Introducing a Series of Reviews Assessing Engagement in Evidence Syntheses

High quality evidence syntheses are used in health decision-making, such as policies, legislation, and clinical recommendations [1]. The usefulness, relevance, meaningfulness, and accessibility of evidence syntheses may be improved when people who are affected by those decisions, called “interest-holders,” are included in the evidence synthesis process [2-4]. This concept of engagement in research is based on the principle that those affected by the health condition under study or the intervention to address it have a moral right to contribute to the decisions about how the research is conducted [3, 5]. While there are increasing expectations from funders regarding the involvement of interest-holders [6], the most effective methods for engaging different interest-holders in evidence syntheses have not been identified [5]. Additionally, while there is some guidance related to engagement in research, it predominantly focuses on patient and public engagement in primary research, not evidence synthesis and there is limited guidance for engaging with other interest-holders [3, 4, 7-9]. The aim of this paper is to introduce a series of articles about how to successfully engage different interest-holders when conducting evidence syntheses. The series of articles will consider methods used to engage different interest-holders (including who to involve and in what way), barriers and facilitators to engagement, impacts of engagement, management of conflicts of interest, and factors relating to equity. This paper presents the shared definitions used across each of the five reviews included in this series. These reviews will inform the development of a guidance checklist and resources for engaging interest-holders through all steps of evidence synthesis. The plan for developing this guidance is described in the project protocol [10]. “Interest-holders” are groups of people with legitimate interests in the health issue under consideration and whose perspectives and views should be considered when conducting this study [2]. Their interests arise and draw their legitimacy from the fact that these people are responsible for or affected by health- and healthcare-related decisions that can be informed by research evidence. Engagement of interest-holders in evidence syntheses can promote transparency, accountability, trust, and help to ensure that the needs of interest-holders are included. Engagement can improve the translation of evidence into policy and practice [11]. Interest-holders can contribute throughout the steps of evidence synthesis including, for example, refining the research question and suggesting appropriate outcomes, suggesting additional references to consider, and providing context to interpret the evidence. This study was conducted by the MuSE Consortium, a group of over 160 individuals from 20 countries who are interested in engagement in health research, evidence synthesis, and health guidelines. This project complements a previous MuSE project which developed guidance for engagement in the development of health guidelines and clinical practice recommendations [12]. We have used a standardised set of terms and definitions that are used consistently across the set of reviews in this series. These definitions have been developed and agreed upon with the collaboration of the MuSE Consortium through our work related to engagement in research [6, 13, 14], guidelines [15, 16]; (Petkovic et al., 2022 [2, 10, 12, 17-19]), and in preparing the series of reviews being introduced here. Evidence syntheses synthesize the research evidence to address health care-related questions. They use rigorous, explicit, and transparent methods and include scoping reviews, rapid reviews, and quantitative or qualitative systematic reviews [1]. There are a number of different types of evidence syntheses which are summarized in Table 1. as an umbrella term, meaning any form of evidence synthesis which employs rigorous methods. As such, the term systematic review is often used interchangeably with, or instead of, the term evidence synthesis. as a term to describe a quantitative evidence synthesis, for example “Cochrane systematic review” (to describe a review of randomised controlled trials, conducted using methods proposed by the Cochrane Collaboration). a clearly stated set of objectives with pre-defined eligibility criteria for studies. an explicit, reproducible methodology. a systematic search that attempts to identify all studies that would meet the eligibility criteria. an assessment of the validity of the findings of the included studies, for example through the assessment of risk of bias; and systematic presentation, and synthesis, of the characteristics and findings of the included studies. Are underpinned by continual, active monitoring of the evidence (i.e. monthly searches) Immediately include any new important evidence (meaning data, studies or information) that is identified Are supported by up-to-date communication about the status of the review, and any new evidence being incorporated Interest-holders include the following 11 P's: patients and caregivers, the public, providers of care, policy makers, program managers, payers of health research, payers of health services, peer review editors, and product makers. Table 2 provides a definition for each group. This taxonomy of interest-holders groups is relevant to evidence synthesis and other taxonomies are used for other types of research, such as biomedical research, clinical research, and environment health research. A complete explanation of the term “interest-holders” is provided in a commentary that is included within this series [2]. Engagement refers to the two-way relationship between interest-holders and the research team. Other terms may be used, such as “involvement,” “partnership,” but for the purposes of our work we use “engagement” (Table 3). This is the preferred