A randomized survey of the preference of gastroenterologists for a Cochrane review versus a traditional narrative review
JWD McDonald | J Mahon | K Zarnke | B Feagan | et al
Clinicians often rely on review material rather than
analysis of primary research to guide therapy. Systematic
reviews use methods to insure thoroughness and to minimize
bias, but many clinicians are not familiar with systematic
reviews and continue to rely on narrative reviews.
To determine whether a traditional narrative review
or a systematic review is perceived to be more useful.
A clinical scenario (patient with chronic Crohn's disease
considered for azathioprine therapy) was circulated
to gastroenterologists, along with a narrative review
of therapy (including azathioprine) for inflammatory
bowel disease written by an acknowledged expert, or
with a systematic Cochrane review of the use of azathioprine
for this disease. Whether knowledge of authorship and
journal source influences the perception of usefulness
of a narrative review was investigated.
The Cochrane review was rated significantly more highly
than the narrative review on a 100 mm visual analogue
scale (21.3 mm; 95% CI 14.5 to 28 mm). The proportion
of respondents who considered the review to be a useful
guide was also higher in the group that received the
Cochrane review (91%) than in the group that received
the narrative review, with author and journal concealed
(62%) or identified (70%) (P<0.001 for both comparisons).
Ratings from the two groups that received the narrative
review were not significantly different.
The focused systematic review was perceived to be more
useful than a traditional broad narrative review as
a guide to making a decision concerning the use of specific
therapy. The possible strengths of systematic reviews
should be more fully investigated. If there is additional
evidence supporting their greater value to clinicians,
they should be made more widely available to clinicians
and their strengths should be publicized.