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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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a systematic qualitative literature review

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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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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews

  • Related content
  • Peer review
  • Matthew J Page , senior research fellow 1 ,
  • Joanne E McKenzie , associate professor 1 ,
  • Patrick M Bossuyt , professor 2 ,
  • Isabelle Boutron , professor 3 ,
  • Tammy C Hoffmann , professor 4 ,
  • Cynthia D Mulrow , professor 5 ,
  • Larissa Shamseer , doctoral student 6 ,
  • Jennifer M Tetzlaff , research product specialist 7 ,
  • Elie A Akl , professor 8 ,
  • Sue E Brennan , senior research fellow 1 ,
  • Roger Chou , professor 9 ,
  • Julie Glanville , associate director 10 ,
  • Jeremy M Grimshaw , professor 11 ,
  • Asbjørn Hróbjartsson , professor 12 ,
  • Manoj M Lalu , associate scientist and assistant professor 13 ,
  • Tianjing Li , associate professor 14 ,
  • Elizabeth W Loder , professor 15 ,
  • Evan Mayo-Wilson , associate professor 16 ,
  • Steve McDonald , senior research fellow 1 ,
  • Luke A McGuinness , research associate 17 ,
  • Lesley A Stewart , professor and director 18 ,
  • James Thomas , professor 19 ,
  • Andrea C Tricco , scientist and associate professor 20 ,
  • Vivian A Welch , associate professor 21 ,
  • Penny Whiting , associate professor 17 ,
  • David Moher , director and professor 22
  • 1 School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
  • 2 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, Netherlands
  • 3 Université de Paris, Centre of Epidemiology and Statistics (CRESS), Inserm, F 75004 Paris, France
  • 4 Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
  • 5 University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA; Annals of Internal Medicine
  • 6 Knowledge Translation Program, Li Ka Shing Knowledge Institute, Toronto, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
  • 7 Evidence Partners, Ottawa, Canada
  • 8 Clinical Research Institute, American University of Beirut, Beirut, Lebanon; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
  • 9 Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
  • 10 York Health Economics Consortium (YHEC Ltd), University of York, York, UK
  • 11 Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada
  • 12 Centre for Evidence-Based Medicine Odense (CEBMO) and Cochrane Denmark, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient data Exploratory Network (OPEN), Odense University Hospital, Odense, Denmark
  • 13 Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, Canada; Clinical Epidemiology Program, Blueprint Translational Research Group, Ottawa Hospital Research Institute, Ottawa, Canada; Regenerative Medicine Program, Ottawa Hospital Research Institute, Ottawa, Canada
  • 14 Department of Ophthalmology, School of Medicine, University of Colorado Denver, Denver, Colorado, United States; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  • 15 Division of Headache, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Head of Research, The BMJ , London, UK
  • 16 Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
  • 17 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
  • 18 Centre for Reviews and Dissemination, University of York, York, UK
  • 19 EPPI-Centre, UCL Social Research Institute, University College London, London, UK
  • 20 Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Canada; Epidemiology Division of the Dalla Lana School of Public Health and the Institute of Health Management, Policy, and Evaluation, University of Toronto, Toronto, Canada; Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada
  • 21 Methods Centre, Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
  • 22 Centre for Journalology, Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
  • Correspondence to: M J Page matthew.page{at}monash.edu
  • Accepted 4 January 2021

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

Systematic reviews serve many critical roles. They can provide syntheses of the state of knowledge in a field, from which future research priorities can be identified; they can address questions that otherwise could not be answered by individual studies; they can identify problems in primary research that should be rectified in future studies; and they can generate or evaluate theories about how or why phenomena occur. Systematic reviews therefore generate various types of knowledge for different users of reviews (such as patients, healthcare providers, researchers, and policy makers). 1 2 To ensure a systematic review is valuable to users, authors should prepare a transparent, complete, and accurate account of why the review was done, what they did (such as how studies were identified and selected) and what they found (such as characteristics of contributing studies and results of meta-analyses). Up-to-date reporting guidance facilitates authors achieving this. 3

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement published in 2009 (hereafter referred to as PRISMA 2009) 4 5 6 7 8 9 10 is a reporting guideline designed to address poor reporting of systematic reviews. 11 The PRISMA 2009 statement comprised a checklist of 27 items recommended for reporting in systematic reviews and an “explanation and elaboration” paper 12 13 14 15 16 providing additional reporting guidance for each item, along with exemplars of reporting. The recommendations have been widely endorsed and adopted, as evidenced by its co-publication in multiple journals, citation in over 60 000 reports (Scopus, August 2020), endorsement from almost 200 journals and systematic review organisations, and adoption in various disciplines. Evidence from observational studies suggests that use of the PRISMA 2009 statement is associated with more complete reporting of systematic reviews, 17 18 19 20 although more could be done to improve adherence to the guideline. 21

Many innovations in the conduct of systematic reviews have occurred since publication of the PRISMA 2009 statement. For example, technological advances have enabled the use of natural language processing and machine learning to identify relevant evidence, 22 23 24 methods have been proposed to synthesise and present findings when meta-analysis is not possible or appropriate, 25 26 27 and new methods have been developed to assess the risk of bias in results of included studies. 28 29 Evidence on sources of bias in systematic reviews has accrued, culminating in the development of new tools to appraise the conduct of systematic reviews. 30 31 Terminology used to describe particular review processes has also evolved, as in the shift from assessing “quality” to assessing “certainty” in the body of evidence. 32 In addition, the publishing landscape has transformed, with multiple avenues now available for registering and disseminating systematic review protocols, 33 34 disseminating reports of systematic reviews, and sharing data and materials, such as preprint servers and publicly accessible repositories. To capture these advances in the reporting of systematic reviews necessitated an update to the PRISMA 2009 statement.

Summary points

To ensure a systematic review is valuable to users, authors should prepare a transparent, complete, and accurate account of why the review was done, what they did, and what they found

The PRISMA 2020 statement provides updated reporting guidance for systematic reviews that reflects advances in methods to identify, select, appraise, and synthesise studies

The PRISMA 2020 statement consists of a 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and revised flow diagrams for original and updated reviews

We anticipate that the PRISMA 2020 statement will benefit authors, editors, and peer reviewers of systematic reviews, and different users of reviews, including guideline developers, policy makers, healthcare providers, patients, and other stakeholders

Development of PRISMA 2020

A complete description of the methods used to develop PRISMA 2020 is available elsewhere. 35 We identified PRISMA 2009 items that were often reported incompletely by examining the results of studies investigating the transparency of reporting of published reviews. 17 21 36 37 We identified possible modifications to the PRISMA 2009 statement by reviewing 60 documents providing reporting guidance for systematic reviews (including reporting guidelines, handbooks, tools, and meta-research studies). 38 These reviews of the literature were used to inform the content of a survey with suggested possible modifications to the 27 items in PRISMA 2009 and possible additional items. Respondents were asked whether they believed we should keep each PRISMA 2009 item as is, modify it, or remove it, and whether we should add each additional item. Systematic review methodologists and journal editors were invited to complete the online survey (110 of 220 invited responded). We discussed proposed content and wording of the PRISMA 2020 statement, as informed by the review and survey results, at a 21-member, two-day, in-person meeting in September 2018 in Edinburgh, Scotland. Throughout 2019 and 2020, we circulated an initial draft and five revisions of the checklist and explanation and elaboration paper to co-authors for feedback. In April 2020, we invited 22 systematic reviewers who had expressed interest in providing feedback on the PRISMA 2020 checklist to share their views (via an online survey) on the layout and terminology used in a preliminary version of the checklist. Feedback was received from 15 individuals and considered by the first author, and any revisions deemed necessary were incorporated before the final version was approved and endorsed by all co-authors.

The PRISMA 2020 statement

Scope of the guideline.

The PRISMA 2020 statement has been designed primarily for systematic reviews of studies that evaluate the effects of health interventions, irrespective of the design of the included studies. However, the checklist items are applicable to reports of systematic reviews evaluating other interventions (such as social or educational interventions), and many items are applicable to systematic reviews with objectives other than evaluating interventions (such as evaluating aetiology, prevalence, or prognosis). PRISMA 2020 is intended for use in systematic reviews that include synthesis (such as pairwise meta-analysis or other statistical synthesis methods) or do not include synthesis (for example, because only one eligible study is identified). The PRISMA 2020 items are relevant for mixed-methods systematic reviews (which include quantitative and qualitative studies), but reporting guidelines addressing the presentation and synthesis of qualitative data should also be consulted. 39 40 PRISMA 2020 can be used for original systematic reviews, updated systematic reviews, or continually updated (“living”) systematic reviews. However, for updated and living systematic reviews, there may be some additional considerations that need to be addressed. Where there is relevant content from other reporting guidelines, we reference these guidelines within the items in the explanation and elaboration paper 41 (such as PRISMA-Search 42 in items 6 and 7, Synthesis without meta-analysis (SWiM) reporting guideline 27 in item 13d). Box 1 includes a glossary of terms used throughout the PRISMA 2020 statement.

Glossary of terms

Systematic review —A review that uses explicit, systematic methods to collate and synthesise findings of studies that address a clearly formulated question 43

Statistical synthesis —The combination of quantitative results of two or more studies. This encompasses meta-analysis of effect estimates (described below) and other methods, such as combining P values, calculating the range and distribution of observed effects, and vote counting based on the direction of effect (see McKenzie and Brennan 25 for a description of each method)

Meta-analysis of effect estimates —A statistical technique used to synthesise results when study effect estimates and their variances are available, yielding a quantitative summary of results 25

Outcome —An event or measurement collected for participants in a study (such as quality of life, mortality)

Result —The combination of a point estimate (such as a mean difference, risk ratio, or proportion) and a measure of its precision (such as a confidence/credible interval) for a particular outcome

Report —A document (paper or electronic) supplying information about a particular study. It could be a journal article, preprint, conference abstract, study register entry, clinical study report, dissertation, unpublished manuscript, government report, or any other document providing relevant information

Record —The title or abstract (or both) of a report indexed in a database or website (such as a title or abstract for an article indexed in Medline). Records that refer to the same report (such as the same journal article) are “duplicates”; however, records that refer to reports that are merely similar (such as a similar abstract submitted to two different conferences) should be considered unique.

