoms, presence and/or severity of disease, diagnostic test, etc.)?
  • Are there any patients who should be excluded from this population (healthy patients, patients above or below a certain threshold, etc.)?

 

 

infants diagnosed with necrotizing enterocolitis (NEC)

 

I

Intervention(s)

 


What is the proposed, new intervention?

  • What is the main intervention, prognostic factor, or exposure being considered?
  • Are you interested in a drug treatment, medical procedure, surgical procedure, or diagnostic test?
  • For drug interventions, what is the dosage, frequency, and method of administration?

 

 

early enteral re-feeding

 

C

Comparison(s)



What is the current or alternative intervention?
  • What is the alternative to the proposed intervention?
  • Are you considering a different dosage of the same drug? Placebo or alternative drug? Another medical or surgical procedure?
  • For diagnostic studies, is there a gold standard or another diagnostic tool against which to compare?

 

 

late enteral re-feeding

 

O

Outcome(s)



What measurable outcome is affected?
  • What are you hoping to accomplish, measure, improve, or affect?
  • Do you want to improve quality of life?
  • Are morbidity or mortality important outcomes to consider?
  • What are the harms of this intervention and its alternatives?

 

 

NEC recurrence

Research question: In infants diagnosed with necrotizing enterocolitis (NEC), what is the effect of early enteral re-feeding on NEC recurrence compared to late enteral re-feeding?

Other question development frameworks

PICO is a helpful framework for clinical research questions, but may not be the best for other types of research questions. Did you know there are at least 25 other question frameworks besides variations of PICO?  Frameworks like PEO, SPIDER, SPICE, ECLIPSE, and others can help you formulate a focused research question. The table and example below were created by the Medical University of South Carolina (MUSC) Libraries.

PEO

The PEO question framework is useful for qualitative research topics. PEO questions identify three concepts: population, exposure, and outcome.

Element Definition Example
Population Who is my question focused on? mothers
Exposure What is the issue I am interested in? postnatal depression
Outcome What, in relation to the issue, do I want to examine? daily living experiences

Research question: What are the daily living experiences of mothers with postnatal depression?

SPIDER

The SPIDER question framework is useful for qualitative or mixed methods research topics focused on "samples" rather than populations.

SPIDER questions identify five concepts: sample, phenomenon of interest, design, evaluation,and research type.

Element Definition Example
Sample Who is the group of people being studied? young parents
Phenomenon of Interest What are the reasons for behavior and decisions? attendance at antenatal education classes
Design How has the research been collected (e.g., interview, survey)? interviews
Evaluation What is the outcome being impacted?

experiences

Research type What type of research (qualitative or mixed methods)? qualitative studies

Research question: What are the experiences of young parents in attendance at antenatal education classes?

SPICE

The SPICE question framework is useful for qualitative research topics evaluating the outcomes of a service, project, or intervention. SPICE questions identify five concepts: setting, perspective, intervention/exposure/interest, comparison, and evaluation.

Element Definition Example
Setting Setting is the context for the question (where). South Carolina
Perspective Perspective is the users, potential users, or stakeholders of the service (for whom). teenagers
Intervention / Interest / Exposure Intervention is the action taken for the users, potential users, or stakeholders (what). provision of Quit Kits to support smoking cessation
Comparison Comparison is the alternative actions or outcomes (compared to what).

no support or "cold turkey"

Evaluation Evaluation is the result or measurement that will determine the success of the intervention (what is the result, how well). number of successful attempts to give up smoking with Quit Kits compared to number of successful attempts with no support

Research question: For teenagers in South Carolina, what is the effect of provision of Quit Kits to support smoking cessation on number of successful attempts to give up smoking compared to no support ("cold turkey")?

ECLIPSE

The ECLIPSE framework is useful for qualitative research topics investigating the outcomes of a policy or service. ECLIPSE questions identify six concepts: expectation, client group, location, impact, professionals, and service.

Element Definition Example
Expectation What are you looking to improve or change? What is the information going to be used for? to increase access to wireless internet in the hospital
Client group Who is the service or policy aimed at? patients and families
Location Where is the service or policy located? hospitals
Impact What is the change in service or policy that the researcher is investigating? clients have easy access to free internet
Professionals Who is involved in providing or improving the service or policy? IT, hospital administration
Service What kind of service or policy is this? provision of free wireless internet to patients

Research question: How can I increase access to wireless internet for hospital patients?

Scope the literature

Does a systematic review already exist on your topic? Is a systematic review currently in progress on the same topic? If the answer to either of these questions is yes, then completing another systematic review may be duplicative and getting it published may be a challenge. The sources below are good places to search for systematic reviews or protocols for pending reviews. Contact a librarian for a more thorough search of published or in-progress systematic reviews.