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• Systematic Review | Definition, Example, & Guide

Systematic Review | Definition, Example & Guide

Published on June 15, 2022 by Shaun Turney . Revised on November 20, 2023.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question “What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?”

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

Table of contents

What is a systematic review, systematic review vs. meta-analysis, systematic review vs. literature review, systematic review vs. scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, other interesting articles, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce bias . The methods are repeatable, and the approach is formal and systematic:

• Formulate a research question
• Develop a protocol
• Search for all relevant studies
• Apply the selection criteria
• Extract the data
• Synthesize the data
• Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesizing all available evidence and evaluating the quality of the evidence. Synthesizing means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

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Systematic reviews often quantitatively synthesize the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesize results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimize bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

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A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

• A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
• If you’re doing a systematic review on your own (e.g., for a research paper or thesis ), you should take appropriate measures to ensure the validity and reliability of your research.
• Access to databases and journal archives. Often, your educational institution provides you with access.
• Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
• Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

• They minimize research bias by considering all available evidence and evaluating each study for bias.
• Their methods are transparent , so they can be scrutinized by others.
• They’re thorough : they summarize all available evidence.
• They can be replicated and updated by others.

Systematic reviews also have a few cons .

• They’re time-consuming .
• They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

• Allow you to more effectively communicate your research to other researchers and practitioners
• Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

• Population(s) or problem(s)
• Intervention(s)
• Comparison(s)

You can rearrange these four components to write your research question:

• What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fifth component, the type of study design . In this case, the acronym is PICOT .

• Type of study design(s)
• The population of patients with eczema
• The intervention of probiotics
• In comparison to no treatment, placebo , or non-probiotic treatment
• The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
• Randomized control trials, a type of study design

Their research question was:

• What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

• Background information : Provide the context of the research question, including why it’s important.
• Research objective (s) : Rephrase your research question as an objective.
• Selection criteria: State how you’ll decide which studies to include or exclude from your review.
• Search strategy: Discuss your plan for finding studies.
• Analysis: Explain what information you’ll collect from the studies and how you’ll synthesize the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

• Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
• Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
• Gray literature: Gray literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of gray literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of gray literature.
• Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

• Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
• Handsearch: Conference proceedings and reference lists of articles
• Gray literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
• Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

• Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
• Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarize what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

• Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
• Your judgment of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomized into the control and treatment groups.

Step 6: Synthesize the data

Synthesizing the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesizing the data:

• Narrative ( qualitative ): Summarize the information in words. You’ll need to discuss the studies and assess their overall quality.
• Quantitative : Use statistical methods to summarize and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analyzed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

• Abstract : A summary of the review
• Introduction : Including the rationale and objectives
• Methods : Including the selection criteria, search method, data extraction method, and synthesis method
• Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
• Discussion : Including interpretation of the results and limitations of the review
• Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

In their report, Boyle and colleagues concluded that probiotics cannot be recommended for reducing eczema symptoms or improving quality of life in patients with eczema. Note Generative AI tools like ChatGPT can be useful at various stages of the writing and research process and can help you to write your systematic review. However, we strongly advise against trying to pass AI-generated text off as your own work.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Student’s  t -distribution
• Normal distribution
• Null and Alternative Hypotheses
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Data cleansing
• Reproducibility vs Replicability
• Peer review
• Prospective cohort study

Research bias

• Implicit bias
• Cognitive bias
• Placebo effect
• Hawthorne effect
• Hindsight bias
• Affect heuristic
• Social desirability bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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Literature Review: Systematic literature reviews

• Traditional or narrative literature reviews
• Scoping Reviews
• Systematic literature reviews
• Annotated bibliography
• Keeping up to date with literature
• Finding a thesis
• Evaluating sources and critical appraisal of literature
• Managing and analysing your literature
• Further reading and resources

Systematic reviews

Systematic and systematic-like reviews

Charles Sturt University library has produced a comprehensive guide for Systematic and systematic-like literature reviews. A comprehensive systematic literature review can often take a team of people up to a year to complete. This guide provides an overview of the steps required for systematic reviews:

• Identify your research question
• Develop your protocol
• Conduct systematic searches (including the search strategy, text mining, choosing databases, documenting and reviewing
• Critical appraisal
• Data extraction and synthesis
• Writing and publishing .
• Systematic and systematic-like reviews Library Resource Guide

Systematic literature review

A systematic literature review (SLR) identifies, selects and critically appraises research in order to answer a clearly formulated question (Dewey, A. & Drahota, A. 2016). The systematic review should follow a clearly defined protocol or plan where the criteria is clearly stated before the review is conducted. It is a comprehensive, transparent search conducted over multiple databases and grey literature that can be replicated and reproduced by other researchers. It involves planning a well thought out search strategy which has a specific focus or answers a defined question. The review identifies the type of information searched, critiqued and reported within known timeframes. The search terms, search strategies (including database names, platforms, dates of search) and limits all need to be included in the review.

Pittway (2008) outlines seven key principles behind systematic literature reviews

• Transparency
• Integration
• Accessibility

Systematic literature reviews originated in medicine and are linked to evidence based practice. According to Grant & Booth (p 91, 2009) "the expansion in evidence-based practice has lead to an increasing variety of review types". They compare and contrast 14 review types, listing the strengths and weaknesses of each review. 

Tranfield et al (2003) discusses the origins of the evidence-based approach to undertaking a literature review and its application to other disciplines including management and science.

References and additional resources

Dewey, A. & Drahota, A. (2016) Introduction to systematic reviews: online learning module Cochrane Training   https://training.cochrane.org/interactivelearning/module-1-introduction-conducting-systematic-reviews

Gough, David A., David Gough, Sandy Oliver, and James Thomas. An Introduction to Systematic Reviews. Systematic Reviews. London: SAGE, 2012.

Grant, M. J. & Booth, A. (2009) A typology of reviews: An analysis of 14 review types and associated methodologies. Health Information & Libraries Journal 26(2), 91-108

Munn, Z., Peters, M. D. J., Stern, C., Tufanaru, C., McArthur, A., & Aromataris, E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol, 18(1), 143. https://doi.org/10.1186/s12874-018-0611-x 

Pittway, L. (2008) Systematic literature reviews. In Thorpe, R. & Holt, R. The SAGE dictionary of qualitative management research. SAGE Publications Ltd doi:10.4135/9780857020109

Tranfield, D., Denyer, D & Smart, P. (2003) Towards a methodology for developing evidence-informed management knowledge by means of systematic review . British Journal of Management 14 (3), 207-222

Evidence based practice - an introduction : Literature reviews/systematic reviews

Evidence based practice - an introduction is a library guide produced at CSU Library for undergraduates. The information contained in the guide is also relevant for post graduate study and will help you to understand the types of research and levels of evidence required to conduct evidence based research.

• Evidence based practice an introduction
• << Previous: Scoping Reviews
• Next: Annotated bibliography >>
• Last Updated: Jan 16, 2024 1:39 PM
• URL: https://libguides.csu.edu.au/review

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Systematic Reviews: Home

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• Systematic review resources

What is a Systematic Review?

A simplified process map, how can the library help, publications by hsl librarians, systematic reviews in non-health disciplines, resources for performing systematic reviews.

• Step 1: Complete Pre-Review Tasks
• Step 2: Develop a Protocol
• Step 3: Conduct Literature Searches
• Step 4: Manage Citations
• Step 5: Screen Citations
• Step 6: Assess Quality of Included Studies
• Step 7: Extract Data from Included Studies
• Step 8: Write the Review

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A systematic review is a literature review that gathers all of the available evidence matching pre-specified eligibility criteria to answer a specific research question. It uses explicit, systematic methods, documented in a protocol, to minimize bias , provide reliable findings , and inform decision-making.  ¹  

There are many types of literature reviews.

Before beginning a systematic review, consider whether it is the best type of review for your question, goals, and resources. The table below compares a few different types of reviews to help you decide which is best for you. 

• Scoping Review Guide For more information about scoping reviews, refer to the UNC HSL Scoping Review Guide.

• UNC HSL's Simplified, Step-by-Step Process Map A PDF file of the HSL's Systematic Review Process Map.
• Text-Only: UNC HSL's Systematic Reviews - A Simplified, Step-by-Step Process A text-only PDF file of HSL's Systematic Review Process Map.

The average systematic review takes 1,168 hours to complete. ¹   A librarian can help you speed up the process.

Systematic reviews follow established guidelines and best practices to produce high-quality research. Librarian involvement in systematic reviews is based on two levels. In Tier 1, your research team can consult with the librarian as needed. The librarian will answer questions and give you recommendations for tools to use. In Tier 2, the librarian will be an active member of your research team and co-author on your review. Roles and expectations of librarians vary based on the level of involvement desired. Examples of these differences are outlined in the table below.

• Request a systematic or scoping review consultation

The following are systematic and scoping reviews co-authored by HSL librarians.

Only the most recent 15 results are listed. Click the website link at the bottom of the list to see all reviews co-authored by HSL librarians in PubMed

Researchers conduct systematic reviews in a variety of disciplines.  If your focus is on a topic outside of the health sciences, you may want to also consult the resources below to learn how systematic reviews may vary in your field.  You can also contact a librarian for your discipline with questions.

• EPPI-Centre methods for conducting systematic reviews The EPPI-Centre develops methods and tools for conducting systematic reviews, including reviews for education, public and social policy.