Study —An investigation, such as a clinical trial, that includes a defined group of participants and one or more interventions and outcomes. A “study” might have multiple reports. For example, reports could include the protocol, statistical analysis plan, baseline characteristics, results for the primary outcome, results for harms, results for secondary outcomes, and results for additional mediator and moderator analyses

PRISMA 2020 is not intended to guide systematic review conduct, for which comprehensive resources are available. 43 44 45 46 However, familiarity with PRISMA 2020 is useful when planning and conducting systematic reviews to ensure that all recommended information is captured. PRISMA 2020 should not be used to assess the conduct or methodological quality of systematic reviews; other tools exist for this purpose. 30 31 Furthermore, PRISMA 2020 is not intended to inform the reporting of systematic review protocols, for which a separate statement is available (PRISMA for Protocols (PRISMA-P) 2015 statement 47 48 ). Finally, extensions to the PRISMA 2009 statement have been developed to guide reporting of network meta-analyses, 49 meta-analyses of individual participant data, 50 systematic reviews of harms, 51 systematic reviews of diagnostic test accuracy studies, 52 and scoping reviews 53 ; for these types of reviews we recommend authors report their review in accordance with the recommendations in PRISMA 2020 along with the guidance specific to the extension.

How to use PRISMA 2020

The PRISMA 2020 statement (including the checklists, explanation and elaboration, and flow diagram) replaces the PRISMA 2009 statement, which should no longer be used. Box 2 summarises noteworthy changes from the PRISMA 2009 statement. The PRISMA 2020 checklist includes seven sections with 27 items, some of which include sub-items ( table 1 ). A checklist for journal and conference abstracts for systematic reviews is included in PRISMA 2020. This abstract checklist is an update of the 2013 PRISMA for Abstracts statement, 54 reflecting new and modified content in PRISMA 2020 ( table 2 ). A template PRISMA flow diagram is provided, which can be modified depending on whether the systematic review is original or updated ( fig 1 ).

Noteworthy changes to the PRISMA 2009 statement

Inclusion of the abstract reporting checklist within PRISMA 2020 (see item #2 and table 2 ).

Movement of the ‘Protocol and registration’ item from the start of the Methods section of the checklist to a new Other section, with addition of a sub-item recommending authors describe amendments to information provided at registration or in the protocol (see item #24a-24c).

Modification of the ‘Search’ item to recommend authors present full search strategies for all databases, registers and websites searched, not just at least one database (see item #7).

Modification of the ‘Study selection’ item in the Methods section to emphasise the reporting of how many reviewers screened each record and each report retrieved, whether they worked independently, and if applicable, details of automation tools used in the process (see item #8).

Addition of a sub-item to the ‘Data items’ item recommending authors report how outcomes were defined, which results were sought, and methods for selecting a subset of results from included studies (see item #10a).

Splitting of the ‘Synthesis of results’ item in the Methods section into six sub-items recommending authors describe: the processes used to decide which studies were eligible for each synthesis; any methods required to prepare the data for synthesis; any methods used to tabulate or visually display results of individual studies and syntheses; any methods used to synthesise results; any methods used to explore possible causes of heterogeneity among study results (such as subgroup analysis, meta-regression); and any sensitivity analyses used to assess robustness of the synthesised results (see item #13a-13f).

Addition of a sub-item to the ‘Study selection’ item in the Results section recommending authors cite studies that might appear to meet the inclusion criteria, but which were excluded, and explain why they were excluded (see item #16b).

Splitting of the ‘Synthesis of results’ item in the Results section into four sub-items recommending authors: briefly summarise the characteristics and risk of bias among studies contributing to the synthesis; present results of all statistical syntheses conducted; present results of any investigations of possible causes of heterogeneity among study results; and present results of any sensitivity analyses (see item #20a-20d).

Addition of new items recommending authors report methods for and results of an assessment of certainty (or confidence) in the body of evidence for an outcome (see items #15 and #22).

Addition of a new item recommending authors declare any competing interests (see item #26).

Addition of a new item recommending authors indicate whether data, analytic code and other materials used in the review are publicly available and if so, where they can be found (see item #27).

PRISMA 2020 item checklist

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PRISMA 2020 for Abstracts checklist*

Fig 1

PRISMA 2020 flow diagram template for systematic reviews. The new design is adapted from flow diagrams proposed by Boers, 55 Mayo-Wilson et al. 56 and Stovold et al. 57 The boxes in grey should only be completed if applicable; otherwise they should be removed from the flow diagram. Note that a “report” could be a journal article, preprint, conference abstract, study register entry, clinical study report, dissertation, unpublished manuscript, government report or any other document providing relevant information.

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We recommend authors refer to PRISMA 2020 early in the writing process, because prospective consideration of the items may help to ensure that all the items are addressed. To help keep track of which items have been reported, the PRISMA statement website ( http://www.prisma-statement.org/ ) includes fillable templates of the checklists to download and complete (also available in the data supplement on bmj.com). We have also created a web application that allows users to complete the checklist via a user-friendly interface 58 (available at https://prisma.shinyapps.io/checklist/ and adapted from the Transparency Checklist app 59 ). The completed checklist can be exported to Word or PDF. Editable templates of the flow diagram can also be downloaded from the PRISMA statement website.

We have prepared an updated explanation and elaboration paper, in which we explain why reporting of each item is recommended and present bullet points that detail the reporting recommendations (which we refer to as elements). 41 The bullet-point structure is new to PRISMA 2020 and has been adopted to facilitate implementation of the guidance. 60 61 An expanded checklist, which comprises an abridged version of the elements presented in the explanation and elaboration paper, with references and some examples removed, is available in the data supplement on bmj.com. Consulting the explanation and elaboration paper is recommended if further clarity or information is required.

Journals and publishers might impose word and section limits, and limits on the number of tables and figures allowed in the main report. In such cases, if the relevant information for some items already appears in a publicly accessible review protocol, referring to the protocol may suffice. Alternatively, placing detailed descriptions of the methods used or additional results (such as for less critical outcomes) in supplementary files is recommended. Ideally, supplementary files should be deposited to a general-purpose or institutional open-access repository that provides free and permanent access to the material (such as Open Science Framework, Dryad, figshare). A reference or link to the additional information should be included in the main report. Finally, although PRISMA 2020 provides a template for where information might be located, the suggested location should not be seen as prescriptive; the guiding principle is to ensure the information is reported.

Use of PRISMA 2020 has the potential to benefit many stakeholders. Complete reporting allows readers to assess the appropriateness of the methods, and therefore the trustworthiness of the findings. Presenting and summarising characteristics of studies contributing to a synthesis allows healthcare providers and policy makers to evaluate the applicability of the findings to their setting. Describing the certainty in the body of evidence for an outcome and the implications of findings should help policy makers, managers, and other decision makers formulate appropriate recommendations for practice or policy. Complete reporting of all PRISMA 2020 items also facilitates replication and review updates, as well as inclusion of systematic reviews in overviews (of systematic reviews) and guidelines, so teams can leverage work that is already done and decrease research waste. 36 62 63

We updated the PRISMA 2009 statement by adapting the EQUATOR Network’s guidance for developing health research reporting guidelines. 64 We evaluated the reporting completeness of published systematic reviews, 17 21 36 37 reviewed the items included in other documents providing guidance for systematic reviews, 38 surveyed systematic review methodologists and journal editors for their views on how to revise the original PRISMA statement, 35 discussed the findings at an in-person meeting, and prepared this document through an iterative process. Our recommendations are informed by the reviews and survey conducted before the in-person meeting, theoretical considerations about which items facilitate replication and help users assess the risk of bias and applicability of systematic reviews, and co-authors’ experience with authoring and using systematic reviews.

Various strategies to increase the use of reporting guidelines and improve reporting have been proposed. They include educators introducing reporting guidelines into graduate curricula to promote good reporting habits of early career scientists 65 ; journal editors and regulators endorsing use of reporting guidelines 18 ; peer reviewers evaluating adherence to reporting guidelines 61 66 ; journals requiring authors to indicate where in their manuscript they have adhered to each reporting item 67 ; and authors using online writing tools that prompt complete reporting at the writing stage. 60 Multi-pronged interventions, where more than one of these strategies are combined, may be more effective (such as completion of checklists coupled with editorial checks). 68 However, of 31 interventions proposed to increase adherence to reporting guidelines, the effects of only 11 have been evaluated, mostly in observational studies at high risk of bias due to confounding. 69 It is therefore unclear which strategies should be used. Future research might explore barriers and facilitators to the use of PRISMA 2020 by authors, editors, and peer reviewers, designing interventions that address the identified barriers, and evaluating those interventions using randomised trials. To inform possible revisions to the guideline, it would also be valuable to conduct think-aloud studies 70 to understand how systematic reviewers interpret the items, and reliability studies to identify items where there is varied interpretation of the items.

We encourage readers to submit evidence that informs any of the recommendations in PRISMA 2020 (via the PRISMA statement website: http://www.prisma-statement.org/ ). To enhance accessibility of PRISMA 2020, several translations of the guideline are under way (see available translations at the PRISMA statement website). We encourage journal editors and publishers to raise awareness of PRISMA 2020 (for example, by referring to it in journal “Instructions to authors”), endorsing its use, advising editors and peer reviewers to evaluate submitted systematic reviews against the PRISMA 2020 checklists, and making changes to journal policies to accommodate the new reporting recommendations. We recommend existing PRISMA extensions 47 49 50 51 52 53 71 72 be updated to reflect PRISMA 2020 and advise developers of new PRISMA extensions to use PRISMA 2020 as the foundation document.

We anticipate that the PRISMA 2020 statement will benefit authors, editors, and peer reviewers of systematic reviews, and different users of reviews, including guideline developers, policy makers, healthcare providers, patients, and other stakeholders. Ultimately, we hope that uptake of the guideline will lead to more transparent, complete, and accurate reporting of systematic reviews, thus facilitating evidence based decision making.

Acknowledgments

We dedicate this paper to the late Douglas G Altman and Alessandro Liberati, whose contributions were fundamental to the development and implementation of the original PRISMA statement.

