Making a meal of it: How I sank my teeth into a Cochrane systematic review

Posted by jchoules

6 December 2019

Dr Jo Butterworth, GP and NIHR Doctoral Research Fellow.

“How are you 300 ahead of me?!” said my colleague, arriving at her desk to start a new day’s work. “Sorry?” I said, finishing off a mouthful of breakfast bar. I already knew what she meant. We’d been ‘competing’ like this for a few days now, egging each other on to maintain our momentum and get through the work on schedule. “Titles and abstracts! You’ve screened 300 overnight!” My mind went back to yesterday evening, sitting in the kitchen watching the potato wedges turn crispy in the oven whilst I flicked through “just a few more” articles on my mobile screening app. I guess that’s the way with screening isn’t it? At the start it’s like being confronted with a gigantic raw potato but once you’ve peeled the skin, gotten rid of a few knobbly bits, you just keep chipping away…

“… if we’d had all of the ingredients to make a shepherd’s pie then we would’ve made a shepherd’s pie, so next time we’re in the kitchen we might think about peeling a few more potatoes.”

In the case of our review of interventions, the evidence was fairly small fry and study authors had chosen different outcomes resulting in a lack of data which could be combined in our analysis. We reached the nevertheless important conclusion that further research was warranted and we made suggestions as to how research teams might go about this.

I never set out to lead on a Cochrane review; my funders thought it might be more than I could chew. However, when both I and the team from Manchester applied to update an existing review, Cochrane served up a sharing platter and suggested that we start with a clean slate. Now, when you’re posing your question and designing your search strategy, you’re just at the tip of the iceberg, with little real idea about where this might lead in terms of the workload ahead. Well, I can tell you now that there is nothing bite-sized about a Cochrane review.

Serving up and submitting a Cochrane review is what I imagine being a contestant on a well-known television cooking show might be like. You know you won’t get through to the next round if it doesn’t look, smell and taste just as the judges expect. However, there is plenty of guidance available to authors to ensure that their writing is up to standard.

There is also a lot of suggested text, which must not be left out, even if it does not seem applicable. For example, you’re expected to say something like, “if we’d had all of the ingredients to make a shepherd’s pie then we would’ve made a shepherd’s pie, so next time we’re in the kitchen we might think about peeling a few more potatoes”.

Carrying out a Cochrane review is, all-in-all, a highly valuable learning experience and it is the gold standard approach to a systematic review. I am grateful that I have been through the process and for the more sophisticated research palate that I have undoubtedly acquired along the way.

Reference:

Butterworth_JE, Hays_R, McDonagh_STJ, Richards_SH, Bower_P, Campbell_J. Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations. Cochrane Database of Systematic Reviews 2019, Issue 10. Art. No.: CD013124. DOI: 10.1002/14651858.CD013124.pub2 .