Environmental Topics

• Collaboration for Environmental Evidence (CEE) CEE seeks to promote and deliver evidence syntheses on issues of greatest concern to environmental policy and practice as a public service

Social Sciences

• Siddaway AP, Wood AM, Hedges LV. How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses. Annu Rev Psychol. 2019 Jan 4;70:747-770. doi: 10.1146/annurev-psych-010418-102803. A resource for psychology systematic reviews, which also covers qualitative meta-syntheses or meta-ethnographies
• The Campbell Collaboration

Social Work

Software engineering

• Guidelines for Performing Systematic Literature Reviews in Software Engineering The objective of this report is to propose comprehensive guidelines for systematic literature reviews appropriate for software engineering researchers, including PhD students.

Sport, Exercise, & Nutrition

• Application of systematic review methodology to the field of nutrition by Tufts Evidence-based Practice Center Publication Date: 2009
• Systematic Reviews and Meta-Analysis — Open & Free (Open Learning Initiative) The course follows guidelines and standards developed by the Campbell Collaboration, based on empirical evidence about how to produce the most comprehensive and accurate reviews of research

• Systematic Reviews by David Gough, Sandy Oliver & James Thomas Publication Date: 2020

Updating reviews

• Updating systematic reviews by University of Ottawa Evidence-based Practice Center Publication Date: 2007

Looking for our previous Systematic Review guide?

Our legacy guide was used June 2020 to August 2022

• Systematic Review Legacy Guide
• Next: Step 1: Complete Pre-Review Tasks >>
• Last Updated: Mar 18, 2024 8:48 AM
• URL: https://guides.lib.unc.edu/systematic-reviews

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How to write a systematic literature review [9 steps]

What is a systematic literature review?

Where are systematic literature reviews used, what types of systematic literature reviews are there, how to write a systematic literature review, 1. decide on your team, 2. formulate your question, 3. plan your research protocol, 4. search for the literature, 5. screen the literature, 6. assess the quality of the studies, 7. extract the data, 8. analyze the results, 9. interpret and present the results, registering your systematic literature review, frequently asked questions about writing a systematic literature review, related articles.

A systematic literature review is a summary, analysis, and evaluation of all the existing research on a well-formulated and specific question.

Put simply, a systematic review is a study of studies that is popular in medical and healthcare research. In this guide, we will cover:

• the definition of a systematic literature review
• the purpose of a systematic literature review
• the different types of systematic reviews
• how to write a systematic literature review

➡️ Visit our guide to the best research databases for medicine and health to find resources for your systematic review.

Systematic literature reviews can be utilized in various contexts, but they’re often relied on in clinical or healthcare settings.

Medical professionals read systematic literature reviews to stay up-to-date in their field, and granting agencies sometimes need them to make sure there’s justification for further research in an area. They can even be used as the starting point for developing clinical practice guidelines.

A classic systematic literature review can take different approaches:

• Effectiveness reviews assess the extent to which a medical intervention or therapy achieves its intended effect. They’re the most common type of systematic literature review.
• Diagnostic test accuracy reviews produce a summary of diagnostic test performance so that their accuracy can be determined before use by healthcare professionals.
• Experiential (qualitative) reviews analyze human experiences in a cultural or social context. They can be used to assess the effectiveness of an intervention from a person-centric perspective.
• Costs/economics evaluation reviews look at the cost implications of an intervention or procedure, to assess the resources needed to implement it.
• Etiology/risk reviews usually try to determine to what degree a relationship exists between an exposure and a health outcome. This can be used to better inform healthcare planning and resource allocation.
• Psychometric reviews assess the quality of health measurement tools so that the best instrument can be selected for use.
• Prevalence/incidence reviews measure both the proportion of a population who have a disease, and how often the disease occurs.
• Prognostic reviews examine the course of a disease and its potential outcomes.
• Expert opinion/policy reviews are based around expert narrative or policy. They’re often used to complement, or in the absence of, quantitative data.
• Methodology systematic reviews can be carried out to analyze any methodological issues in the design, conduct, or review of research studies.

Writing a systematic literature review can feel like an overwhelming undertaking. After all, they can often take 6 to 18 months to complete. Below we’ve prepared a step-by-step guide on how to write a systematic literature review.

• Decide on your team.
• Formulate your question.
• Plan your research protocol.
• Search for the literature.
• Screen the literature.
• Assess the quality of the studies.
• Extract the data.
• Analyze the results.
• Interpret and present the results.

When carrying out a systematic literature review, you should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

You may also need to team up with a librarian to help with the search, literature screeners, a statistician to analyze the data, and the relevant subject experts.

Define your answerable question. Then ask yourself, “has someone written a systematic literature review on my question already?” If so, yours may not be needed. A librarian can help you answer this.

You should formulate a “well-built clinical question.” This is the process of generating a good search question. To do this, run through PICO:

• Patient or Population or Problem/Disease : who or what is the question about? Are there factors about them (e.g. age, race) that could be relevant to the question you’re trying to answer?
• Intervention : which main intervention or treatment are you considering for assessment?
• Comparison(s) or Control : is there an alternative intervention or treatment you’re considering? Your systematic literature review doesn’t have to contain a comparison, but you’ll want to stipulate at this stage, either way.
• Outcome(s) : what are you trying to measure or achieve? What’s the wider goal for the work you’ll be doing?

Now you need a detailed strategy for how you’re going to search for and evaluate the studies relating to your question.

The protocol for your systematic literature review should include:

• the objectives of your project
• the specific methods and processes that you’ll use
• the eligibility criteria of the individual studies
• how you plan to extract data from individual studies
• which analyses you’re going to carry out

For a full guide on how to systematically develop your protocol, take a look at the PRISMA checklist . PRISMA has been designed primarily to improve the reporting of systematic literature reviews and meta-analyses.

When writing a systematic literature review, your goal is to find all of the relevant studies relating to your question, so you need to search thoroughly .

This is where your librarian will come in handy again. They should be able to help you formulate a detailed search strategy, and point you to all of the best databases for your topic.

➡️ Read more on on how to efficiently search research databases .

The places to consider in your search are electronic scientific databases (the most popular are PubMed , MEDLINE , and Embase ), controlled clinical trial registers, non-English literature, raw data from published trials, references listed in primary sources, and unpublished sources known to experts in the field.

➡️ Take a look at our list of the top academic research databases .

Tip: Don’t miss out on “gray literature.” You’ll improve the reliability of your findings by including it.

Don’t miss out on “gray literature” sources: those sources outside of the usual academic publishing environment. They include:

• non-peer-reviewed journals
• pharmaceutical industry files
• conference proceedings
• pharmaceutical company websites
• internal reports

Gray literature sources are more likely to contain negative conclusions, so you’ll improve the reliability of your findings by including it. You should document details such as:

• The databases you search and which years they cover
• The dates you first run the searches, and when they’re updated
• Which strategies you use, including search terms
• The numbers of results obtained

➡️ Read more about gray literature .

This should be performed by your two reviewers, using the criteria documented in your research protocol. The screening is done in two phases:

• Pre-screening of all titles and abstracts, and selecting those appropriate
• Screening of the full-text articles of the selected studies

Make sure reviewers keep a log of which studies they exclude, with reasons why.

➡️ Visit our guide on what is an abstract?

Your reviewers should evaluate the methodological quality of your chosen full-text articles. Make an assessment checklist that closely aligns with your research protocol, including a consistent scoring system, calculations of the quality of each study, and sensitivity analysis.

The kinds of questions you'll come up with are:

• Were the participants really randomly allocated to their groups?
• Were the groups similar in terms of prognostic factors?
• Could the conclusions of the study have been influenced by bias?

Every step of the data extraction must be documented for transparency and replicability. Create a data extraction form and set your reviewers to work extracting data from the qualified studies.

Here’s a free detailed template for recording data extraction, from Dalhousie University. It should be adapted to your specific question.

Establish a standard measure of outcome which can be applied to each study on the basis of its effect size.

Measures of outcome for studies with:

• Binary outcomes (e.g. cured/not cured) are odds ratio and risk ratio
• Continuous outcomes (e.g. blood pressure) are means, difference in means, and standardized difference in means
• Survival or time-to-event data are hazard ratios

Design a table and populate it with your data results. Draw this out into a forest plot , which provides a simple visual representation of variation between the studies.

Then analyze the data for issues. These can include heterogeneity, which is when studies’ lines within the forest plot don’t overlap with any other studies. Again, record any excluded studies here for reference.

Consider different factors when interpreting your results. These include limitations, strength of evidence, biases, applicability, economic effects, and implications for future practice or research.

Apply appropriate grading of your evidence and consider the strength of your recommendations.

It’s best to formulate a detailed plan for how you’ll present your systematic review results. Take a look at these guidelines for interpreting results from the Cochrane Institute.

Before writing your systematic literature review, you can register it with OSF for additional guidance along the way. You could also register your completed work with PROSPERO .

Systematic literature reviews are often found in clinical or healthcare settings. Medical professionals read systematic literature reviews to stay up-to-date in their field and granting agencies sometimes need them to make sure there’s justification for further research in an area.

The first stage in carrying out a systematic literature review is to put together your team. You should employ multiple reviewers in order to minimize bias and strengthen analysis. A minimum of two is a good rule of thumb, with a third to serve as a tiebreaker if needed.