We thank the following contributors who completed the survey to inform discussions at the development meeting: Xavier Armoiry, Edoardo Aromataris, Ana Patricia Ayala, Ethan M Balk, Virginia Barbour, Elaine Beller, Jesse A Berlin, Lisa Bero, Zhao-Xiang Bian, Jean Joel Bigna, Ferrán Catalá-López, Anna Chaimani, Mike Clarke, Tammy Clifford, Ioana A Cristea, Miranda Cumpston, Sofia Dias, Corinna Dressler, Ivan D Florez, Joel J Gagnier, Chantelle Garritty, Long Ge, Davina Ghersi, Sean Grant, Gordon Guyatt, Neal R Haddaway, Julian PT Higgins, Sally Hopewell, Brian Hutton, Jamie J Kirkham, Jos Kleijnen, Julia Koricheva, Joey SW Kwong, Toby J Lasserson, Julia H Littell, Yoon K Loke, Malcolm R Macleod, Chris G Maher, Ana Marušic, Dimitris Mavridis, Jessie McGowan, Matthew DF McInnes, Philippa Middleton, Karel G Moons, Zachary Munn, Jane Noyes, Barbara Nußbaumer-Streit, Donald L Patrick, Tatiana Pereira-Cenci, Ba’ Pham, Bob Phillips, Dawid Pieper, Michelle Pollock, Daniel S Quintana, Drummond Rennie, Melissa L Rethlefsen, Hannah R Rothstein, Maroeska M Rovers, Rebecca Ryan, Georgia Salanti, Ian J Saldanha, Margaret Sampson, Nancy Santesso, Rafael Sarkis-Onofre, Jelena Savović, Christopher H Schmid, Kenneth F Schulz, Guido Schwarzer, Beverley J Shea, Paul G Shekelle, Farhad Shokraneh, Mark Simmonds, Nicole Skoetz, Sharon E Straus, Anneliese Synnot, Emily E Tanner-Smith, Brett D Thombs, Hilary Thomson, Alexander Tsertsvadze, Peter Tugwell, Tari Turner, Lesley Uttley, Jeffrey C Valentine, Matt Vassar, Areti Angeliki Veroniki, Meera Viswanathan, Cole Wayant, Paul Whaley, and Kehu Yang. We thank the following contributors who provided feedback on a preliminary version of the PRISMA 2020 checklist: Jo Abbott, Fionn Büttner, Patricia Correia-Santos, Victoria Freeman, Emily A Hennessy, Rakibul Islam, Amalia (Emily) Karahalios, Kasper Krommes, Andreas Lundh, Dafne Port Nascimento, Davina Robson, Catherine Schenck-Yglesias, Mary M Scott, Sarah Tanveer and Pavel Zhelnov. We thank Abigail H Goben, Melissa L Rethlefsen, Tanja Rombey, Anna Scott, and Farhad Shokraneh for their helpful comments on the preprints of the PRISMA 2020 papers. We thank Edoardo Aromataris, Stephanie Chang, Toby Lasserson and David Schriger for their helpful peer review comments on the PRISMA 2020 papers.

Contributors: JEM and DM are joint senior authors. MJP, JEM, PMB, IB, TCH, CDM, LS, and DM conceived this paper and designed the literature review and survey conducted to inform the guideline content. MJP conducted the literature review, administered the survey and analysed the data for both. MJP prepared all materials for the development meeting. MJP and JEM presented proposals at the development meeting. All authors except for TCH, JMT, EAA, SEB, and LAM attended the development meeting. MJP and JEM took and consolidated notes from the development meeting. MJP and JEM led the drafting and editing of the article. JEM, PMB, IB, TCH, LS, JMT, EAA, SEB, RC, JG, AH, TL, EMW, SM, LAM, LAS, JT, ACT, PW, and DM drafted particular sections of the article. All authors were involved in revising the article critically for important intellectual content. All authors approved the final version of the article. MJP is the guarantor of this work. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding: There was no direct funding for this research. MJP is supported by an Australian Research Council Discovery Early Career Researcher Award (DE200101618) and was previously supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Fellowship (1088535) during the conduct of this research. JEM is supported by an Australian NHMRC Career Development Fellowship (1143429). TCH is supported by an Australian NHMRC Senior Research Fellowship (1154607). JMT is supported by Evidence Partners Inc. JMG is supported by a Tier 1 Canada Research Chair in Health Knowledge Transfer and Uptake. MML is supported by The Ottawa Hospital Anaesthesia Alternate Funds Association and a Faculty of Medicine Junior Research Chair. TL is supported by funding from the National Eye Institute (UG1EY020522), National Institutes of Health, United States. LAM is supported by a National Institute for Health Research Doctoral Research Fellowship (DRF-2018-11-ST2-048). ACT is supported by a Tier 2 Canada Research Chair in Knowledge Synthesis. DM is supported in part by a University Research Chair, University of Ottawa. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

Competing interests: All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/conflicts-of-interest/ and declare: EL is head of research for the BMJ ; MJP is an editorial board member for PLOS Medicine ; ACT is an associate editor and MJP, TL, EMW, and DM are editorial board members for the Journal of Clinical Epidemiology ; DM and LAS were editors in chief, LS, JMT, and ACT are associate editors, and JG is an editorial board member for Systematic Reviews . None of these authors were involved in the peer review process or decision to publish. TCH has received personal fees from Elsevier outside the submitted work. EMW has received personal fees from the American Journal for Public Health , for which he is the editor for systematic reviews. VW is editor in chief of the Campbell Collaboration, which produces systematic reviews, and co-convenor of the Campbell and Cochrane equity methods group. DM is chair of the EQUATOR Network, IB is adjunct director of the French EQUATOR Centre and TCH is co-director of the Australasian EQUATOR Centre, which advocates for the use of reporting guidelines to improve the quality of reporting in research articles. JMT received salary from Evidence Partners, creator of DistillerSR software for systematic reviews; Evidence Partners was not involved in the design or outcomes of the statement, and the views expressed solely represent those of the author.

Provenance and peer review: Not commissioned; externally peer reviewed.

Patient and public involvement: Patients and the public were not involved in this methodological research. We plan to disseminate the research widely, including to community participants in evidence synthesis organisations.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/ .

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Qualitative and mixed methods in systematic reviews

  • David Gough 1  

Systematic Reviews volume  4 , Article number:  181 ( 2015 ) Cite this article

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Expanding the range of methods of systematic review

The logic of systematic reviews is very simple. We use transparent rigorous approaches to undertake primary research, and so we should do the same in bringing together studies to describe what has been studied (a research map) or to integrate the findings of the different studies to answer a research question (a research synthesis). We should not really need to use the term ‘systematic’ as it should be assumed that researchers are using and reporting systematic methods in all of their research, whether primary or secondary. Despite the universality of this logic, systematic reviews (maps and syntheses) are much better known in health research and for answering questions of the effectiveness of interventions (what works). Systematic reviews addressing other sorts of questions have been around for many years, as in, for example, meta ethnography [ 1 ] and other forms of conceptual synthesis [ 2 ], but only recently has there been a major increase in the use of systematic review approaches to answer other sorts of research questions.

There are probably several reasons for this broadening of approach. One may be that the increased awareness of systematic reviews has made people consider the possibilities for all areas of research. A second related factor may be that more training and funding resources have become available and increased the capacity to undertake such varied review work.

A third reason could be that some of the initial anxieties about systematic reviews have subsided. Initially, there were concerns that their use was being promoted by a new managerialism where reviews, particularly effectiveness reviews, were being used to promote particular ideological and theoretical assumptions and to indirectly control research agendas. However, others like me believe that explicit methods should be used to enable transparency of perspectives driving research and to open up access to and participation in research agendas and priority setting [ 3 ] as illustrated, for example, by the James Lind Alliance (see http://www.jla.nihr.ac.uk/ ).

A fourth possible reason for the development of new approaches is that effectiveness reviews have themselves broadened. Some ‘what works’ reviews can be open to criticism for only testing a ‘black box’ hypothesis of what works with little theorizing or any logic model about why any such hypothesis should be true and the mechanisms involved in such processes. There is now more concern to develop theory and to test how variables combine and interact. In primary research, qualitative strategies are advised prior to undertaking experimental trials [ 4 , 5 ] and similar approaches are being advocated to address complexity in reviews [ 6 ], in order to ask questions and use methods that address theories and processes that enable an understanding of both impact and context.

This Special Issue of Systematic Reviews Journal is providing a focus for these new methods of review whether these use qualitative review methods on their own or mixed together with more quantitative approaches. We are linking together with the sister journal Trials for this Special Issue as there is a similar interest in what qualitative approaches can and should contribute to primary research using experimentally controlled trials (see Trials Special Issue editorial by Claire Snowdon).

Dimensions of difference in reviews

Developing the range of methods to address different questions for review creates a challenge in describing and understanding such methods. There are many names and brands for the new methods which may or may not withstand the changes of historical time, but another way to comprehend the changes and new developments is to consider the dimensions on which the approaches to review differ [ 7 , 8 ].

One important distinction is the research question being asked and the associated paradigm underlying the method used to address this question. Research assumes a particular theoretical position and then gathers data within this conceptual lens. In some cases, this is a very specific hypothesis that is then tested empirically, and sometimes, the research is more exploratory and iterative with concepts being emergent and constructed during the research process. This distinction is often labelled as quantitative or positivist versus qualitative or constructionist. However, this can be confusing as much research taking a ‘quantitative’ perspective does not have the necessary numeric data to analyse. Even if it does have such data, this might be explored for emergent properties. Similarly, research taking a ‘qualitative’ perspective may include implicit quantitative themes in terms of the extent of different qualitative findings reported by a study.

Sandelowski and colleagues’ solution is to consider the analytic activity and whether this aggregates (adds up) or configures (arranges) the data [ 9 ]. In a randomized controlled trial and an effectiveness review of such studies, the main analysis is the aggregation of data using a priori non-emergent strategies with little iteration. However, there may also be post hoc analysis that is more exploratory in arranging (configuring) data to identify patterns as in, for example, meta regression or qualitative comparative analysis aiming to identify the active ingredients of effective interventions [ 10 ]. Similarly, qualitative primary research or reviews of such research are predominantly exploring emergent patterns and developing concepts iteratively, yet there may be some aggregation of data to make statements of generalizations of extent.

Even where the analysis is predominantly configuration, there can be a wide variation in the dimensions of difference of iteration of theories and concepts. In thematic synthesis [ 11 ], there may be few presumptions about the concepts that will be configured. In meta ethnography which can be richer in theory, there may be theoretical assumptions underlying the review question framing the analysis. In framework synthesis, there is an explicit conceptual framework that is iteratively developed and changed through the review process [ 12 , 13 ].

In addition to the variation in question, degree of configuration, complexity of theory, and iteration are many other dimensions of difference between reviews. Some of these differences follow on from the research questions being asked and the research paradigm being used such as in the approach to searching (exhaustive or based on exploration or saturation) and the appraisal of the quality and relevance of included studies (based more on risk of bias or more on meaning). Others include the extent that reviews have a broad question, depth of analysis, and the extent of resultant ‘work done’ in terms of progressing a field of inquiry [ 7 , 8 ].

Mixed methods reviews

As one reason for the growth in qualitative synthesis is what they can add to quantitative reviews, it is not surprising that there is also growing interest in mixed methods reviews. This reflects similar developments in primary research in mixing methods to examine the relationship between theory and empirical data which is of course the cornerstone of much research. But, both primary and secondary mixed methods research also face similar challenges in examining complex questions at different levels of analysis and of combining research findings investigated in different ways and may be based on very different epistemological assumptions [ 14 , 15 ].

