Table 7 Results of thematic analysis and barriers and facilitators to the use of Cochrane reviews in the development of guidance
Themes and subthemes | Barriers and facilitators |
|---|---|
Theme 1. The process of using Cochrane reviews (CRs) in the development of guidance | |
  • CRs used early in process/used in development phase | Barriers |
  • Systematic reviews top of evidence hierarchy/priority over other forms of evidence |   • CRs may not be available, may not fit with guideline scope |
  • Guideline developers (GD) will use CR if available, but not always possible—CR may not be available/may not ‘fit’ |   • CR may be out of date |
  • GD may use whole CR or parts of CR (e.g. using evidence tables)/parts used vary | Facilitators |
  • CRs can save GD time (e.g. using existing searches/data) |   • Similar evidence hierarchy |
  • GD may build on work of Cochrane reviewers/existing reviews |   • Cochrane processes for searching/ identifying studies seen as reliable and thorough |
  • GD may redo the review (depending on resources) |   • Similar processes for critical appraisal |
|  |   • Structure of CR means that GD can use all or part of it |
Theme 2. Quality of Cochrane reviews | |
  • Cochrane is a respected/trustworthy brand | Barriers |
  • Transparent/easy to replicate |   • Quality not always good |
  • Robust methods |   • Quality may be poorer in older reviews |
  • Variable quality (not all good) | Facilitators |
  • Perception that quality may be poorer in older reviews |   • Generally respected/trustworthy brand |
|  |   • Robust methods that can be replicated |
Theme 3. Culture and approaches | |
  • Cochrane and GD have similar attitudes towards evaluating and appraising evidence | Barriers |
  • Cochrane reviews routinely used to inform guideline development process |   • Different time frames and resources |
  • Some differences in methods (e.g. CR double data extraction but some GD not) |   • Different priorities of Cochrane and GD |
  • Role of judgement (part of guideline development process but not CR) |   • Different needs and perspectives |
  • Cochrane and GDs may have different scopes/focus/drivers behind review questions | Facilitators |
  • Tensions between different perspectives and interests (e.g. academic/clinical/policy) |   • Similar attitudes towards evaluating and synthesising evidence |
  • Resources—different time frames and sources of funding |   • Cochrane embedded in culture of guidelines |
Theme 4. Up-to-date evidence | |
  • CRs can be out of date (become out of data quickly) | Barriers |
  • Some confusion around dates of updates |   • Cochrane too slow to update |
  • Some GD (e.g. WHO) work with CRGs to update reviews (they fund this) |   • Lack of resources to fund reviews/updates |
  • Delay in publication/updating |   • Slow editorial processes |
| Â | Facilitators |
|  |   • Guideline developers fund CRG to update review |
Theme 5. Methodological issues | |
  • Newer is better (newer CRs seen as methodologically better) | Barriers |
  • May be statistical issues (wrong data/statistical methods—barrier to use) |   • Statistical issues (e.g. CR not used outcome measures, statistics GD want) |
  • Lack of clarity on which follow-up data used from papers |   • Need for network meta-analysis and comparative analysis reviews |
  • Network meta-analysis, comparative analysis reviews |   • Lack of facilities for sharing data |
  • GRADE (NICE have to use it, Cochrane do not) |  |
  • Cochrane focus on RCTs—not always appropriate, particularly for public health |  |
  • GD want better facilities for sharing and reanalysing data from CRs |  |
Theme 6. Collaboration/communication | |
  • Good communication improves use of review | Barriers |
  • Timing of communication is important |   • Problems communicating with review authors and CRGs |
  • Dialogue/clear communication/negotiation important with appropriate persons |   • Issues of ownership and authorship |
  • Collaboration and positive engagement might help speed things up | Facilitators |
  • Close collaboration between WHO and certain Cochrane groups |   • Good communication between GD and authors or CRGs improves use of CR (timing important) |
  • Formal links between CRG and guideline developers to promote use of CR |   • Financial support |
  • GD experience problems communicating with CRGs |  |
  • Issues of ownership/authorship—recognition and reward |  |