Your systematic review should include the following details:

A literature review simply provides a summary of the literature available on a topic. A systematic review, on the other hand, is more than just a summary. It also includes an analysis and evaluation of existing research. Put simply, it's a study of studies.

The final stage of conducting a systematic literature review is interpreting and presenting the results. It’s best to formulate a detailed plan for how you’ll present your systematic review results, guidelines can be found for example from the Cochrane institute .

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Systematic reviews are a type of literature review of research which require equivalent standards of rigour as primary research. They have a clear, logical rationale that is reported to the reader of the review. They are used in research and policymaking to inform evidence-based decisions and practice. They differ from traditional literature reviews particularly in the following elements of conduct and reporting.

Systematic reviews: 

• use explicit and transparent methods
• are a piece of research following a standard set of stages
• are accountable, replicable and updateable
• involve users to ensure a review is relevant and useful.

For example, systematic reviews (like all research) should have a clear research question, and the perspective of the authors in their approach to addressing the question is described. There are clearly described methods on how each study in a review was identified, how that study was appraised for quality and relevance and how it is combined with other studies in order to address the review question. A systematic review usually involves more than one person in order to increase the objectivity and trustworthiness of the reviews methods and findings.

Research protocols for systematic reviews may be peer-reviewed and published or registered in a suitable repository to help avoid duplication of reviews and for comparisons to be made with the final review and the planned review.

• History of systematic reviews to inform policy (EPPI-Centre)
• Six reasons why it is important to be systematic (EPPI-Centre)
• Evidence Synthesis International (ESI): Position Statement Describes the issues, principles and goals in synthesising research evidence to inform policy, practice and decisions

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Should all literature reviews be 'systematic reviews', different methods for systematic reviews, reporting standards for systematic reviews.

Literature reviews provide a more complete picture of research knowledge than is possible from individual pieces of research. This can be used to: clarify what is known from research, provide new perspectives, build theory, test theory, identify research gaps or inform research agendas.

A systematic review requires a considerable amount of time and resources, and is one type of literature review.

If the purpose of a review is to make justifiable evidence claims, then it should be systematic, as a systematic review uses rigorous explicit methods. The methods used can depend on the purpose of the review, and the time and resources available.

A 'non-systematic review' might use some of the same methods as systematic reviews, such as systematic approaches to identify studies or quality appraise the literature. There may be times when this approach can be useful. In a student dissertation, for example, there may not be the time to be fully systematic in a review of the literature if this is only one small part of the thesis. In other types of research, there may also be a need to obtain a quick and not necessarily thorough overview of a literature to inform some other work (including a systematic review). Another example, is where policymakers, or other people using research findings, want to make quick decisions and there is no systematic review available to help them. They have a choice of gaining a rapid overview of the research literature or not having any research evidence to help their decision-making. 

Just like any other piece of research, the methods used to undertake any literature review should be carefully planned to justify the conclusions made. 

Finding out about different types of systematic reviews and the methods used for systematic reviews, and reading both systematic and other types of review will help to understand some of the differences. 

Typically, a systematic review addresses a focussed, structured research question in order to inform understanding and decisions on an area. (see the  Formulating a research question  section for examples). 

Sometimes systematic reviews ask a broad research question, and one strategy to achieve this is the use of several focussed sub-questions each addressed by sub-components of the review.  

Another strategy is to develop a map to describe the type of research that has been undertaken in relation to a research question. Some maps even describe over 2,000 papers, while others are much smaller. One purpose of a map is to help choose a sub-set of studies to explore more fully in a synthesis. There are also other purposes of maps: see the box on  systematic evidence maps  for further information. 

Reporting standards specify minimum elements that need to go into the reporting of a review. The reporting standards refer mainly to methodological issues but they are not as detailed or specific as critical appraisal for the methodological standards of conduct of a review.

A number of organisations have developed specific guidelines and standards for both the conducting and reporting on systematic reviews in different topic areas.  

• PRISMA PRISMA is a reporting standard and is an acronym for Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The Key Documents section of the PRISMA website links to a checklist, flow diagram and explanatory notes. PRISMA is less useful for certain types of reviews, including those that are iterative.
• eMERGe eMERGe is a reporting standard that has been developed for meta-ethnographies, a qualitative synthesis method.
• ROSES: RepOrting standards for Systematic Evidence Syntheses Reporting standards, including forms and flow diagram, designed specifically for systematic reviews and maps in the field of conservation and environmental management.

Useful books about systematic reviews

Systematic approaches to a successful literature review

An introduction to systematic reviews

Cochrane handbook for systematic reviews of interventions

Systematic reviews: crd's guidance for undertaking reviews in health care.

Finding what works in health care: Standards for systematic reviews

Systematic Reviews in the Social Sciences

Meta-analysis and research synthesis.

Research Synthesis and Meta-Analysis

Doing a Systematic Review

Literature reviews.

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• Why are literature reviews important?
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Systematic review Q & A

What is a systematic review.

A systematic review is guided filtering and synthesis of all available evidence addressing a specific, focused research question, generally about a specific intervention or exposure. The use of standardized, systematic methods and pre-selected eligibility criteria reduce the risk of bias in identifying, selecting and analyzing relevant studies. A well-designed systematic review includes clear objectives, pre-selected criteria for identifying eligible studies, an explicit methodology, a thorough and reproducible search of the literature, an assessment of the validity or risk of bias of each included study, and a systematic synthesis, analysis and presentation of the findings of the included studies. A systematic review may include a meta-analysis.

For details about carrying out systematic reviews, see the Guides and Standards section of this guide.

Is my research topic appropriate for systematic review methods?

A systematic review is best deployed to test a specific hypothesis about a healthcare or public health intervention or exposure. By focusing on a single intervention or a few specific interventions for a particular condition, the investigator can ensure a manageable results set. Moreover, examining a single or small set of related interventions, exposures, or outcomes, will simplify the assessment of studies and the synthesis of the findings.

Systematic reviews are poor tools for hypothesis generation: for instance, to determine what interventions have been used to increase the awareness and acceptability of a vaccine or to investigate the ways that predictive analytics have been used in health care management. In the first case, we don't know what interventions to search for and so have to screen all the articles about awareness and acceptability. In the second, there is no agreed on set of methods that make up predictive analytics, and health care management is far too broad. The search will necessarily be incomplete, vague and very large all at the same time. In most cases, reviews without clearly and exactly specified populations, interventions, exposures, and outcomes will produce results sets that quickly outstrip the resources of a small team and offer no consistent way to assess and synthesize findings from the studies that are identified.

If not a systematic review, then what?

You might consider performing a scoping review . This framework allows iterative searching over a reduced number of data sources and no requirement to assess individual studies for risk of bias. The framework includes built-in mechanisms to adjust the analysis as the work progresses and more is learned about the topic. A scoping review won't help you limit the number of records you'll need to screen (broad questions lead to large results sets) but may give you means of dealing with a large set of results.

This tool can help you decide what kind of review is right for your question.

Can my student complete a systematic review during her summer project?

Probably not. Systematic reviews are a lot of work. Including creating the protocol, building and running a quality search, collecting all the papers, evaluating the studies that meet the inclusion criteria and extracting and analyzing the summary data, a well done review can require dozens to hundreds of hours of work that can span several months. Moreover, a systematic review requires subject expertise, statistical support and a librarian to help design and run the search. Be aware that librarians sometimes have queues for their search time. It may take several weeks to complete and run a search. Moreover, all guidelines for carrying out systematic reviews recommend that at least two subject experts screen the studies identified in the search. The first round of screening can consume 1 hour per screener for every 100-200 records. A systematic review is a labor-intensive team effort.

How can I know if my topic has been been reviewed already?

Before starting out on a systematic review, check to see if someone has done it already. In PubMed you can use the systematic review subset to limit to a broad group of papers that is enriched for systematic reviews. You can invoke the subset by selecting if from the Article Types filters to the left of your PubMed results, or you can append AND systematic[sb] to your search. For example:

"neoadjuvant chemotherapy" AND systematic[sb]

The systematic review subset is very noisy, however. To quickly focus on systematic reviews (knowing that you may be missing some), simply search for the word systematic in the title:

"neoadjuvant chemotherapy" AND systematic[ti]

Any PRISMA-compliant systematic review will be captured by this method since including the words "systematic review" in the title is a requirement of the PRISMA checklist. Cochrane systematic reviews do not include 'systematic' in the title, however. It's worth checking the Cochrane Database of Systematic Reviews independently.

You can also search for protocols that will indicate that another group has set out on a similar project. Many investigators will register their protocols in PROSPERO , a registry of review protocols. Other published protocols as well as Cochrane Review protocols appear in the Cochrane Methodology Register, a part of the Cochrane Library .

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• Last Updated: Feb 26, 2024 3:17 PM
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Easy guide to conducting a systematic review

Affiliations.

• 1 Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia.
• 2 Department of Nephrology, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
• 3 Education Department, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
• PMID: 32364273
• DOI: 10.1111/jpc.14853

A systematic review is a type of study that synthesises research that has been conducted on a particular topic. Systematic reviews are considered to provide the highest level of evidence on the hierarchy of evidence pyramid. Systematic reviews are conducted following rigorous research methodology. To minimise bias, systematic reviews utilise a predefined search strategy to identify and appraise all available published literature on a specific topic. The meticulous nature of the systematic review research methodology differentiates a systematic review from a narrative review (literature review or authoritative review). This paper provides a brief step by step summary of how to conduct a systematic review, which may be of interest for clinicians and researchers.

