Incorporating uncertainty regarding applicability of evidence from meta-analyses into clinical decision making

TY - JOUR

T1 - Incorporating uncertainty regarding applicability of evidence from meta-analyses into clinical decision making

AU - Kriston, Levente

AU - Meister, Ramona

N1 - Copyright © 2014 Elsevier Inc. All rights reserved.

PY - 2014/3/1

Y1 - 2014/3/1

N2 - OBJECTIVES: Judging applicability (relevance) of meta-analytical findings to particular clinical decision-making situations remains challenging. We aimed to describe an evidence synthesis method that accounts for possible uncertainty regarding applicability of the evidence.STUDY DESIGN AND SETTING: We conceptualized uncertainty regarding applicability of the meta-analytical estimates to a decision-making situation as the result of uncertainty regarding applicability of the findings of the trials that were included in the meta-analysis. This trial-level applicability uncertainty can be directly assessed by the decision maker and allows for the definition of trial inclusion probabilities, which can be used to perform a probabilistic meta-analysis with unequal probability resampling of trials (adaptive meta-analysis). A case study with several fictitious decision-making scenarios was performed to demonstrate the method in practice.RESULTS: We present options to elicit trial inclusion probabilities and perform the calculations. The result of an adaptive meta-analysis is a frequency distribution of the estimated parameters from traditional meta-analysis that provides individually tailored information according to the specific needs and uncertainty of the decision maker.CONCLUSION: The proposed method offers a direct and formalized combination of research evidence with individual clinical expertise and may aid clinicians in specific decision-making situations.

AB - OBJECTIVES: Judging applicability (relevance) of meta-analytical findings to particular clinical decision-making situations remains challenging. We aimed to describe an evidence synthesis method that accounts for possible uncertainty regarding applicability of the evidence.STUDY DESIGN AND SETTING: We conceptualized uncertainty regarding applicability of the meta-analytical estimates to a decision-making situation as the result of uncertainty regarding applicability of the findings of the trials that were included in the meta-analysis. This trial-level applicability uncertainty can be directly assessed by the decision maker and allows for the definition of trial inclusion probabilities, which can be used to perform a probabilistic meta-analysis with unequal probability resampling of trials (adaptive meta-analysis). A case study with several fictitious decision-making scenarios was performed to demonstrate the method in practice.RESULTS: We present options to elicit trial inclusion probabilities and perform the calculations. The result of an adaptive meta-analysis is a frequency distribution of the estimated parameters from traditional meta-analysis that provides individually tailored information according to the specific needs and uncertainty of the decision maker.CONCLUSION: The proposed method offers a direct and formalized combination of research evidence with individual clinical expertise and may aid clinicians in specific decision-making situations.

KW - Decision Making

KW - Evidence-Based Medicine

KW - Humans

KW - Meta-Analysis as Topic

KW - Probability

KW - Research Design

KW - Uncertainty

U2 - 10.1016/j.jclinepi.2013.09.010

DO - 10.1016/j.jclinepi.2013.09.010

M3 - SCORING: Journal article

C2 - 24332396

VL - 67

SP - 325

EP - 334

JO - J CLIN EPIDEMIOL

JF - J CLIN EPIDEMIOL

SN - 0895-4356

IS - 3

ER -