Some mixed methods approaches are convergent in that they integrate different data and methods of analysis together at the same time [ 16 , 17 ]. Convergent systematic reviews could be described as having broad inclusion criteria (or two or more different sets of criteria) for methods of primary studies and have special methods for the synthesis of the resultant variation in data. Other reviews (and also primary mixed methods studies) are sequences of sub-reviews in that one sub-study using one research paradigm is followed by another sub-study with a different research paradigm. In other words, a qualitative synthesis might be used to explore the findings of a prior quantitative synthesis or vice versa [ 16 , 17 ].

An example of a predominantly aggregative sub-review followed by a configuring sub-review is the EPPI-Centre’s mixed methods review of barriers to healthy eating [ 18 ]. A sub-review on the effectiveness of public health interventions showed a modest effect size. A configuring review of studies of children and young people’s understanding and views about eating provided evidence that the public health interventions did not take good account of such user views research, and that the interventions most closely aligned to the user views were the most effective. The already mentioned qualitative comparative analysis to identify the active ingredients within interventions leading to impact could also be considered a qualitative configuring investigation of an existing quantitative aggregative review [ 10 ].

An example of a predominantly configurative review followed by an aggregative review is realist synthesis. Realist reviews examine the evidence in support of mid-range theories [ 19 ] with a first stage of a configuring review of what is proposed by the theory or proposal (what would need to be in place and what casual pathways would have to be effective for the outcomes proposed by the theory to be supported?) and a second stage searching for empirical evidence to test for those necessary conditions and effectiveness of the pathways. The empirical testing does not however use a standard ‘what works’ a priori methods approach but rather a more iterative seeking out of evidence that confirms or undermines the theory being evaluated [ 20 ].

Although sequential mixed methods approaches are considered to be sub-parts of one larger study, they could be separate studies as part of a long-term strategic approach to studying an issue. We tend to see both primary studies and reviews as one-off events, yet reviews are a way of examining what we know and what more we want to know as a strategic approach to studying an issue over time. If we are in favour of mixing paradigms of research to enable multiple levels and perspectives and mixing of theory development and empirical evaluation, then we are really seeking mixed methods research strategies rather than simply mixed methods studies and reviews.

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Gough, D. Qualitative and mixed methods in systematic reviews. Syst Rev 4 , 181 (2015). https://doi.org/10.1186/s13643-015-0151-y

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About Systematic Reviews

Are Systematic Reviews Qualitative or Quantitative?

a systematic qualitative literature review

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A systematic review is designed to be transparent and replicable. Therefore, systematic reviews are considered reliable tools in scientific research and clinical practice. They synthesize the results using multiple primary studies by using strategies that minimize bias and random errors. Depending on the research question and the objectives of the research, the reviews can either be qualitative or quantitative. Qualitative reviews deal with understanding concepts, thoughts, or experiences. Quantitative reviews are employed when researchers want to test or confirm a hypothesis or theory. Let’s look at some of the differences between these two types of reviews.

To learn more about how long it takes to do a systematic review , you can check out the link to our full article on the topic.

Differences between Qualitative and Quantitative Reviews

The differences lie in the scope of the research, the methodology followed, and the type of questions they attempt to answer. Some of these differences include:

Research Questions

As mentioned earlier qualitative reviews attempt to answer open-ended research questions to understand or formulate hypotheses. This type of research is used to gather in-depth insights into new topics. Quantitative reviews, on the other hand, test or confirm existing hypotheses. This type of research is used to establish generalizable facts about a topic.

Type of Sample Data

The data collected for both types of research differ significantly. For qualitative research, data is collected as words using observations, interviews, and interactions with study subjects or from literature reviews. Quantitative studies collect data as numbers, usually from a larger sample size.

Data Collection Methods

To collect data as words for a qualitative study, researchers can employ tools such as interviews, recorded observations, focused groups, videos, or by collecting literature reviews on the same subject. For quantitative studies, data from primary sources is collected as numbers using rating scales and counting frequencies. The data for these studies can also be collected as measurements of variables from a well-designed experiment carried out under pre-defined, monitored conditions.

Data Analysis Methods

Data by itself cannot prove or demonstrate anything unless it is analyzed. Qualitative data is more challenging to analyze than quantitative data. A few different approaches to analyzing qualitative data include content analysis, thematic analysis, and discourse analysis. The goal of all of these approaches is to carefully analyze textual data to identify patterns, themes, and the meaning of words or phrases.

Quantitative data, since it is in the form of numbers, is analyzed using simple math or statistical methods. There are several software programs that can be used for mathematical and statistical analysis of numerical data.

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a systematic qualitative literature review

Final Takeaway – Qualitative or Quantitative?

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Galdas P, Darwin Z, Fell J, et al. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). Southampton (UK): NIHR Journals Library; 2015 Aug. (Health Services and Delivery Research, No. 3.34.)

Cover of A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN)

A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN).

Chapter 3 qualitative review methods.

The objective of the qualitative metaethnography was to systematically identify experiences of, and perceptions of, interventions or specific activities aimed at supporting or promoting self-management of LTCs among men of differing age, ethnicity and socioeconomic background.

A summary of the methods used in the metaethnography is provided in Appendix 3 , using the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) reporting standards for qualitative evidence synthesis, developed by Tong et al. 93

The evidence synthesis was conducted using a metaethnography approach originally described by Noblit and Hare. 94 This approach was chosen because of its emphasis on conceptual development and generating new insights (i.e. being interpretive rather than integrative 94 ) and because it is compatible with synthesising all types of qualitative research. 95

Metaethnography involves seven stages: getting started, deciding what is relevant, reading the studies, determining how studies are related to each other, translating studies into each other, synthesising translations and expressing the synthesis; 94 these seven, often overlapping, stages are depicted in Figure 7 .

Seven steps of metaethnography.

  • Step 1: getting started

The first stage involved identifying a ‘worthy’ research question and one that could be addressed through qualitative evidence synthesis. 94 This stage took place in developing the original funding application for the current review and its justification is presented in Chapter 1 .

  • Step 2: deciding what is relevant

The second stage, ‘deciding what is relevant’, was viewed as comprising the search strategy, inclusion criteria and quality appraisal, consistent with the experiences of Atkins et al. 96 These are presented next, before steps 3–7 are described in the section Data extraction strategy and data analysis .

  • Search methods

Search strategy

A comprehensive electronic search strategy ( Appendix 4 ) was developed in liaison with information specialists. It sought to identify all available studies, rather than using purposive sampling to identify all available concepts. Five electronic databases were searched in July 2013 [Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PsycINFO and Social Science Citation Index].

Because of challenges with methodological indexing of qualitative research, 97 the electronic search was complemented by checking reference lists, and using an adapted strategy published elsewhere 98 that includes ‘thesaurus terms’ (keywords indexed in electronic databases, e.g. ‘Qualitative Research’), ‘free text terms’ (commonly used research methodology terms searched for in the titles, abstracts and keywords) and ‘broad-based terms’ (i.e. the broad free-text terms ‘qualitative’, ‘findings’ and ‘interview$’ and the thesaurus term ‘Interviews’). Terms relating to gender were combined with other terms to narrow the search and increase the precision of the strategy (e.g. ‘men’, ‘male’, ‘masculine$’, ‘gender’, ‘sex difference$’, ‘sex factors’).

Study selection: study screening methods and inclusion criteria

Records were initially screened by one reviewer (ZD) on the basis of the title and abstract. Decisions were recorded in EndNote X7.0.2 (Thomson Reuters, CA, USA), a reference management database. All articles identified as potentially eligible for inclusion were obtained in full. Attempts were made to identify and obtain published findings for unpublished literature that was otherwise eligible, for example doctoral theses or conference proceedings.

The full-text literature was screened independently by two reviewers (ZD and PG) using the inclusion criteria listed in Table 5 . Studies that explored the experiences of men alone, or included a clear and explicit comparison between men and women, were included. Studies which focused on self-management experiences of people with LTCs more generally (i.e. did not consider experiences of, or perceptions of, a self-management support intervention or activity) were excluded. The approach to screening was inclusive; for example, studies where the qualitative findings were limited (e.g. Iredale et al. , 99 Ramachandra et al. , 100 Smith et al. 101 ) and mixed-sex studies with limited findings on gender comparisons (e.g. Barlow et al. 102 , 103 ) were retained in case they contributed to the synthesis.

TABLE 5

Screening criteria: qualitative

  • Classification of self-management interventions and support activities in the qualitative evidence synthesis

The original study protocol sought to code self-management interventions and support activities using the most up-to-date version of the taxonomy of BCT. 104 – 106 As in the quantitative review (see Chapter 2 , Coding interventions for analysis ), we found that the level of detail reported on self-management interventions or activities in the qualitative literature was limited in detail, precision and consistency, making coding with the BCT taxonomy unfeasible.

Most of the qualitative literature did not focus on behaviour change per se or seek to address men’s views and experiences of behaviour change techniques; for example, some papers were concerned with the dynamics of social support groups, or the use of other self-management support and information. The BCT taxonomy is applicable to only studies that are judged as targeting behaviour change; we were therefore limited to ‘lifestyle’ and ‘psychological’ studies. Only a minority of the studies ( n  = 13) provided sufficient information on interventions to allow even rudimentary coding with the BCT taxonomy, and these are presented in Appendix 5 . Issues around application of the BCT taxonomy are returned to in the discussion chapter (see Chapter 6 ).

The lack of detail reported in the qualitative literature also made it unfeasible to classify interventions using the system developed for the quantitative review. Whereas the quantitative review concerned trials of specific interventions, approximately half of the studies in the qualitative review 99 , 101 , 107 – 130 included more than one intervention or activity (e.g. ‘any cancer support group’).

We therefore developed a broad system for classifying interventions and support activities that offered a pragmatic way to group studies and make the analysis process more manageable. The categories are shown in Table 6 .

TABLE 6

Categories and descriptions of self-management interventions and support activities in the qualitative evidence synthesis

  • Quality assessment strategy

The purpose of quality appraisal in the review was to provide descriptive information on the quality of the included studies rather than as a basis for inclusion. We considered that studies of weaker quality either would not contribute or would contribute only minimally to the final synthesis. 94 , 131 We therefore chose not to use design-specific appraisal tools (which the original protocol stated we would) because we placed emphasis on conceptual contribution, which did not require a detailed design-specific appraisal of methodological quality. With that in mind, we used the Critical Appraisal Skills Programme (CASP) tool. 132

The CASP tool comprises 10 checklist-style questions (see Appendix 6 ) for assessing the quality of various domains (including aims, design, methods, data analysis, interpretation, findings and value of the research). Because of the checklist nature of the CASP tool, we developed some additional questions informed by other metaethnography studies 96 , 131 that enabled us to extract and record more detailed narrative summaries of the main strengths, limitations and concerns of each study (see Appendix 7 ).