Keywords: research; research design; systematic review.

© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

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Systematic Reviews encompasses all aspects of the design, conduct and reporting of systematic reviews. The journal publishes high quality systematic review products including systematic review protocols, systematic reviews related to a very broad definition of human health, rapid reviews, updates of already completed systematic reviews, and methods research related to the science of systematic reviews, such as decision modelling. At this time Systematic Reviews does not accept reviews of in vitro studies.  The journal also aims to ensure that the results of all well-conducted systematic reviews are published, regardless of their outcome.

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Licensed under a  Creative Commons Attribution 4.0 International License , except where otherwise noted. This work is licensed under an  Ontario Commons License (Version 1.0) .

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Medical Library Association,, Foster, M. J., & Jewell, S. T. (2017).  Assembling the pieces of a systematic review: Guide for librarians . Lanham: Rowman & Littlefield.

Bonato, S. (2018).  Searching the grey literature: A handbook for searching reports, working papers, and other unpublished research . Lanham, Maryland: Rowman & Littlefield.

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Antecedents of unfinished nursing care: a systematic review of the literature

• Stefania Chiappinotto 1 ,
• Evridiki Papastavrou 2 ,
• Georgios Efstathiou 2 , 3 ,
• Panayiota Andreou 4 ,
• Renate Stemmer 5 ,
• Christina Ströhm 5 ,
• Maria Schubert 6 ,
• Susanne de Wolf-Linder 6 ,
• Jessica Longhini 7 &
• Alvisa Palese 7  

BMC Nursing volume  21 , Article number:  137 ( 2022 ) Cite this article

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Unfinished Nursing Care (UNC) concept, that express the condition when nurses are forced to delay or omit required nursing care, has been largely investigated as tasks left undone, missed care, and implicit rationing of nursing care. However, no summary of the available evidence regarding UNC antecedents has been published. The aim of this study is to identify and summarise antecedents of UNC as documented in primary studies to date.

A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. MEDLINE, CINAHL, SCOPUS, and PROSPERO databases were searched for quantitative studies reporting the relationships between antecedents and UNC published after 2004 up to 21 January 2020. The reference lists of secondary studies have been scrutinised to identify additional studies. Two reviewers independently identified studies and evaluated them for their eligibility and disagreements were resolved by the research team. The quality appraisal was based on the Joanna Briggs Institute Critical Appraisal tools, according to the study designs. A data extraction grid was piloted and then used to extract data. The antecedents that emerged were thematically categorised with an inductive approach.

Fifty-eight studies were included; among them, 54 were cross-sectional, three were cohort studies, and one was a quasi-experimental study. They were conducted mainly in the United States and in hospital settings. The UNC antecedents have been investigated to date at the (a) unit (e.g., workloads, non-nursing tasks), (b) nurse (e.g., age, gender), and (c) patient levels (clinical instability).

Conclusions

At the unit level, it is highly recommended to provide an adequate staff level, strategies to deal with unpredictable workloads, and to promote good practice environments to reduce or minimise UNC. By contrast, at the nurse and patient levels, there were no clear trends regarding modifiable factors that could decrease the occurrence of UNC. The map of antecedents that emerged can be used to design interventional studies aimed at changing research from merely descriptive to that which evaluates the effectiveness of interventions.

Peer Review reports

Unfinished Nursing Care (UNC) is an overarching term encompassing several concepts [ 1 ] that express the condition when nurses are forced to delay or omit required nursing care [ 2 ]. The various concepts included in UNC have been largely conceptualised both theoretically [ 3 , 4 ] and empirically by validating instruments measuring the occurrence of the phenomenon, namely the Tasks Left Undone Scale [ 5 ], the Basel Extent of Rationing of Nursing Care instrument [ 3 ], the MISSCARE Survey [ 6 ], and the Perceived Implicit Rationing of Nursing Care survey instrument [ 7 ]. Moreover, several studies have established outcomes associated with UNC both at the patient (e.g., falls, hospital-acquired infections, pressure ulcers) and at the nurse level (e.g., job satisfaction, intention to leave) [ 8 , 9 ]. However, to inform decisions regarding which interventions should be implemented to minimise and/or reduce UNC [ 10 ], more studies about UNC antecedents have been recommended [ 11 ]. Above all, sound systematizations of the available evidence base on factors contributing to providing high quality nursing care or posing barriers in providing the care needed for shaping and optimizing nursing care are need. Despite the impetus reported in this research area [ 12 ], no summary of the available evidence about UNC antecedents has been produced to date: therefore, the primary intent of this study was to fill this gap.

Antecedents of unfinished nursing care

Within the overarching UNC term [ 1 ], there are three main concepts: Tasks Left Undone, Missed Nursing Care, and Implicit Rationing of Nursing Care. Tasks Left Undone was first conceptualised by Solchalski in 2004 [ 4 ], defined it as activities left unfinished during the last shift because nurses lacked the time to undertake them. In this context, nurse workloads and time constrains were both considered antecedents; however, specific factors triggering or hindering tasks left undone were not conceptualized [ 4 ].

A few years later, Kalisch [ 13 ] introduced the concept of Missed Nursing Care as every aspect of nursing care required by a patient that is partly or totally omitted or significantly delayed. In the first theoretical model, four elements at the nurse level were related to Missed Nursing Care: team norms, decision-making processes, internal values and beliefs, and habits [ 14 ]. In the same year, Kalisch and Williams [ 6 ] developed the MISSCARE survey to measure Missed Nursing Care. This instrument also includes a set of other reasons of missed care as perceived by nurses, namely deficiencies in communication, material resources, and labour resources. A few years later, Kalisch and Xie [ 15 ] advanced their model by including three additional antecedents regarding (a) the hospital (size, teaching status, Magnet status), (b) the unit(s) (case mix index, nurse staffing levels, type of nurse staffing, absenteeism, overtime, and work schedules), and (c) the teamwork characteristics. In the same period, Schubert et al. [ 3 ] established the Implicit Rationing of Care concept as the withholding of or failure to carry out necessary nursing measures for patients. In their theoretical model, antecedents considered (a) the organizational variables (namely the budget, policy priorities, resource allocation, the management structure, the culture, and the climate); (b) the nursing work environment variables, including the adequacy of resources and skill mix, interdisciplinary collaboration, nursing management, autonomy, and responsibility; and (c) the philosophy of care variables, such as the priority setting, the cultural values, the standards of care, and local and national guidelines. Moreover, patient variables, including illness severity and co-morbidities, and nurse variables, such as the nurses’ experience(s), education, skills, and knowledge have been established as other factors affecting the occurrence of Implicit Rationing of Nursing Care [ 3 ].

According to the state of the research in this field, UNC antecedents were considered in a linear relationship [ 4 , 14 ], within an input–process–outcome model [ 16 ]. In more recent years, the debate has moved to more complex models, the so-called systems approach [ 16 ], where UNC has been examined holistically rather than as the sum of different parts. In this context, researchers have considered several factors as interrelated each other [ 3 ]. For example, hospital units comprising different sub-systems interacting with each other, are influenced by the nursing philosophy and the work environment that might be different in each of them [ 3 ]. Alongside these internal interactions, external factors might affect each unit, as for example, the hospital’s organisational variables [ 3 ]. Therefore, a multi-level approach has been introduced in this research debate, examining how upper-level management might affect the clinical nurses and, consequently, the UNC occurrence at the bedside [ 16 ]. Thus, factors external to the unit at the hospital, regional, or national levels (e.g., policies, rules) as implementing cost-containing measures in the attempt to increase productivity and efficiency, might affect the UNC occurrence at the bedside [ 3 , 16 ].

The following research questions were addressed: (a) What antecedents have been investigated to date as associated with the UNC? (b) What is the direction of the relationships between such antecedents and the UNC that has been documented to date?

Therefore, the aims of the study were to (a) map factors, predictors, correlates, or linked factors – hereafter, ‘antecedents’, and (b) summarise the direction of their relationships with UNC. A systematic review of the literature was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [ 17 ].

The Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) [ 18 ] methodology was used to establish the review question. Then, according to the elements specified (Table 1 ), the search terms were identified [ 19 ] (Table 2 ) without considering specific key words as expressing the influence of specific factors (e.g., morning shifts) [ 20 ].

In a preliminary phase, the International Prospective Register of Systematic Reviews (PROSPERO) database was checked to determine whether there were ongoing systematic reviews about the antecedents of UNC. Then, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and SCOPUS were searched.

Search strategy

There were included those primary studies: (a) investigating antecedents of the UNC in adult care settings (patients ≥ 18 years of age); (b) providing measures of relationships between the investigated antecedent(s) and the occurrence of the UNC; (c) employing quantitative designs and reporting the abstract, (d) published in English, German, Greek or Italian, the languages accessible to the research team (see authors); (e) from 2004 up to 21 January 2020, when the Task Left Undone concept, included in the UNC overarching term, was first established [ 4 , 21 ]. Reviews, systematic reviews, overviews, or integrative reviews retrieved were scrutinised in their references manually for relevant primary studies potential eligible according to the inclusion criteria.