and most commonly used term in some parts of the world (including Canada and USA). It is therefore the term used in our series of evidence syntheses. It is important to note that the definition we use here is the same as the definition of the term involvement used in other parts of the world (e.g. UK). In the UK, and some other parts of the world, engagement is considered something distinct from involvement, generally comprising interactions which may fall short of the definition we provide here. However, within this series, we adopt the Canadian/US usage, and we do not make any distinction between engagement and involvement. To accommodate international variations in terminology, we use the same definitions for the terms engagement and involvement. At times we use the term involve in our work. For example, when referring to the questions within the ACTIVE framework (who was involved? etc) [33]. This reflects the original published terms. We consider these “co-” terms specific approaches which are related to, but which may go beyond, engagement. Sharing of power and responsibility are key principles of these “co-” terms [35] potentially creating fundamental differences from some approaches to engagement. As definitions vary, we will not use these terms in this study, instead describing the levels of engagement that interested people and groups may have. This series comprises six papers addressing different aspects of engaging interest-holders in evidence syntheses. These papers have each been co-authored by a team that include representatives from a variety of our identified interest-holder groups and all members of the MuSE Consortium were invited to contribute. Our first paper has already been published and introduces the term “interest-holder [2].” The remaining five papers are evidence syntheses describing different issues related to engagement. The first synthesis is a scoping review which identifies methods for engaging interest-holders in evidence syntheses. This scoping review, is an update to a previous review [5], describes the methods used to engage interest-holders, including who was engaged, the aims of their engagement, how they were engaged, and in what stages of the review process [38]. The second review is a mixed-methods evidence synthesis examining the factors affecting the engagement of interest-holders. Specifically, it aims to identify and synthesise what the barriers and facilitators are to involving interest-holders across all stages of the review cycle using the Theoretical Domains Framework [39]. The review also examines how contextual factors may impact the nature and degree of involvement among different groups of interest-holderst [40]. The third review assesses the impacts of interest-holder engagement on evidence syntheses. For this review, “impact” with regard to engagement refers to “any change in the research process, the research product, the people involved, or broader society as a result of engagement in the conduct of an evidence synthesis” [41]. The fourth review describes issues related to conflicts of interest in engagement in evidence syntheses. This review identifies the types of conflicts of interest among different interest-holders, how to manage them, and the impact of those conflicts on the evidence synthesis process [42]. Finally, the last review in the series aims to identify and characterize the equity considerations for the engagement of interest-holders in evidence synthesis [10]. Equitable engagement focuses on the deliberate inclusion of diverse individuals and groups. These reviews will inform the development of draft guidance for engagement with interest-holders throughout the evidence synthesis process. We will explore agreement with this draft guidance through interviews with interest-holders, and an international survey. We will use consensus methods to finalize a checklist for engaging with each of the 11 identified interest-holder groups throughout the stages of the evidence synthesis process. We welcome expressions of interest to take part in the subsequent stages of this ongoing project. Jennifer Petkovic: conceptualization, writing – original draft, project administration, writing – review and editing, funding acquisition. Joanne Khabsa: conceptualization, writing – original draft, writing – review and editing, funding acquisition. Lyubov Lytvyn: conceptualization, writing – original draft, writing – review and editing. Alex Todhunter-Brown: conceptualization, writing – original draft, writing – review and editing, funding acquisition. Olivia Magwood: conceptualization, writing – review and editing, writing – original draft, funding acquisition. Pauline Campbell: conceptualization, writing – review and editing. Elie A. Akl: conceptualization, writing – review and editing, funding acquisition. Thomas W. Concannon: conceptualization, writing – review and editing, funding acquisition. Holger Schunemann: conceptualization, writing – review and editing, funding acquisition. Vivian Welch: conceptualization, writing – review and editing, funding acquisition. Peter Tugwell: conceptualization, supervision, writing – review and editing, funding acquisition. The project was funded by a Canadian Institutes of Health Research Project Grant (FRN 178242). Cochrane Evidence Synthesis and Methods, as a Cochrane Collaboration journal abides by Cochrane's conflict of interest policy for Cochrane Library content (2020), which applies to all journal content. Cochrane's conflicts of interest policy for Cochrane Evidence Synthesis and Methods not only requires study funding and author interests to be declared at the earliest point possible, but also mandates that some funding and conflicts of interest will prevent people from being authors of submissions. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study. The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer-review/10.1002/cesm.70057.

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