The CASP tool was used in the light of the experiences reported by other researchers who recommended that, despite rather low inter-rater agreement, such an approach ‘encourag[es] the reviewers to read the papers carefully and systematically, and serves as a reminder to treat the papers as data for the synthesis’ (p. 44). 131

Its focus is on procedural aspects of the conduct of the research rather than the insights offered. 133 The quality appraisal (which focused on methodological quality) did not form part of the inclusion criteria because, as recognised by Campbell et al. , 131 it is conceptual quality that is most important for evidence synthesis and it is the process of synthesis that judges the ‘worth’ of studies, with conceptually limited studies making a limited contribution. 94 Additionally, it is acknowledged that agreement is often slight, with low reproducibility. 131 , 133 Appraisal was conducted by two reviewers independently (ZD and PG), with discrepancies resolved through discussion.

Search outcome

The electronic search strategy identified 6330 unique references. Screening based on title and abstract identified 149 papers for full-text screening. Dual screening of these full-text articles identified 34 studies (reported in 38 papers) to be included in the review. Reasons for excluding the remaining 111 articles are shown in Table 7 .

TABLE 7

Reasons for exclusion of full-text articles

Inter-rater agreement on the decision to include was 88.6%. The majority of disagreements ( n  = 17) concerned the definition of self-management intervention or activity. Having discussed the 17 disagreements, we agreed that five studies on which there was disagreement would be included. 100 , 103 , 110 , 116 , 134

An additional four studies were identified through reference checks and efforts to locate published literature linked to unpublished work identified through the electronic search. 111 , 112 , 135 , 136 An additional two papers (women only), although individually ineligible, were located as ‘linked papers’ for two of the original 34 studies, 114 , 120 giving a total of 38 studies (reported in 44 papers), as shown in Figure 8 .

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram for the qualitative review.

  • Data extraction strategy and data analysis

The lead reviewer (ZD) extracted all papers using data extraction forms previously tested and refined through a pilot study of four papers. All study details (including aim, participant details, methodology, method of data collection and analysis) were extracted into Microsoft Excel ® version 14 (Microsoft Corporation, Redmond, WA, USA) and checked by a second reviewer (PG). Extraction and analysis of study findings was undertaken by a group of coreviewers within the research team (ZD, PG, LK, CB, KM, KH) and followed steps 3–7 of the metaethnography process described by Noblit and Hare. 94 Despite being numbered sequentially, these phases do not occur in a linear process. 94

Step 3: reading the studies

The metaethnography process involved three levels of constructs, as described by Schutz 137 and operationalised by Atkins et al. : 96

  • first-order: participant quotes and participant observations, while recognising that in secondary analysis these represent the participants’ views as selected by the study authors in evidencing their second-order constructs
  • second-order: study authors’ themes/concepts and interpretations, also described by Noblit and Hare 94 as ‘metaphors’
  • third-order: our ‘interpretations of interpretations of interpretations’ (p. 35), 94 based on our analysis of the first-order and second-order constructs extracted from the studies.

Each paper was read in full and copied verbatim into NVivo version 10 (QSR International, Warrington, UK) for line-by-line coding by the lead reviewer. Coding involved repeated reading and line-by-line categorising of first-order and second-order constructs, using participants’ and authors’ words wherever possible, and reading for possible third-order constructs.

Third-order constructs were developed by building second-order constructs into broader categories and themes in a framework which was revised iteratively using the hierarchical functions of the NVivo software (i.e. using ‘parent’ and ‘child’ nodes).

Rather than simply being a synthesis of the second-order constructs, third-order-constructs were derived inductively from the extracted data; this was an interpretive process that was not limited to interpretations offered by the original authors of included studies.

Coding by coreviewers (i.e. other members of the research team) was idiosyncratic but commonly involved working with printed papers, noting key ‘metaphors’ (themes, concepts and ideas) in the margins and highlighting first-order and second-order evidence that supported the coreviewers’ interpretations. The lead reviewer, ZD, met with each coreviewer to discuss/debrief coding decisions and ensure the credibility (i.e. the congruence of coding decisions with the original author interpretations) of the overall analytical process.

Step 4: determining how the studies are related

To offer a ‘way in’ to the synthesis, we adopted a similar approach to that of Campbell et al. : 131 initially grouping studies by the broad categories of self-management intervention and support activity shown in Table 6 . Each coreviewer was allocated one or more category of studies to analyse. The lead reviewer then read each category of studies in the following order: face-to-face group support, online support, online information, information, psychological, lifestyle and ‘various’; within this, she read the studies in alphabetical order of first author rather than nominating ‘key’ papers. All included papers were analysed, rather than reading until saturation of concepts.

The lead reviewer and coreviewer independently completed matrices to report the second-order constructs and emerging third-order constructs for each paper (which for the lead reviewer were based on a more comprehensive line-by-line coding using NVivo). This facilitated the juxtaposing of metaphors and/or constructs alongside each other, leading to initial assumptions about relationships between studies.

Step 5: translating studies into one another

A defining element of metaethnography is the ‘translation’ of studies into each other, whereby metaphors, together with their inter-relationships, are compared across studies. Facilitated by discussions using the matrices of second- and third-order constructs, we translated studies firstly within types of support activity and then, secondly, across types.

The lead reviewer initially developed the constructs in relation to face-to-face support (the largest category of studies) and read other categories of studies with reference to this, using a constant comparison approach to identify and refine concepts. The ‘models’ function in NVivo was used to depict relationships between third-order constructs; this helped to develop the line-of-argument synthesis, which is discussed next.

Step 6: synthesising translations

Studies can be synthesised in three ways: 94

  • reciprocal translation, where the findings are directly comparable
  • refutational translation, where the findings are in opposition
  • a line-of-argument synthesis, where both similarities and contradictions are found and translations are encompassed in one overarching interpretation that aims to discover a whole among the set of parts, uncovering aspects that may be hidden in individual studies.

Because we found similarities and contradictions, we developed a line-of-argument synthesis (rather than reciprocal or refutational translation) that encompassed four key concepts, each of which was based around a set of third-order constructs.

Step 7: expressing the synthesis

The output of the synthesis, that is communicating our third-order concepts and overarching line-of-argument synthesis, is described by Noblit and Hare 94 as ‘expressing the synthesis’ (p. 29). They state that ‘the worth of any synthesis is in its comprehensibility to some audience’ (p. 82), 94 emphasising the importance of communicating the synthesis effectively, being mindful of the intended audience and using concepts and language that are meaningful (and understandable). We worked to make the synthesis comprehensible by discussion with coreviewers and, critically, through involvement of the patient and public involvement (PPI) group. The synthesis is presented in Chapter 5 and will also be expressed through other dissemination activities, for example the SELF-MAN symposium ( www.self-man.com ), mini-manuals and journal publications.

We undertook several steps to enhance the rigour of our analysis. Authors’ themes and interpretations (second-order constructs) were independently extracted by two reviewers, each of whom additionally suggested their own interpretations of the study findings (third-order constructs).

We were influenced by a recent Health Technology Assessment metaethnography which found multiple reviewers offered ‘broad similarities in interpretation, but differences of detail’ (p. x). 131 We therefore treated the lead reviewer’s analyses as the ‘master copy’ and compared these with the coreviewers’ extractions and interpretations. Peer debriefing meetings were held between the lead reviewer and each coreviewer to discuss matrices of second-order and third-order constructs which facilitated the consideration of alternative interpretations.

The third-order constructs and line-of-argument synthesis were further refined at a full-day meeting (January 2014) attended by the lead qualitative reviewer and wider team of five coreviewers involved in coding, extraction, analysis and interpretation (PG, KH, LK, KM, CB).

We identified the need to be reflexive about our interpretations and recognised potential sources of influence on our interpretations; for example, two reviewers (PG, KH) identified having a ‘constructions of masculinity’ lens, and we agreed to focus the line-of-argument synthesis on interpretations offered by authors of studies being synthesised, rather than framing our interpretations around constructions of masculinity. We considered it a strength that the six reviewers involved reflected a wide range of backgrounds and perspectives. Although PPI colleagues were not involved in the coding process, the line-of-argument synthesis and four key concepts were discussed with the PPI group to ensure credibility.

  • Public and patient involvement

The SELF-MAN research team worked with a specially constituted public and patient advisory group comprising men living with one or more LTCs who were involved in either running or attending a LTC support group in the north of England. Members were recruited via the research team’s existing networks. Stakeholders’ support groups were all condition-specific – arthritis ( n  = 1), diabetes ( n  = 1), heart failure ( n  = 2) and Parkinson’s disease ( n  = 1) – although some men lived with multiple LTCs. All stakeholders attended a welcome meeting prior to the commencement of the study to prepare them for the involvement in the research, and were provided with ongoing support and guidance by the chief investigator throughout the research process. Members were reimbursed for travel, expenses and time throughout the duration of the project (in line with current INVOLVE recommendations 138 ).

The overarching aims of PPI in the project were, first, to help ensure that the review findings spoke to the self-management needs and priorities of men with LTCs, and, second, to ensure the development of appropriate outputs that would have benefit and relevance for service users. A recognised limitation of our group was that stakeholder representation was drawn from face-to-face group-based support interventions.

The stakeholder group met on three half-days over the course of the 12-month project. On each occasion, the group provided positive affirmation that the project was being conducted in accordance with its stated objectives. In the first two meetings, the group offered feedback and advice to the investigative team on preliminary and emerging analysis of the qualitative data throughout the research process: specifically, the development of third-order constructs and the line-of-argument synthesis. Responding to their input, we made revisions to some of our interpretations, particularly in relation to the importance of physical aspects of environments in which interventions took place. The group’s input also highlighted the need for future research to address depression as a common and often overlooked comorbidity in men (see Chapter 7 , Recommendations for future research ), and that they welcomed recommendations for sustainability of support groups and improving communication within groups. When considering the key outcomes to be assessed in the quantitative review, stakeholders also recommended that emphasis should be placed on quality-of-life outcome measures when considering whether or not a self-management support intervention is effective.

In the final meeting, the stakeholder group provided detailed recommendations for the content of the Self-Manual: Man’s Guide to Better Self-Management of Long Term Conditions (not yet available). It advised that the guide should be rephrased from ‘how to’ self-manage to ‘how to better ’ self-manage because men may view themselves as already self-managing and therefore not identify with the former.