Specifically, there were included those studies providing inferential statistics such as correlations, associations (odds ratios, relative risks), or other estimations (e.g., beta) to evaluate the relationship between one or more antecedents and the occurrence of the UNC. In some studies, the authors did not provide sufficient data to establish how the investigated variables were associated with UNC [ 22 ]. In these cases, the available conceptual models of the UNC were used to assess the study’s eligibility [ 3 , 14 , 23 ].

There were excluded those studies: (a) qualitative in nature; (b) regarding settings caring for patients < 18 years (paediatric) and other settings (obstetrics and psychiatric) due to specific care provided and the relevance of other potential factors in hindering/increasing UNC (e.g. the role of family relatives) [ 21 ]; (c) including other health care professionals (e.g., midwives), (d) reporting only descriptive measures of antecedents (e.g., frequencies), thus not assessing associations with UNC; (e) not reporting an abstract and published in languages other than those previously listed. Reviews were also excluded, although their reference lists were checked manually for appropriate studies.

Selection and data extraction

A total of 1,120 sources were identified (Fig.  1 ). Subsequently, 990 studies, including 291 duplicates, were excluded by two researchers’ experts in the unfinished care field, who evaluated titles and abstracts independently and then agreed upon which studies to evaluate further. The remaining 132 studies were carefully read in their full texts by the same researchers, in an independent fashion. Disagreements emerged regarding four studies; thus, the entire research team (see authors) was involved in multiple meetings, in order to reach consensus regarding the inclusion. At the end of the process, 58 studies were included.

Flow diagram of included studies. Abbreviations: CINAHL, Cumulative Index to Nursing and Allied Health Literature; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PROSPERO, Prospective Register of Systematic Review; UNC, Unfinished Nursing Care

Two researchers developed the data extraction grid by including the following elements: author(s); country; aims; design (if longitudinal: assessment points); when the study was performed (year(s); the setting (hospital, community, number of units or centres involved); the sampling methods used; the participants involved and their main demographic characteristics; the instruments used for data collection (explanatory variables [as antecedents] and the UNC phenomenon); and the main findings regarding the relationships between the antecedent(s) and the occurrence of UNC.

The entire research team then approved the extraction grid via an online meeting. Three researchers piloted the grid independently with three studies, and all authors agreed that no changes were needed at the end of the pilot. Then, the same three researchers independently extracted the data and agreed upon.

The data extracted were thematically analysed [ 24 ] using an inductive approach [ 25 ]. First, all antecedents have been summarised and categorised; then, the directions of their relationships with UNC were also summarised as increasing, decreasing, or not influencing the UNC occurrence by considering the study design and the data extracted. Researchers worked independently and then agreed upon the findings. The entire research team (see authors) reached consensus about the identified categories and the overall findings in two online meetings.

Quality appraisal

The 58 studies were evaluated for their methodological quality with the Joanna Briggs Institute Critical Appraisal approach. This was selected according to its capacity to guide the development of high-quality systematic reviews addressing policy and practice interventions [ 26 ]. First, different tools were selected according to the design of the studies included, namely the critical appraisal tool for analytical cross-sectional, cohort, and quasi-experimental studies [ 26 , 27 , 28 ]. Then, the evaluators were trained in the use of each tool with an online meeting; during the training, multiple exercises were offered to answer each item included in the tools (Y: yes; N: no; U: unclear; NA: not applicable) in order to ensure rigor in the assessment. Then, there were identified three couples of researchers responsible for around 19 studies/each: the evaluation was performed by one researcher and then cross-checked by a second researcher. In the case of disagreements, the entire research team was involved in multiple meetings, in order to discuss the evaluation and reach a consensus. All 58 studies demonstrated sufficient quality and, therefore, all were included in the review.

Characteristic of studies

The 58 studies included (Additional File 1 ) collected from 2006 [ 29 , 30 ] to 2018–19 [ 31 ]. The majority were cross-sectional, except for three cohort studies [ 30 , 32 , 33 ] and one quasi-experimental study [ 34 ]. Most of the studies aimed to investigate the occurrence of UNC and its antecedents and only one was performed to validate the MISSCARE survey [ 35 ].

Twenty-one studies were conducted in the United States [ 29 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]; five in Australia [ 11 , 55 , 56 , 57 , 58 ]; three each in Switzerland [ 59 , 60 , 61 ] and Cyprus [ 8 , 62 , 63 ]; and two each in England [ 32 , 64 ], South Korea [ 65 , 66 ], Israel [ 67 , 68 ] and China [ 69 , 70 ]. The remaining were conducted in Brazil, Canada, Denmark, Germany, Korea, Kuwait, Iceland, Italy, Ireland, Mexico, the Philippines, South Africa, Sweden, and Jordan. Only four multi-country studies have been conducted to date [ 37 , 71 , 72 , 73 ].

Most of the studies involved acute care hospitals, predominantly medical, surgical, rehabilitation, and intensive care units, and only six studies were conducted in nursing homes [ 33 , 44 , 45 , 54 , 60 , 61 ].

The convenience sampling method was used in 47 studies; the remaining 11 studies [ 29 , 33 , 35 , 42 , 45 , 54 , 60 , 61 , 64 , 73 , 74 ] used random selection. The assessment of both antecedents and the occurrence of UNC was largely based on nursing staff perceptions. Sample sizes ranged from 71 to 33,659 nurses, mostly including registered nurses (RNs) and nursing assistants, with participation ranging from 8.1% to 100%. The majority of them were female (48.9%–100%), with experience in the role ranging between 5.14 and 16.6 years. Only two studies included patients as a target population [ 32 , 70 ].

Thirty-four studies used a version of the MISSCARE survey [ 34 , 35 , 36 , 37 , 38 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 55 , 56 , 57 , 58 , 62 , 63 , 66 , 67 , 68 , 73 , 74 , 75 , 76 , 77 , 78 , 79 ] while seven used the Basel Extent of Rationing Nursing Care Assessment tool [ 8 , 59 , 60 , 61 , 64 , 65 , 70 ]. Only one study used the Perceived Implicit Rationing of Nursing Care survey instrument [ 39 ].

Studies were conducted with a variable methodological quality. Failures in reporting confounding factors and the strategies implemented to deal with the confounders identified, were the major deficiency for the cross-sectional studies. Among cohort and the quasi-experimental studies fewer failures have emerged (Supplementary Files 2 , 3 and 4 ).

The antecedents of unfinished nursing care

Antecedents of the UNC have been categorised at the unit, nurse, and patient levels as summarised in Table 3 .

As reported in Table 4 , staff levels, measured as the adequacy of staff perceived by nurses, the nurse-to-patient ratio, or the hours-per-patient day, have been the most investigated UNC antecedent to date. According to the adopted measure (e.g., adequacy versus inadequacy), studies have documented a positive or negative influence on UNC. Evidence has been accumulated regarding the relationship between a low nurse-to-patient ratio and the increase in the UNC occurrence. Exceptions have been documented by Orique et al. [ 40 ] and Zhu et al. [ 70 ] in their cross-sectional studies, and by Griffiths et al. [ 32 ] underlying a non-linear effect when the nursing hours per patient day were greater than seven. Regarding a component of staff adequacy, as the nursing unit’s number of bedside duty hours out of the number of hours offered by licensed and unlicensed personnel (= skill mix), only Castner et al. [ 41 ] documented that an increased skill mix decreased the occurrence of UNC.

The workloads measured with different metrics as the number of patients admitted or discharged [ 32 , 80 ] have been reported to increase the occurrence of the UNC when measured as a global score by using the MISSCARE survey [ 41 ]. Exceptions have been reported by McNair et al. [ 42 ] and Orique et al. [ 40 ] where workloads were not found to affect the occurrence of UNC. Moreover, performing non-nursing tasks, which might contribute to increased workloads, has also been reported to affect, mainly increasing, the occurrence of UNC [ 34 , 69 , 84 ].

Regarding working shifts, studies have documented conflicting findings, with some reporting that nurses working during the day shift perceived an increase in the occurrence of the UNC [ 37 , 43 , 55 ] while others did not [ 33 , 56 ]. Moreover, working overtime has also been documented to increase the perceived occurrence of UNC [ 11 , 44 , 57 , 65 ], except for the study performed by Phelan et al. [ 75 ].

Differently, concerning the quality of the work environment, including aspects ranging from better communication, better grading of caring ethical climate or patient safety, studies have consistently documented that a better environment decreases the occurrence of UNC [ 8 , 11 , 29 , 31 , 38 , 41 , 44 , 45 , 46 , 47 , 49 , 52 , 53 , 54 , 57 , 59 , 60 , 64 , 66 , 69 , 71 , 76 , 77 , 84 ]. Effective teamwork [ 11 , 29 , 45 , 46 , 57 , 76 ] as well as a higher score in all dimensions of the Nursing Teamwork Scale (including for example, team leadership, team orientation) [ 38 ] were also reported to decrease the perception of UNC. Conversely, communication issues were documented to increase UNC [ 41 , 55 , 77 ]. Moreover, working according to team nurses’ model care delivery as compared to total patient care have been reported to increase the UNC perceptions among nurses [ 78 ]. Conflicting findings have emerged instead regarding the type of unit, with Bragadóttir et al. [ 76 ] and Coleman [ 47 ], documenting that medical and surgical nurses perceived a higher occurrence of UNC compared with those working in other units such as intensive care units. On the other hand, Papastavrou et al. [ 8 ] reported that nurses in surgical units perceived low UNC when compared with those working in medical units.

