Importance of prioritisation
Cochrane Stroke has over 200 published reviews to keep up-to-date and up to 20 new reviews in development at any one time, which is a significant amount of work for the Editorial and review author teams. Therefore, it is important to prioritise these reviews to ensure that we use our limited, publically-funded resources to focus on those topics that are most important to stakeholders (patients, carers, service planners, healthcare professionals).
Priority setting partnership
The James Lind Alliance (JLA) is an initiative which brings patients, carers and clinicians together in Priority Setting Partnerships (PSPs) to identify and prioritise the top research questions for different health conditions and topics.
During 2019 – 2021 Cochrane Stroke was a key partner in a Stroke JLA Priority Setting Partnership. This Stroke Priority Setting Partnership, led by the Stroke Association, brought stroke survivors and carers together with professionals across the stroke pathway, including GPs, neurologists, nurses and allied health professionals. Cochrane Stroke representatives (Gillian Mead, Alex Pollock, Joshua Cheyne) were core members of the Steering Group for this Priority Setting Partnership, contributing to all meetings and processes. A description of the priority setting process is available here.
In addition, the Cochrane Stroke Information Specialist advised on search methodology best practice and practicalities, evidence checking, information retrieval, and constructing search strategies throughout the lifecycle of the Stroke Priority Setting Partnership. We also advised on the classification scheme used to divide Stroke PSP questions into practical categories and subcategories to enable forming of indicative questions. This was adapted from Cochrane Stroke’s trial register Intervention classifications taxonomy used to categorise studies included in the Stroke Group’s register.
Between February and August 2020, almost 4,000 questions about stroke were submitted by 1407 people, around half of who were stroke survivors or carers. Some questions overlapped, so similar questions were merged, and these were checked against existing evidence and prioritised. Cochrane Stroke (Peter Langhorne and Amanda Barugh) played a key role in checking submitted questions against existing evidence by mapping questions to Cochrane reviews and concluding whether further research was required, based on the conclusions of the Cochrane reviews. In March 2021, over 1000 people, including stroke survivors, carers and health professionals, completed an online survey to indicate which of 93 unique questions they considered most important; this survey was shared with all Cochrane Stroke authors and editors. Two final consensus workshops were held to decide on the top 10 priorities relating to (1) Stroke prevention, diagnosis, pre-hospital and hospital care, and (2) Rehabilitation and long-term care. The results of this PSP were widely disseminated, with formal feedback provided to the stakeholders who were involved in it.
How is Cochrane Stroke using these priorities?
Cochrane Stroke is using these priorities in the following ways to inform decisions around prioritisation of reviews and review updates:
- Mapping questions to existing reviews. Cochrane Stroke has mapped the 93 unique unanswered questions, and both Top 10 priorities, within our database of research: www.askDORIS.org. A ‘priorities’ option has been added to the database, so that the research priorities relevant to any entered search term can be instantly accessed. This mapping provides a unique and accessible way of viewing prioritised research questions alongside our portfolio of Cochrane Stroke reviews and protocols.
- Informing acceptance of new reviews. All proposals for new reviews submitted to Cochrane Stroke are compared with the list of priorities from the Priority Setting Partnership, and this is used by editors to inform decisions about whether to accept a new review title.
- Informing prioritisation for review updates. For a number of years Cochrane Stroke has run an ongoing priority-setting process. This involved the members of the International Editorial Board, on an annual basis, ranking all review titles as 'high', 'medium', or 'low' priority. This process uses information about:
o The results of the JLA Priority Setting Partnership
o the frequency of access of our reviews;
o the use of our reviews in clinical practice guidelines.
- Knowledge translation activities. A knowledge translation strategy is considered for all new reviews and updates during the editorial process. Reviews which address questions within the top priorities as identified by the JLA Priority Setting Partnership will be promoted using the accepted Cochrane knowledge translation approach.
Ongoing prioritisation plans
Following the successful completion of the Stroke Priority Setting Partnership, Cochrane Stroke continues to work closely with the Stroke Association on a number of activities relating to the identified priorities. These include:
- Ensuring promotion of the prioritised questions, including on www.askDORIS.org
- Exploring ideas and opportunities for further work to ‘unpack’ the prioritised questions
- Constructing a search methods protocol on health inequalities and access to stroke healthcare to support collation of evidence relating to these priority areas
- Contributing as authors to further documentation and dissemination relating to the results of the PSP process.
The Cochrane Stroke Editorial Board continues to explore optimal ways to integrate the results of the JLA Priority Setting Partnership with our portfolio of current reviews, and will discuss and refine prioritisation processes on an annual basis. We next plan to review this process in April 2022.