Six or seven stakeholders attended each meeting. The female partner of one of the men attended and contributed to discussions at each meeting. Members of the group each received reimbursement of travel expenses and a £150 honorarium for each meeting they attended. In the final meeting, the stakeholders provided feedback on their involvement in the research process overall, focusing on what was done well and what could be improved. Feedback indicated that most stakeholders had a positive experience, particularly valuing the opportunity to have their ‘voices heard’ and make a potential impact on future service delivery. Recommendations for improvements mostly centred on ensuring prompt reimbursement of expenses incurred in attending the meetings.

Included under terms of UK Non-commercial Government License .

  • Cite this Page Galdas P, Darwin Z, Fell J, et al. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). Southampton (UK): NIHR Journals Library; 2015 Aug. (Health Services and Delivery Research, No. 3.34.) Chapter 3, Qualitative review methods.
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A systematic review on the qualitative experiences of people living with lung cancer in rural areas

  • Open access
  • Published: 06 February 2024
  • Volume 32 , article number  144 , ( 2024 )

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  • Nabilah Ali 1 ,
  • David Nelson 2 , 3 ,
  • Daisy McInnerney 4 ,
  • Samantha L. Quaife 4 ,
  • Despina Laparidou 5 ,
  • Peter Selby 6 , 1 ,
  • Ros Kane 7 ,
  • Sarah Civello 8 ,
  • Dawn Skinner 9 ,
  • Zara Pogson 8 ,
  • Michael D. Peake 10 , 11 ,
  • Ava Harding-Bell 12 &
  • Samuel Cooke   ORCID: orcid.org/0000-0002-3027-7807 2  

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To synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas.

Searches were performed in MEDLINE, CINAHL, and PsycINFO. Articles were screened independently by two reviewers against pre-determined eligibility criteria. Data were synthesized using Thomas and Harden’s framework for the thematic synthesis of qualitative research. The CASP qualitative checklist was used for quality assessment and the review was reported in accordance with the ENTREQ and PRISMA checklists.

Nine articles were included, from which five themes were identified: (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, (5) symptoms and health-seeking behaviors. Lung cancer diagnosis was unexpected for some with several reporting treatment delays and long wait times regarding diagnosis and treatment. Accessing treatment was perceived as challenging and time-consuming due to distance and financial stress. Inadequate communication of information from healthcare professionals was a common concern expressed by rural people living with lung cancer who also conveyed dissatisfaction with their healthcare professionals. Some were reluctant to seek help due to geographical distance and sociocultural factors whilst others found it challenging to identify symptoms due to comorbidities.

Conclusions

This review provides a deeper understanding of the challenges faced by people with lung cancer in rural settings, through which future researchers can begin to develop tailored support to address the existing disparities that affect this population.

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Avoid common mistakes on your manuscript.

Lung cancer is the second most diagnosed cancer globally, accounting for approximately 2.2 million cases and is the leading cause of cancer mortality [ 1 , 2 , 3 ]. In 2020, lung cancer represented approximately one in 10 (11.4%) of all cancer diagnoses and one in five (18.0%) of all cancer deaths worldwide [ 1 ]. Smoking remains the primary risk factor for developing lung cancer [ 4 , 5 ], although other contributors include environmental pollution, occupational exposures, radon exposure, age, gender, race, and pre-existing lung disease [ 4 , 5 , 6 ]. Not all people with these risk factors will develop lung cancer and others without any known risk factors will, suggesting that genetic factors play an important role in the etiology of lung cancer [ 7 , 8 ]. Lung cancer has the widest deprivation gap of all cancers, with people who experience worse socioeconomic deprivation having a higher risk of mortality compared to those from more affluent backgrounds [ 9 ]. However, attention is increasingly turning to factors beyond socio-economic deprivation that interact to perpetuate inequities in both lung cancer incidence and survival rates [ 10 ].

One factor to consider is the intersectionality between lung cancer and rurality. Whilst there remains no universal definition of “rural,” in the UK, the Department for Environment, Food & Rural Affairs defines areas as “rural” if they have less than 10,000 residents [ 11 ]. There is increasing evidence to suggest that people living with lung cancer in rural areas may experience unique inequalities in care and treatment compared to those living in urban areas [ 12 , 13 ]. Examples include greater treatment delays [ 14 ], poorer access to care including preventative services [ 15 ], higher incidence rates [ 16 ], later stage presentation and diagnosis [ 16 ], worse survival rates, and higher overall mortality [ 17 ]. Whilst there is clear and substantial epidemiological evidence indicating that people with lung cancer in rural areas experience inequalities, there is a need for a systematic review of published qualitative evidence to better understand patterns of health behaviors, lived experiences, and healthcare needs [ 18 ] of rural lung cancer patients. The qualitative evidence generated from this review may enhance quantitative evidence in informing the development of recommendations for potential interventions that may begin to address the unique challenges faced by this population.

This systematic review focuses exclusively on rural areas in high-income countries which we define as those belonging to the Organization for Economic Co-operation and Development (OECD), due to the significant healthcare disparities between high- and low-income countries [ 19 , 20 ]. This was to enable a comprehensive exploration of experiences of living with lung cancer in rural areas where healthcare infrastructure and resources are comparatively advanced compared to low-income countries. Furthermore, addressing inequalities associated with rurality remains largely absent from cancer health policy in economically developed countries [ 21 ] many of which have sizeable rural populations. The aim of this systematic review is to synthesize the qualitative literature exploring the experiences of people living with lung cancer in rural areas. To date, evidence has largely focused on improving the quality of clinical lung cancer services and much less on individual patient experience. This review therefore aims to answer the following question: What are the qualitative experiences of people living with lung cancer in rural areas in OECD countries? This review has the following objectives:

To identify and collate evidence surrounding the qualitative experiences of people with lung cancer living in rural areas.

To thematically synthesize evidence surrounding the qualitative experiences of people with lung cancer living in rural areas.

Study design

This systematic review was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist (ENTREQ) [ 22 ] (Supplementary information 1 ) and the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) (Supplementary information 2 ). The protocol was registered on the Open Science Framework ( https://osf.io/mjyhn/ , last updated 08-Dec-2022). The initial idea for the review and design was led on by DN and SC with support from all of the wider team who sat on a project Steering Group.

Search strategy

The search strategy (Supplementary information 3 ) was developed by two members of the review team SC and DN. Keyword searches together with Truncation (*) and Boolean operators (OR and AND) were performed in MEDLINE, CINAHL, and PsycINFO by SC on 12-April-2023. Searches of databases were pre-determined as to identify all available evidence. Retrieved records were downloaded and stored in Rayyan software [ 23 ] to support management and screening. Titles, abstracts, and full texts were independently screened by NA and SC with DN cross-checking for quality or in the event of any discrepancies. All database searches were supplemented with searches on Google Scholar and the reference lists of included articles. Publication date was limited to between the years 2000 and 2023.

Eligibility criteria

Peer-reviewed qualitative (including mixed methods) studies (in the English language) reporting primary data on the experiences of adults (18 +) living with lung cancer residing in rural, regional, or remote areas of OECD countries were included. Studies reporting on the experiences of people with lung cancer alongside other types of cancer were included but all studies had to explicitly report their setting or sample as “rural,” “remote,” or “regional” to be included. Where studies had both rural and urban samples, only data from the rural, regional, or remote respondents were included.

Studies that explicitly focused on lung cancer populations within urban and metropolitan settings or whose study populations were under age 18 years were excluded from this review. Furthermore, studies that provided cancer experience data where it was not definitively clear as to the residence of participants or the cancer type and those conducted in middle- and low-income countries were excluded as were secondary research studies (studies including systematic reviews, editorials, case reports, and opinion pieces).

Data extraction

Following the identification of relevant articles after title, abstract, and full text screening, data were extracted using an adapted Cochrane Data Extraction Template [ 24 ]. The data extracted from each study included as follows: (1) author and year of publication, (2) study setting, (3) aim of study, (4) participants, (5) methods and design, (6) rural setting, (7) summary of key findings. NA extracted all data, with SC and DN cross-checking for accuracy.

Quality assessment

The quality of included studies was independently assessed by DL and DN using the Critical Appraisal Skills Program (CASP) Qualitative Studies Checklist [ 25 ]. Where there were discrepancies over the quality of articles, DL, DN, and SC met to reach agreement on the final decision. This checklist consists of 10 questions that cover rigor, methodology, credibility, and relevance. Some papers used a mixed methods design, in which case the CASP checklist was only applied to the qualitative components.

Data analysis

Thematic synthesis of the qualitative data was undertaken using Thomas and Harden’s approach to the thematic synthesis of qualitative research in systematic reviews [ 26 ]. A thematic synthesis approach was chosen as it provides a flexible, systematic, and transparent method in identifying rich and detailed qualitative data across multiple studies for synthesis [ 26 , 27 ]. This process involves as follows: (1) inductive line-by-line coding of relevant text; (2) developing “descriptive themes”; and (3) generating “analytical themes.” Initial line by line codes was created in Microsoft Word, then uploaded to the NVivo software system to facilitate the generation of both the descriptive and analytical themes. NA led on the thematic synthesis with iterative input from SC and DN. The development of descriptive themes remains close to the primary research studies that were included in the review, whereas the analytical themes are where the reviewers go beyond the primary studies and generate new interpretive insights or explanations [ 26 ]. Clinical members of the team supported the analysis and interpretation of qualitative data.

Author reflexivity

It is important for researchers conducting qualitative research to understand the assumptions and preconceptions they have which may influence the research process allowing the reader to contextualize the relationship between the researchers and the research [ 28 , 29 ]. The current research team represents diverse professional backgrounds with a range of clinical and academic expertise. The team includes as follows: NA, a medical student with interest in cancer and rurality; DN and SC, rural health researchers with expertise in cancer survivorship and systematic reviews; DL, a health services researcher with experience in systematic reviews and qualitative analysis; SQ and DM, behavioral researchers with experience in lung cancer screening and cancer lived experience research; ZP, a respiratory consultant and SCi and DS, clinical nurse specialists, all with clinical experience in respiratory and lung cancer care; PS, a professor of cancer medicine with clinical research in oncology and cancer care; RK, a professor of nursing and public health with experience in cancer survivorship and rurality; AH-B, a public contributor with lived experience as a lung cancer caregiver; and MP, an emeritus consultant and honorary professor of respiratory medicine.