Studies about the influence of the facility/hospital were also performed. Knopp-Sihota et al. [ 33 ] and Blackman et al. [ 55 ] documented that nurses working in urban and metropolitan hospitals reported a higher occurrence of UNC compared with those working in private hospitals [ 11 ]. By contrast, Knopp-Sihota et al. [ 33 ] reported that nurses working in a not-for-profit hospital perceived a low occurrence of UNC, similar to that documented in Magnet hospitals [ 48 ].

Nurse level

As reported in Table 4 , the age of nurses has been investigated for its role in the perception of UNC with conflicting findings. Some have documented that older age is associated with low levels of UNC [ 77 , 78 , 80 ], while others have reported the opposite [ 33 , 43 , 58 , 75 ]. Similarly, professional experience has been documented to have a variable influence on UNC, with more clinical experience associated with a higher perceived occurrence of UNC [ 37 , 38 , 41 , 43 , 57 ] and others documenting the opposite findings [ 66 , 71 , 73 , 75 , 77 ]. In addition, also the gender has been investigated with conflicting findings, with some studies reporting that female nurses perceived more UNC [ 43 ] or less [ 71 , 78 ] as compared with male nurses.

Regarding nursing education, RNs were reported as perceiving more UNC compared with other roles [ 38 , 43 , 57 , 58 , 76 ]. However, some authors [ 34 , 40 , 84 ] reported that higher education as attending multiple educational opportunities, prevents the perception of UNC.

In terms of working profiles, Blackman et al. [ 11 ] and Chapman et al. [ 57 ] have both documented that working part-time decreases the perception of UNC among nurses while working full time remains unclear [ 68 , 77 ]. Moreover, nurses reporting a higher ratio of absenteeism have been documented to perceive higher levels of UNC [ 37 , 43 ], except for Kalisch et al. [ 36 ] who did not find any relationship.

Almost all studies, except for the one conducted by Knopp-Sihota et al. [ 33 ], have reported similar findings regarding nurses’ dissatisfaction, stress, emotional exhaustion, intention to leave, and other elements of poor professional well-being, all of which increase the perceived occurrence of UNC [ 35 , 40 , 84 ]. Moreover, Drach-Zahavy and Srulovici [ 67 ] and Srulovici and Drach-Zahavy [ 68 ] documented that nurse’s personal degree of accountability influences their perception of UNC, while Blackman et al. [ 73 ] analysed the association between UNC and the country of origin of nurses, documenting that Australian nurses perceived more UNC compared with Italian nurses.

Patient level

Only two studies have investigated antecedents at the patient levels suggesting that clinical instability may play a role regarding the UNC. Caring for more unstable or critical patients, requiring frequent monitoring or units with higher patient death rate [ 64 , 80 ] were reported as factors increasing the occurrence of UNC (Table 4 ).

Characteristics of studies available

Several studies were conducted in a short period, mainly in the United States (US). Subsequently, the process of missed nursing care concept development firstly reported among US studies, was researched also across the world, especially to Europe [ 2 ]. An important impetus for this development has been a project funded by the European Union in 2016, the RANCARE [ 86 ], which brought together scholars and practitioners from 34 countries who had worked for four years, giving an international perspective to a relatively unacknowledged nursing problem. However, there are only a few examples of studies conducted at a multi-country level [ 37 , 71 , 72 , 73 ], where antecedents might function differently according to variances in national health services, education systems, cultures, and resources devoted to the nursing care. Moreover, studies have been mainly focused on the hospital/acute care setting, suggesting that more research is needed in community and nursing home settings to accumulate evidence in these settings of care.

To date, both antecedents and the occurrence of UNC have been studied mainly from the point of view of nursing staff as a self-assessment, perceptions that can be influenced by several biases. Moreover, some studies have examined perceptions of both nurses and nurse’s aides [ 40 , 43 , 48 , 77 ]; these professionals have a different scope of practice, and this may have influenced their assessments. Only two studies involved patients, a perspective that should be considered in future research to better understand the occurrence of UNC also from their point of view [ 87 ].

The study designs were largely cross-sectional in nature, with mainly convenience samples and a great variance in the participation rates, that all might have introduced biases in the evaluation of both antecedents and the UNC occurrence. In addition, antecedents and UNC occurrence have been largely measured at the same time point, thus assuming that the former has influenced the latter whereas control variables and/or confounding factors (e.g., the overtime, as paid or not) were not investigated. These issues have been reported also by Griffiths et al. [ 88 ] regarding the state of the art of the evidence about the nursing staffing and outcomes.

Longitudinal, pre- and post-study designs, or comparative studies are encouraged to increase the strength of evidence, by quantifying also the benefits of reducing/minimizing unfinished care and the costs, feasibility and long-term sustainability of implemented interventions. However, study designs should be considered in light of the complexity of the nursing care and the issue under study: UNC occurs in the real world of nursing across the world as a multifactorial phenomenon. Assessing precise antecedents might be difficult—moreover, designing interventional studies manipulating for example, the work environment, or the number of staff might be not feasible given the complexity of the turbulence of environments, and the challenges of the long-term implementation. Therefore, an in-depth discussion regarding the research issues in this field is required, analogously to that already developed in the context of nursing staffing and outcomes [ 88 ].

Conceptual articles have highlighted that UNC is influenced by patient care demand, resource allocation, and relationship/communication issues [ 14 ] as well as by patient, organisational, nursing work environment, philosophy of care, and nurse variables [ 3 ]. In recent years, there has been a more comprehensive consideration of macro-, meso-, and micro-level factors by examining how upper-level management might affect clinical nurses and, consequently, UNC at the bedside [ 16 ]. However, according to the findings of this review, primary studies available to date appear to have investigated antecedents only at the unit, nurse, and patient levels. Therefore, despite a clear conceptualisation of the importance of the factors at the system level [ 16 ], empirical studies seem to have captured only a limited extent of factors with heterogeneous findings.

At the unit level, the staff adequacy as measured with different methods (e.g., workloads [ 40 , 41 , 44 , 55 , 68 , 80 ] versus nurse-to-patient ratio [ 43 , 51 , 59 , 65 , 67 , 69 , 70 , 71 , 81 , 82 ], using subjective or objective data) influences the occurrence of UNC. Moreover, other processes such as patients’ admissions and discharges or caring for patients with complex needs increase the occurrence of UNC, likely because they affect workloads in an unpredictable manner that requires a revision of staff dynamics and resource assignments [ 89 ]. On the other hand, performing non-nursing tasks [ 69 , 80 , 84 ] were documented to increase UNC as well as working overtime [ 11 , 44 , 57 , 65 ]. Unfinished care might be triggered by the underuse of nurses, constrained to compensate for deficiencies in auxiliary resources thus leaving nursing care undone; conversely, unfinished care might be the consequence of the tiredness and reduced performance of nurses due to the amount of overtime work. A clear direction has not emerged regarding shifts (e.g., morning versus nights) and this might be due to the different patterns of both shifts (e.g., 12 h) and workloads established at the unit level. Specifically, those working morning shifts are required to deal with the high number of concentrated activities, while those working night shifts have few resources to meet care needs.

Within the unit level, the findings mainly reflect the structural variables [ 90 ] of the unit, with modifiable factors that might reduce or minimise UNC. These factors include adequate staff levels, preventing nurses from performing non-nursing tasks and working overtime, and implementing strategies to deal with the unpredictability of workloads for some shifts. The findings support the conceptualisation of Jones et al. [ 16 ] that factors affecting the occurrence of UNC can be considered in light of micro-economic theories as the efficient allocation of scarce resources to nursing care.

Several studies [ 8 , 11 , 29 , 31 , 38 , 41 , 44 , 45 , 46 , 47 , 49 , 52 , 53 , 54 , 57 , 59 , 60 , 62 , 64 , 66 , 69 , 71 , 76 , 77 , 84 ] have concluded that a better work environment leads to a decrease in the UNC. Hence, promoting greater communication, better caring ethical climate, and respect among nurses and across health care professionals, all reduce or minimise the UNC. These factors, mainly reflecting the process variables of the unit [ 90 ], suggest that there is a need to invest in good practice environments for nurses, a strategy that can be developed by nurse managers but requires profound support from the entire system and education to work together effectively. Indeed, the findings that emerged regarding Magnet hospitals [ 48 ] and some hospitals/units (rural versus urban [ 11 , 33 ], surgical versus medical [ 8 , 47 , 76 ]) can explain their capacity to minimise or reduce the UNC as work environments where nursing care is supported and valued.

Studies investigating the relationships between some individual characteristics of nurses (e.g., age, gender, and work experience) and the occurrence of UNC have mainly reported conflicting findings. Some authors also included variables that are not usually measured, such as the nurse’s personality and the country of origin [ 67 , 73 ] and no trends in this dimension were detected. The interest in individual variables seems to be linked with the fact that the UNC has been investigated mainly as nurses’ perceptions; therefore, it is influenced by the profile of the nurse. However, apart from some antecedents (e.g., education), most of them appear to be unmodifiable, thus suggesting that they should be considered by nurse managers while, for example, they compose shifts that mix different nurse profiles (e.g., age, gender, education). Conceptually, authors have emphasised that nurses’ experience [ 36 , 37 , 38 , 41 , 43 , 57 , 66 , 71 , 73 , 75 , 77 ], education [ 11 , 32 , 34 , 38 , 40 , 43 , 51 , 56 , 57 , 58 , 76 , 84 ], and skill mix [ 41 ] may influence the quality of the decision-making processes and, ultimately, the occurrence of UNC. However, when nurses are called to make decisions on how to allocate the limited time available, they desire to provide the best care for their patients and eliminate unfinished care. They also need to be supported in making decisions though a positive ethical climate and organisational guidance [ 62 ]. Unfortunately, the mental processes involved in decision-making regarding care that can be left undone has been unexplored and more studies are needed to increase understanding of how nurses set priorities while they are trying to cope with the endless needs of patients in the complex environments of the contemporary care facilities [ 91 ]. This reflection might also explain why nurses perceive more UNC [ 38 , 43 ] compared with nurse’s aides suggesting that in studies investigating the unfinished care perceived, a stratification of the responders according to their educational level, is required. Additionally, some of the nurse variables that have been investigated seem to play a dual role as antecedents and as consequences of UNC. For example, decreased professional satisfaction levels [ 33 , 35 , 40 , 54 , 84 , 85 ] might lead to increase the unfinished care but also might be a consequence of the UNC, as reported in conceptual models [ 15 ].

Patient characteristics as antecedents of UNC have been poorly investigated. According to the available studies, clinical instability [ 64 , 80 ] can increase the need for nursing care due to the additional care patients required in context with limited resources. Moreover, only recently the patients’ perceptions about UNC have been summarised [ 63 ]: authors concluded that many of the unmet needs perceived by patients do not always correspond to the perceptions of nurses. It is therefore vital to understand the UNC phenomenon from the patients’ point of view with more research; this endeavour will allow researchers to design appropriate interventions. For example, complex clinical cases might require more care with unpredictable flows that can be provided with flexible processes and models of care delivery.

Limitations and recommendations for research

This systematic review has several limitations. Despite the rigorous approach, some studies might be missed for different reasons and among other, the fact that no quantitative measures (Cohen’s kappa coefficient) were used to evaluate the agreement across researchers regarding the study inclusion. Moreover, according to the limitations applied in the languages (English, Greek, Dutch, and Italian) a potential publication bias might have been introduced. Furthermore, the timeframe was limited by including only studies published after 2004, the year when the first concept pertaining to the UNC was established [ 4 , 21 ]. However, studies using different key words might have been performed before the establishment of the mentioned conceptual definition; other studies might have been conducted after without using the conceptual definition, leading in both cases to a publication bias. In addition, to map antecedents, the search terms identified were general and designed to capture all studies in the field and not those addressing specific (known) antecedents of the UNC (for example shift patterns) [ 20 ]. Finally, there were excluded those studies conducted in specific settings (paediatric, psychiatric) according to the available knowledge [ 21 ]: the inclusion of these settings in future reviews might contribute to broaden the evidence available.

In performing the data extraction, some antecedents might have been neglected in favour of providing a comprehensive map of those investigated to date. Commonalities across antecedents by using an inductive approach [ 25 ] were searched to summarise the data: although an investigator triangulation was performed [ 92 ], researchers might have been influenced in the data analysis process by their previous background and experience regarding the issue. Furthermore, the relationship between antecedents and the UNC as decreasing, increasing or not influencing its occurrence, has not been weighted in its evidence according to the study design or for example the effect size, suggesting an area of improvement in future reviews.

To the best of our knowledge, this is the first systematic review summarising the antecedents of the unfinished nursing care. Several studies have been conducted throughout the world, indicating a clear interest in this research field. However, the available evidence has mainly been collected with cross-sectional designs, performed at the hospital level, and describing nursing staff perceptions as collected with different tools. Hence, more robust studies are needed in this field challenging the multifactorial nature of the UNC where assessing precise antecedents might be difficult.

Several antecedents of UNC were investigated to date at the unit, nurse, and at the patient levels. At the unit level, (a) structural factors such as an adequate staff levels and strategies to deal with unpredictable variations in the workloads, and (b) process factors, as investing in good work environments for nurses, are highly recommended to minimize/reduce the occurrence of the UNC. At the nurse and patient levels, no clear trends emerged regarding modifiable factors.

The antecedents emerged can be used to design interventional studies in the field that are also aimed at changing the patterns of research from merely descriptive to evaluate the effectiveness of interventions targeting some modifiable factors. This endeavour could minimise and/or reduce the UNC and, ultimately, ameliorate patient, nurse, and system outcomes. Future studies should also consider community settings and involve more robust measures by using different sources of data to identify additional meaningful factors that could contribute to explain the UNC. However, an in-depth discussion regarding the research issues in this field is recommended in order to design studies capable to add value and, therefore, to inform policy-makers shaping nursing services.

Availability of data and materials

All data generated or analysed during this study are included in this published article [and its supplementary information files].

Abbreviations

Unfinished Nursing Care

Sample, Phenomenon of Interest, Design, Evaluation, Research

International Prospective Register of Systematic Reviews

Cumulative Index to Nursing and Allied Health Literature

Registered Nurses

United States

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Acknowledgements

We thank Lucia Cadorin, Valentina Bressan, and Chiara Visintini for their valuable support in performing the first round of the critical assessment.

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Made substantial contributions to conception and design, or acquisition of data: the author SC, AP, EP, GE, PA, SM, SR. Made substantial contributions to analysis and interpretation of data: AP, JL, dWLS, EP, GE, SC, PA, CS, SM, SR. Involved in drafting the manuscript or revising it critically for important intellectual content: SC, JL, AP. Given final approval of the version to be published. Each author should have participated sufficiently in the work to take public responsibility for appropriate portions of the content: SC, AP, JL, dWLS, EP, GE, PA, CS, SM, SR. Agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved: SC, dWLS, EP, GE, PA, CS, SM, SR, JL, AP. All the authors read and approved the final manuscript.

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Chiappinotto, S., Papastavrou, E., Efstathiou, G. et al. Antecedents of unfinished nursing care: a systematic review of the literature. BMC Nurs 21 , 137 (2022). https://doi.org/10.1186/s12912-022-00890-6

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Systematic and other reviews: criteria and complexities

Robert t. sataloff.

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Review articles can be extremely valuable. They synthesize information for readers, often provide clarity and valuable insights into a topic; and good review articles tend to be cited frequently. Review articles do not require Institutional Review Board (IRB) approval if the data reviewed are public (including private and government databases) and if the articles reviewed have received IRB approval previously. However, some institutions require IRB review and exemption for review articles. So, authors should be familiar with their institution’s policy. In assessing and interpreting review articles, it is important to understand the article’s methodology, scholarly purpose and credibility. Many readers, and some journal reviewers, are not aware that there are different kinds of review articles with different definitions, criteria and academic impact [ 1 ]. In order to understand the importance and potential application of a review article, it is valuable for readers and reviewers to be able to classify review articles correctly.

Systematic reviews

Authors often submit articles that include the term “systematic” in the title without realizing that that term requires strict adherence to specific criteria. A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative or quantitative. However, if adequate and comparable quantitative data are available then a meta-analysis can be performed to assess the weighted and summarized effect size of the studies included. Depending on the research question and the data collected, systematic reviews may or may not include quantitative meta-analyses; however, meta-analyses should be performed in the setting of a systematic review to ensure that all of the appropriate data were accessed. The components of a systematic review can be found in an important article by Moher et al. published in 2009 that defined requirements for systematic reviews and meta-analyses [ 2 ].

In order to optimize reporting of meta-analyses, an international group developed the Quality of Reporting of Meta-Analyses (QUOROM) statement at a meeting in 1996 that led to publication of the QUOROM statement in 1999 [ 3 ]. Moher et al. revised that document and re-named the guidelines the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PRISMA statement included both meta-analyses and systematic reviews, and the authors incorporated definitions established by the Cochrane Collaboration [ 4 ]. The PRISMA statement established the current standard for systematic reviews. To qualify as a systematic review, the methods section should acknowledge use of the PRISMA guidelines, and all PRISMA components should be incorporated strictly in all facets of the paper from the research question to the discussion. The PRISMA statement includes a checklist of 27 items that must be included when reporting a systematic review or meta-analysis [ 2 ]. A downloadable version of this checklist can be used by authors, reviewers, and journal editorial staff to ensure compliance with recommended components [ 5 ]. All 27 will not be listed in this brief editorial (although authors and reviewers are encouraged to consult the article by Moher et al. and familiarize themselves with all items), but a few will be highlighted.

The research question, as reflected in the title, should be a hypothesis-based specific research inquiry. The introduction must describe the rationale for the review and provide a specific goal or set of goals to be addressed. The type of systematic review, according to the Cochrane Collaboration, is based on the research question being asked and may assess diagnostic test accuracy, review prognostic studies evidence, evaluate intervention effect, scrutinize research methodology, or summarize qualitative evidence [ 6 ].