Database searches returned 1012 articles, with an additional eight articles identified through secondary sources. Seven duplicates were removed leaving 1013 articles that were screened by title and abstract. Following title and abstract screening, 992 articles were removed leaving 21 articles to be screened by full text. Twelve did not meet the eligibility criteria following full-text screening. The primary reasons included incorrect study population ( n  = 5), incorrect study design ( n  = 5), and the authors could not be contacted ( n  = 2). A total of nine [ 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 ] articles met the pre-defined eligibility criteria and were included in the final analysis. A study flow diagram outlining the screening process and outcomes for this systematic review is reported in Fig.  1 .

figure 1

PRISMA flow diagram

Study characteristics

A total of nine studies were included in this review. Eight studies were conducted in Australia [ 30 , 31 , 32 , 33 , 35 , 36 , 37 , 38 ] and one in New Zealand [ 34 ]. The number of rural lung cancer participants included across studies ranged from n  = 1 to n  = 70. Two studies included lung cancer participants alongside a range of cancer populations [ 30 , 32 ], whereas six studies included lung cancer participants among other cancer types, healthcare professionals, carers, and family [ 31 , 33 , 34 , 35 , 36 , 37 ]. Only one study focused exclusively on lung cancer patients [ 38 ]. All studies included rural, regional, or remote lung cancer populations, with four studies providing a comparison with non-rural populations [ 33 , 36 , 37 , 38 ]. The majority of studies ( n  = 5) used solely qualitative designs [ 30 , 31 , 34 , 35 , 37 ] with four studies using mixed methods [ 32 , 33 , 36 , 38 ]. Qualitative data were collected using semi-structured interviews [ 30 , 31 , 32 , 33 , 35 , 36 , 38 ] with one study using focus groups [ 34 ] and another using interviews and focus groups [ 37 ]. Six studies defined rurality using a classification system [ 30 , 32 , 33 , 35 , 37 , 38 ] whilst three studies did not report using a geographical classification system but did report conducting research in a rural, regional, or remote area [ 31 , 34 , 36 ]. For further details of study characteristics, see Table  1 .

There was a low risk of bias across the majority of included studies [ 30 , 32 , 34 , 35 , 37 ]. Three of the studies gave vague details around the ethical approvals that were in place with no dates or ethics committee reference numbers [ 33 , 36 , 38 ]. The same three studies provided limited details surrounding data analysis [ 33 , 36 , 38 ]. Three studies [ 30 , 34 , 37 ] provided limited details surrounding the relationship between the researcher and participants whilst four studies failed to report on this at all [ 31 , 33 , 36 , 38 ]. The results of the quality assessment are reported in Table  2 .

Thematic synthesis

A total of 50 initial codes were generated from all studies. These codes were grouped together based on similarities to form 18 descriptive themes. This led to the development of five analytical themes related to the experiences of people living with lung cancer who reside in rural areas. These included (1) diagnosis and treatment pathways, (2) travel and financial burden, (3) communication and information, (4) experiences of interacting with healthcare professionals, and (5) symptoms and health-seeking behaviors. Each analytical theme along with the descriptive themes and supporting verbatim quotations is presented in Table  3 . A narrative account of the analytical themes is presented below.

Diagnosis and treatment pathways

Participants expressed frustration in the delay in being diagnosed with lung cancer and the initiation of subsequent treatment with individuals suggesting having to wait months before receiving a formal diagnosis or beginning treatment [ 33 , 35 ]. Some individuals had received an unexpected diagnosis [ 32 , 35 ], with others suggesting that they were initially misdiagnosed and surprised at how their healthcare professional missed signs of lung cancer before being diagnosed [ 35 ]. Participants were dissatisfied with the long waiting times for results and treatment which they found frustrating and needless [ 33 ]. Participants alluded to a lack of choice as to where they received treatment suggesting that GP preference and those who received private medical cover were factors that minimized patient choice [ 33 ]. Participants emphasized the importance in having family members and even healthcare professionals that acted as patient advocates suggesting that they were integral in receiving timely information and coordinating treatment needs [ 34 , 35 ]. Post-treatment, one participant expressed feeling abandoned and suggested having to revisit their GP for further information and support [ 33 ] whilst another participant experienced receiving no information regarding follow-up appointments or scans suggesting the healthcare team underperformed [ 35 ].

Travel and financial burden

Travelling to and from urban areas was viewed as a major barrier in seeking or receiving medical treatment [ 31 , 32 , 33 , 36 , 37 , 38 ]. Some patients were reluctant to travel to urban areas at all due to the complexities of navigating long distances [ 31 , 33 , 36 , 37 ] whereas others were mindful of travelling long distances to seek medical advice or treatment over minor symptoms [ 32 ]. Other patients suggested they would rather stop receiving treatment if travelling became too difficult [ 38 ]. For example, one participant suggested that if they had to receive treatment at a distant location that they would not go, and neither would others they knew, as travelling to these locations was perceived as challenging [ 36 ]. Another participant suggested that they were unsure about their upcoming trip and suggested that if it all became too hard that they might just let nature take its course [ 38 ]. Participants expressed feeling frustrated regarding the lack of understanding from healthcare professionals over the time, effort, and money required to travel to receive treatment [ 31 ]. Whilst finance was a worry for many individuals, the use of private medical cover reduced the stress associated with travel for some [ 33 ]. Several patients reported experiencing financial worry and stress in receiving treatment largely related to travel and accommodation [ 31 , 33 , 38 ].

Communication and information

Individuals reported poor communication from healthcare professionals related to their lung cancer diagnosis and treatment [ 33 , 35 ]. Patients desired better communication from their healthcare professionals including enhanced explanations surrounding their diagnosis and treatment and more time to ask questions. One individual felt that they were irritating healthcare professionals by asking questions and felt that it was challenging to obtain information from healthcare professionals [ 33 ]. Others experienced receiving information about their diagnosis in an unexpected and contextualized manner with little opportunity to process the information or ask questions about the diagnosis [ 35 ]. One individual suggested that there was a poor focus on the quality of self-management information provided by healthcare professionals with respect to the nutrition needed to gain weight following treatment [ 30 ], whilst others explained that they were initially unaware of the type of cancer they had been diagnosed with [ 33 ], or any financial support available to them [ 33 ]. In some cases, patients were less interested in receiving information concerning their diagnosis but were more concerned with receiving information about potential treatment and disease prognosis [ 35 ]. Whilst poor communication and lack of information from healthcare professionals was problematic for some, others did report positive experiences regarding the communication and information provided by healthcare professionals [ 30 , 33 , 35 ]. For several individuals, information was explained clearly by their healthcare professional and opportunities were provided to express their opinion and ask any questions [ 30 , 33 ]. One participant explained how their healthcare professional adapted their communication style to effectively communicate their diagnosis through use of pictures and x-rays rather than solely through words [ 35 ]. Others expressed their appreciation regarding their advice received on how to cope with being diagnosed with lung cancer as well as the resources provided from hospitals [ 33 ].

Experiences of interacting with healthcare professionals

Individuals’ experiences with healthcare professionals contrasted with some expressing dissatisfaction whilst others expressed positive experiences. Those who reported negative experiences were frustrated with the attitudes of healthcare professionals whilst receiving care, citing them as shocking, disgusting, and not forthcoming [ 30 , 33 , 35 ]. Others expressed disappointment with the lack of effort made to make them feel comfortable whilst in hospital. For example, one patient experienced nothing being offered in terms of food and drink [ 33 ]. A prominent concern expressed by patients was the lack of compassion from healthcare professionals during their diagnosis and treatment. Some patients were unhappy with the lack of sympathy regarding their diagnosis whilst others were frustrated with what was perceived by patients as a lack of compassion and arrogance of healthcare professionals [ 33 ]. On the other hand, patients did express positive experiences when interacting with healthcare professionals. Patients reported healthcare professionals to have been outstanding, knowledgeable, and practical with aspects of their treatment and support and felt that they were genuinely concerned for their well-being [ 33 ]. Some patients suggested that the support provided by healthcare professionals gave them confidence going forward [ 33 ].

Symptoms and health-seeking behaviors

Some did not recognize their symptoms of lung cancer due to perceiving them to be related to existing comorbidities [ 35 ]. Another participant reported having to engage in significant care responsibilities for family members suggesting that because of this they did not notice their potential symptoms of lung cancer worsening [ 38 ]. Some individuals living with lung cancer in rural areas showed traits of stoicism and appeared reluctant to seek help [ 32 ]. Some individuals simply did not want to visit a doctor with one participant suggesting that males living in rural areas known as “bush blokes” were perceived as particularly reluctant to seek help due to their stoic attitude whereas others were put off by the distance required to travel [ 32 ].

Globally, lung cancer is the second most common cancer [ 3 ] and this systematic review is novel in that it was the first to synthesize the qualitative academic evidence exploring the experiences of rural people living with lung cancer in OECD countries. Despite many OECD countries having large rural areas and populations, addressing cancer inequalities associated with residing in a rural area continues to be largely absent from health policy [ 21 ]. The wider existing literature explicitly reinforces that rural people living with cancer can experience unique care inequalities compared to their urban counterparts [ 12 , 13 ]. Rurality is therefore a salient factor that merits urgent consideration by the lung cancer community. This review provides important insight on the individual experiences of rural people living with lung cancer, where much of the previous scientific activity in lung cancer has focused on the epidemiological and quality of clinical services.

Nine studies were included in this review from only two countries (Australia and New Zealand). The wider existing literature highlights that rural oncology research has been dominated by scholarly activity from North America and Australia [ 39 , 40 , 41 , 42 , 43 , 44 ] with an emerging body of survivorship research now coming from the UK [ 45 , 46 , 47 , 48 ]. Despite this, there were no European, North American, or UK-based studies included in this review indicating the need for further qualitative research within these geographic settings. That said, this review provides an important starting point in which the findings can be verified or challenged with additional high-quality research evidence in other OECD countries. The limited rural lung cancer research substantiates the need to reconceptualize the rural cancer research agenda as advocated by previous research [ 13 , 49 ] through focusing on localized, community-based investigations that utilize qualitative and quantitative methods, as well as, co-production, to better capture the experiences and needs of rural people with lung cancer. This is markedly important in the context of the UK where there are currently three million people living with cancer [ 50 ] yet only limited research exists concerning the intersectionality between cancer and rurality. There are a significant number of people living with lung cancer residing in rural areas who likely face unique challenges related to travel, finances, and access [ 44 ]. It is important that rural coastal areas are not neglected either as they are typically characterized by high levels of deprivation, alcohol abuse, smoking, and poor physical and mental health [ 51 ] that may impact on lung cancer risk. This is particularly evident within the UK in which there have been recent calls from the UK government for a national strategy to improve the health and well-being of coastal communities [ 52 ].