In the methods section, the participants, interventions, comparisons, outcomes and study design (PICOS) must be put forward. In addition to mentioning compliance with PRISMA, the methods section should state whether a review protocol exists and, if so, where it can be accessed (including a registration number). Systematic reviews are eligible for registration in the International Prospective Register of Systematic Reviews (PROSPERO) as established at the University of York (York, UK). When PROSPERO is used (it is available but not required for systematic reviews), registration should occur at the initial protocol stage of the review, and the final paper should direct to the information in the register. The methods section also must include specific study characteristics including databases used, years considered, languages of articles included, specific inclusion and exclusion criteria for studies; and rationale for each criterion must be included. Which individuals specifically performed searches should be noted. Electronic search strategy (with a full description of at least one electronic search strategy sufficient to allow replication of the search), process for article selection, data variables sought, assumptions and simplifications, methods for assessing bias risk of each individual study (such as selective reporting in individual studies) and utilization of this information in data synthesis, principal summary measures (risk ratio, hazard ratio, difference in means, etc.), methods of data management and combining study results, outcome level assessment, and other information should be reported.

The results section should include the number of studies identified, screened, evaluated for eligibility (including rationale for exclusion), and those included in the final synthesis. A PRISMA flow diagram should be included to provide this information succinctly [ 7 ]. The results also should include the study characteristics, study results, risk of bias within and across studies, and a qualitative or quantitative synthesis of the results of the included studies. This level of rigor in acquiring and evaluating the evidence of each individual study is one of the criteria that distinguishes systematic reviews from other categories. If the systematic review involves studies with paired samples and quantitative data, a summary of data should be provided for each intervention group along with effect estimates and confidence intervals for all outcomes of each study. If a meta-analysis is performed, then synthesized effect size should be reported with confidence intervals and measures of consistency (i.e. – data heterogeneity such as I 2 ) for each meta-analysis, and assessment of bias risk across studies. A forest plot, which provides a graphical presentation of the meta-analysis results, should be included.

The discussion section should summarize the main findings commenting on the strength of evidence for each outcome, as well as relevance to healthcare providers, policymakers and other key stake-holders; limitations of the study and outcomes; and conclusions highlighting the interpretation of results in the context of other research, and implications for future research.

Without adhering to of all of these criteria and the others listed in the PRISMA statement and checklist, the review does not qualify to be classified as “systematic”.

Meta-analyses

Meta-analyses, when feasible based on available and comparable quantitative data, supplement a systematic review evaluation, by adding a secondary statistical analysis of the pooled weighted outcomes of similar studies. This adds a level of objectivity in the synthesis of the review’s findings. Meta-analyses are appropriate when at least 2 individual studies contain paired samples (experimental group and control group) and provide quantitative outcome data and sample size. Studies that lack a control group may over-estimate the effect size of the experimental intervention or condition being studied and are not ideal for meta-analyses [ 8 ]. It also should be remembered that the conclusions of a meta-analysis are only as valid as the data on which the analysis is based. If the articles included are flawed, then the conclusions of the meta-analysis also may be flawed. Systematic reviews and meta-analyses are the most rigorous categories of review.

Other types of reviews

Mixed methods reviews.

Systematic reviews typically contain a single type of data, either qualitative or quantitative; however, mixed methods reviews bring together a combination of data types or study types. This approach may be utilized when quantitative data, in the setting of an intervention study, only provide a narrow perspective of the efficacy or effectiveness of the intervention. The addition of qualitative data or qualitative studies may provide a more complete picture of the knowledge, attitudes, and behaviors of clinicians, patients or researchers regarding that intervention. This type of review could involve collecting either the quantitative or the qualitative data using systematic review methodology, but often the qualitative data are gathered using a convenience sampling. Many qualitative studies provide useful insights into clinical management and/or implementation of research interventions; and incorporating them into a mixed methods review may provide valuable perspective on a wide range of literature. Mixed methods reviews are not necessarily systematic in nature; however, authors conducting mixed methods reviews should follow systematic review methodology, when possible.

Literature and narrative reviews

Literature reviews include peer-reviewed original research, systematic reviews, and meta-analyses, but also may include conference abstracts, books, graduate degree theses, and other non-peer reviewed publications. The methods used to identify and evaluate studies should be specified, but they are less rigorous and comprehensive than those required for systematic reviews. Literature reviews can evaluate a broad topic but do not specifically articulate a specific question, nor do they synthesize the results of included studies rigorously. Like mixed method reviews, they provide an overview of published information on the topic, although they may be less comprehensive than integrative reviews; and, unlike systematic reviews, they do not need to support evidence-based clinical or research practices, or highlight high-quality evidence for the reader. Narrative reviews are similar to literature reviews and evaluate the same scope of literature. The terms sometimes are used interchangeably, and author bias in article selection and data interpretation is a potential concern in literature and narrative reviews.

Umbrella reviews

An umbrella review integrates previously published, high-quality reviews such as systematic reviews and meta-analyses. Its purpose is to synthesize information in previously published systematic reviews and meta-analyses into one convenient paper.

Rapid review

A rapid review uses systematic review methodology to evaluate existing research. It provides a quick synthesis of evidence and is used most commonly to assist in emergent decision-making such as that required to determine whether COVID-19 vaccines should receive emergent approval.

Scoping, mapping, and systematized reviews

If literature has not been reviewed comprehensively in a specific subject that is varied and complex, a mapping review (also called scoping review) may be useful to organize initial understanding of the topic and its available literature. While mapping reviews may be helpful in crystallizing research findings and may be published, they are particularly useful in helping to determine whether a topic is amenable to systematic review, and to help organize and direct the approach of the systematic review or other reviews of the subject. Systematized reviews are used most commonly by students. The systematized review provides initial assessment of a topic that is potentially appropriate for a systematic review, but a systematized review does not meet the rigorous criteria of a systematic review and has substantially more limited value. Additional types of reviews exist including critical review, state-of-the-art review, and others.

Reviews can be invaluable; but they also can be misleading. Systematic reviews and meta-analyses provide readers with the greatest confidence that rigorous efforts have attempted to eliminate bias and ensure validity, but even they have limitations based upon the strengths and weaknesses of the literature that they have assessed (and the skill and objectivity with which the authors have executed the review). Risks of bias, incomplete information and misinformation increase as the rigor of review methodology decreases. While review articles may summarize research related to a topic for readers, non-systematic reviews lack the rigor to answer adequately hypothesis-driven research questions that can influence evidence-based practice. Journal authors, reviewers, editorial staff, and should be cognizant of the strengths and weaknesses of review methodology and should consider them carefully as they assess the value of published review articles, particularly as they determine whether the information presented should alter their patient care.

Authors’ contributions

The author(s) read and approved the final manuscript.

Declarations

The authors declare no competing interests.

This article is co-published in the following journals: Journal of Voice, Otology & Neurotology, Ear, Nose and Throat Journal, Journal of Laryngology and Otology, Operative Techniques in Otolaryngology – Head and Neck Surgery, Head & Neck, International Journal of Pediatric Otorhinolaryngology, Journal of Neurological Surgery Part B: Skull Base, Otolaryngology – Head and Neck Surgery, World Journal of Otorhinolaryngology – Head and Neck Surgery, The Laryngoscope, American Journal of Rhinology & Allergy, Annals of Otology, Rhinology & Laryngology, Clinical Otolaryngology, American Journal of Otolaryngology, Laryngoscope Investigative Otolaryngology.

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Empowering education development through AIGC: A systematic literature review

• Published: 29 February 2024

Cite this article

• Xiaojiao Chen 1 ,
• Zhebing Hu 2 &
• Chengliang Wang   ORCID: orcid.org/0000-0003-2208-3508 3  

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As an exemplary representative of AIGC products, ChatGPT has ushered in new possibilities for the field of education. Leveraging its robust text generation and comprehension capabilities, it has had a revolutionary impact on pedagogy, learning experiences, personalized education and other aspects. However, to date, there has been no comprehensive review of AIGC technology’s application in education. In light of this gap, this study employs a systematic literature review and selects 134 relevant publications on AIGC’s educational application from 4 databases: EBSCO, EI Compendex, Scopus, and Web of Science. The study aims to explore the macro development status and future trends in AIGC’s educational application. The following findings emerge: 1) In the AIGC’s educational application field, the United States is the most active country. Theoretical research dominates the research types in this domain; 2) Research on AIGC’s educational application is primarily published in journals and academic conferences in the fields of educational technology and medicine; 3) Research topics primarily focus on five themes: AIGC technology performance assessment, AIGC technology instructional application, AIGC technology enhancing learning outcomes, AIGC technology educational application’s Advantages and Disadvantages analysis, and AIGC technology educational application prospects. 4) Through Grounded Theory, the study delves into the core advantages and potential risks of AIGC’s educational application, deconstructing the scenarios and logic of AIGC’s educational application. 5) Based on a review of existing literature, the study provides valuable future agendas from both theoretical and practical application perspectives. Discussing the future research agenda contributes to clarifying key issues related to the integration of AI and education, promoting more intelligent, effective, and sustainable educational methods and tools, which is of great significance for advancing innovation and development in the field of education.

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College of Educational Science and Technology, Zhejiang University of Technology, Hangzhou, China

Xiaojiao Chen

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Chen, X., Hu, Z. & Wang, C. Empowering education development through AIGC: A systematic literature review. Educ Inf Technol (2024). https://doi.org/10.1007/s10639-024-12549-7

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Received : 19 October 2023

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Published : 29 February 2024

DOI : https://doi.org/10.1007/s10639-024-12549-7

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