Difficulty in accessing cancer services was reported by rural people with lung cancer, largely related to significant travel distances and financial constraints. This is evidenced across the wider cancer survivorship literature [ 53 , 54 ], where the lack of available specialist treatment centers and support services [ 55 , 56 ] combined with poor recruitment and retention of highly skilled healthcare professionals [ 57 , 58 ] are underlying factors that exacerbate poor accessibility experienced by rural communities. The inaccessibility of readily available treatment has significant implications for disease outcomes with greater travel distance being associated with more advanced disease at diagnosis, inadequate treatment, poorer disease prognosis, and worse quality of life [ 59 ]. These issues may also be compounded by sociocultural factors (e.g., attitudes, beliefs, societal norms) that may dissuade rural communities from seeking help [ 60 ]. This was evident in the current review where individuals suggested that they avoided seeking medical help due to factors such as travel distance, socialcultrial beliefs, and the prioritization of their work and family commitments. It is paramount that more equitable access to cancer services is provided for rural people with lung cancer that addresses travel distance and its financial impact as well as the sociocultural factors that may prevent individuals from seeking treatment. Mobile screening and detection services [ 61 , 62 ] as well as telemedicine [ 63 , 64 ] are two proactive and innovative approaches that should be considered a focal point of future strategies to mitigate travel and financial barriers, provide outreach and education, and improve rural cancer outcomes.

Rural people living with lung cancer in our review reported being surprised with their diagnosis and the progression of the disease at the time of diagnosis. This is widely reported across the existing literature as lung cancer can often be difficult to diagnose early [ 65 ]. Long treatment delays and waiting times were also two prominent findings in the current review. Delays in cancer treatment are a global issue, in which a recent meta-analysis suggests that even a 4-week delay in treatment (surgery, systemic treatment, or radiotherapy) is associated with a significant increase in lung cancer mortality [ 66 ]. Greater efforts are therefore needed to address system level treatment delays to improve lung cancer survival following diagnosis. However, it is important to note that longer treatment delays are observed in less symptomatic lung patients but typically associated with better disease prognosis [ 67 ]. Some participants in the current review also experienced poor follow-up support from healthcare professionals and services post-lung cancer treatment. Cancer patients are often faced with a range of physical and psychosocial challenges post-treatment in which the support provided by clinicians is rated poorly [ 68 ]. Improved awareness is needed by healthcare professionals surrounding the support needs of lung cancer patients post-treatment in addition to greater signposting to professional, community, and voluntary organizations who may provide tailored support for lung cancer patients.

The poor communication of information from healthcare professionals was another issue identified in this review that reflects the wider experiences of people living with cancer [ 69 ]. Many people living with lung cancer experience uncertainty about their diagnosis and prognosis and are unclear about management and treatment plans [ 70 ]. Consequently, poor communication and information can have a detrimental impact upon the management of symptoms, treatment decisions, psychosocial health, and overall quality of life [ 71 , 72 ], indicating the need to introduce more practical efforts to improve the communication of information between the patient and healthcare system in addition to the communicative skills of individual healthcare professionals. Furthermore, the quality and amount of information provided to patients was highlighted as problematic in this review. Health literacy (i.e., the skills, knowledge, understanding and confidence to access, comprehend, and use information) should be an important consideration when communicating and providing information. Evidence suggests that cancer outcomes may be poorer for those who experience difficulty understanding information or who are overloaded with information [ 73 ]. Greater efforts must be made by healthcare professionals to understand how patients process information and how they use information to make decisions about their treatment and care.

We acknowledge several limitations as part of this research. Firstly, the included studies and findings are entirely drawn from an Australasian perspective. We recognize that the restricted geographic scope limits the international generalizability of our findings, and thus we strongly advocate for further qualitative investigations to examine and assess the applicability of our findings in the context of other geographical settings. However, findings from this study may hold great importance for people living with lung cancer in rural, regional, and remote areas of Australia. Approximately 7 million people (28% of the Australian population) reside in outer regional, rural, or remote areas spread across a large geographical area [ 74 ]. Our findings contribute towards a better understanding of the experiences and challenges of people living with lung cancer in rural Australia which could be used to better support researchers and healthcare providers in developing tailored services and interventions that lead to more personalized and patient-centered care in these settings. Secondly, this review is wholly focused on providing a patient-centered perspective of living with lung cancer in rural areas in which we acknowledge that the omission of carer and healthcare professionals’ perspectives as a limitation. Integrating the experiences of carers and healthcare professionals alongside people with lung cancer’s perspectives could enhance our understanding of lung cancer care in rural areas and augment the potential for the practical implementation of targeted interventions and support strategies. Thirdly, whilst we employed a rigorous and systematic approach to identify appropriate evidence, there were relevant qualitative studies that were excluded as they did not provide adequate detail to differentiate between geographical location or tumor site. We strongly encourage future studies to ensure that data is collected and presented with greater transparency to allow researchers to distinguish between study population groups. Furthermore, we recognize that certain themes (e.g., experiences of interacting with healthcare professionals) as well as sub-themes (e.g., long waiting times, indifferent attitude, and satisfied with healthcare professionals) rely heavily on the findings on a single paper from 2008 [ 28 ]. We acknowledge this as a limitation of the review and suggest that these findings are interpreted with caution. The inclusion of an individual with lived experience of caring for someone with lung cancer (AH-B) as a member of the research team greatly enhanced the review through providing unique perspectives that helped interpret and contextualize the study findings. However, we recognize the omission of people with lived experience of lung cancer when conducting this systematic review and we strongly recommend that future studies include both people with lung cancer and their carers where appropriate. Finally, the included studies in this review were deemed to be of moderate–high quality. However, future research efforts should prioritize more transparent reporting practices especially surrounding author reflexivity and the relationship between the authors and the participants.

This review has several potential clinical implications for health professionals supporting rural people with lung cancer. Support in accessing high-quality diagnostic and treatment services may be important with timely and clear communication of information regarding patient illness and the services which will treat and care for individuals. Lung cancer care should be provided by structured teams with integrated care across the various healthcare sectors [ 75 , 76 ], with a focus on quality of life, survival, integrated palliative care services, and access to research, clear survivorship policies [ 77 ], and information [ 78 , 79 ]. Healthcare systems should consider greater training and support for healthcare professionals [ 80 , 81 ] to better engage with lung cancer patients. The use of cancer care coordinators could be a potential solution as part of future strategies to help improve care co-ordination, navigate complex healthcare systems, facilitate enhanced communication, and signpost to appropriate resources and support services [ 82 ]. Clearer cancer awareness campaigns should be considered to place greater emphasis on lung cancer screening, education, and treatment pathway awareness in rural areas [ 83 ]. Furthermore, greater support could be provided, for example, by governments and healthcare organizations, to reduce the financial and travel burden placed on rural lung cancer patients as well as close family and friends [ 84 ]. In doing so, this could potentially facilitate improved early detection and screening uptake, better patient access to specialized cancer services, and ensure timely and continuous treatment for rural lung cancer patients. Whilst support services (e.g., financial, psychological, and transport) are already available in some countries (e.g., the UK), they vary regionally and are often underutilized highlighting the need for greater awareness for these services. Finally, although many individuals express preference for face-to-face appointments, the use of telemedicine should be considered to provide remote care and support to help negate the financial and travel barriers placed upon individuals living in rural areas. Telemedicine has the potential to revolutionize cancer care [ 85 ], especially in areas where healthcare resources are limited, and should be used as a complementary tool as part of cancer care [ 63 ].

This systematic review is the first to synthesize the qualitative academic evidence surrounding the experiences of rural people living with lung cancer in OECD countries. Addressing cancer inequalities associated with residing in a rural area continues to be mostly absent from international policy. The findings of this review enable a deeper understanding of the issues faced by people with lung cancer in rural areas, through which future researchers could develop tailored support to better address the existing health disparities that they may face. Additionally, this study provides an important starting point in which the findings can be verified or challenged through further high-quality evidence across other geographical settings.

Data availability

All data supporting the findings of this research are available within the article or its supplementary material.

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Acknowledgements

We are grateful to Cancer Research UK for funding this review and the primary research study which the findings from this review will inform (PICATR-2022/100019).

This research was funded by Cancer Research UK (PICATR-2022/100019).

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DN and SC concepted and designed the study with support from all the wider team (NA, DM, SQ, DL, PS, RK, SCi, DS, ZP, MP, AH-B). The search strategy was developed by SC and DN. Title, abstract, and full text screening was performed by NA and SC with quality checking by DN. Quality assessment was performed by DL, DN, and SC. NA, SC, and DN led on the writing of the first draft of the manuscript. All authors critically reviewed the manuscript and approved the final version for publication. All authors agree to be accountable for all aspects of the research.

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Correspondence to Samuel Cooke .

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This was a secondary piece of research that involved no primary data collection from human participants. However, it was registered with the University of Lincoln ethics committee (Ref number: 2023_13323).

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NA, DN, DM, SQ, DL, PS, RK, SCi, DS, ZP, AH-B, and SC have no competing interests. MP is a Specialist Clinical Advisor to Cancer Research UK who have funded the study.

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Ali, N., Nelson, D., McInnerney, D. et al. A systematic review on the qualitative experiences of people living with lung cancer in rural areas. Support Care Cancer 32 , 144 (2024). https://doi.org/10.1007/s00520-024-08342-4

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A Systematic Review of Qualitative Research in Hand Surgery

Affiliations.

  • 1 Department of Medicine, McMaster University, Hamilton, ON, Canada.
  • 2 Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
  • 3 Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, ON, Canada.
  • 4 Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
  • PMID: 38265010
  • DOI: 10.1177/15589447231225271

No formal review of qualitative research in hand surgery has been previously performed. The primary objective of this study was to evaluate the reporting quality of hand surgery qualitative research with the Standards for Reporting Qualitative Research (SRQR), a 21-item checklist. The secondary objectives were to describe qualitative research in hand surgery by domain, determine differences in reporting quality based on use of a reporting guideline, publication of SRQR and journal of publication, and to identify important outcomes in hand surgery conditions. Fifty-five studies were included from MEDLINE, Embase, PsycINFO, and Emcare. The median SRQR score was 16. The lowest reported sections were context, data collection methods , and data analysis. Qualitative research was found in multiple domains of hand surgery. There was a significant difference between papers that used a reporting guideline and studies published after the publication of the SRQR. Clinical/medical/basic science journals had the highest median SRQR score. Outcomes identified were pain for carpal tunnel syndrome and pain, function, unintentional harm, recurrence, and recovery time for Dupuytren disease. To further improve reporting quality in hand surgery qualitative research, we recommend that investigators ensure they provide rationale for their methodology and become familiar with the SRQR guidelines.

Keywords: Standards for Reporting Qualitative Research; hand surgery; qualitative research; reporting guidelines; systematic review.

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