A scoping approach to systematically review ... - Wiley Online Library

Received: 30 June 2016

Revised: 9 September 2017

Accepted: 29 September 2017

DOI: 10.1002/jrsm.1272

BRIEF METHOD NOTE

A scoping approach to systematically review published reviews: Adaptations and recommendations Annette Schultz1

| Leah Goertzen2 | Janet Rothney3 | Pamela Wener4 | Jennifer Enns5 |

Gayle Halas6 | Alan Katz7 1

College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada 2

Faculty of Kinesiology and Recreation Management and Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

Knowledge translation is a central focus of the health research community, which includes strategies to synthesize published research to support uptake within health care practice and policy arenas. Within the literature concerning review methodologies, a new discussion has emerged concerning methods that review and synthesize published review articles. In this paper, our multidisciplinary team from family medicine, nursing, dental hygiene, kinesiology, occu-

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Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada 4

Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada 5 Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada 6

Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada 7

Manitoba Centre for Health Policy, Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada

pational therapy, physiology, population health, clinical psychology, and library sciences contributes to this discussion by sharing our experiences in conducting 3 scoping reviews of published review studies. A brief discussion of Cochrane Collaboration overview reviews and Joanna Briggs Institute umbrella reviews foreshadows a discussion of insights from our experiences of conducting the 3 scoping reviews of published reviews. We address 6 adaptations along with our recommendations for each, which may guide other researchers with designing scoping review approaches to synthesize published reviews. The ability of researchers to publish research findings is growing, and our ability to effectively transfer findings into useful evidence for health care practice and policy is imperative to our work. KEYWORDS knowledge translation, review of review methods, scoping review methods, synthesis methodology

Funding information Manitoba Health Research Council; Heart and Stroke Foundation of Canada

1 | INTRODUCTION Globally, the volume of published health research grows at an exponential rate, resulting in rich and diverse evidence‐base available to inform health practice and

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policies.1-6 Unfortunately, the translation of evidence into practice tends to be slow for several reasons.7 One strategy to accelerate practical application has been the development of a variety of rigorous and systematic review methodologies, which produce a synthesis of evidence thought

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to be easier to uptake into practice.1,6 Today, publication of review articles has flourished, and there is an emerging concern that the volume of review articles hinders uptake of this synthesized evidence into health care.4,5,7 Within the health scientific community, a new discussion has emerged concerning review methodologies to synthesize published review articles.4,5,8,9 In this paper, we contribute to the emerging methodology discourse concerning the review of published reviews by sharing our experiences in conducting scoping reviews of published systematically conducted review studies. Prior to presenting our experiences and recommendations, we situate our research team and provide a precis of the emerging discourse of reviewing published reviews methods. Our multidisciplinary research team has a primary prevention focus, with faculty and graduate students from family medicine, nursing, dental hygiene, kinesiology, occupational therapy, physiology, population health, clinical psychology, and library sciences. In support of a research chair in primary prevention, we came together to facilitate multidisciplinary approaches to study primary prevention, stimulating research excellence, and advancing the availability of best practices for all Manitobans.10 The research team has been meeting to work on 3 scoping reviews of published review studies for over 4 years. Our first step was to review current literature to inform a research agenda specific to three primary prevention areas: physical activity, tobacco control, and mental health promotion. Initial database searches produced a considerable volume of primary research for the tobacco and physical activity areas. As the team deliberated on the volume of primary research, we decided to design scoping review studies of published review literature. At this time, we have produced 2 published protocols papers,11,12 1 published results paper,13 along with 2 recently completed SRR results manuscripts and another findings manuscript based on a secondary analysis a SRR data set; we have also delivered multiple conference presentations and workshops. Our decision to conduct scoping reviews of published review literature was a novel methodological decision within the fields of scoping reviews and of reviewing published reviews.

2 | REVIEW I N G P U B LI S H ED REVIEWS METHODOLOGICAL H IG H L I G H T S The Cochrane Collaboration and the Joanne Briggs Institute (JBI) have addressed methods to review published review articles. A chapter in the Cochrane Collaboration handbook addresses overviews5,14 that provides guidance in designing reviews of published reviews. Alternatively,

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the JBI published a review methods article that outlines, umbrella reviews.8 Selection of eligible review articles is a central discussion point with each suggesting only high‐quality published reviews ought to be included; however, how high quality is defined differs. Eligibility criteria based on the Cochrane Collaboration focus on high‐quality systematic reviews of randomized clinical trials. Whereas the JBI suggests two principles: be transparent about the types of published reviews eligible for inclusion and exclude theoretical studies or opinion articles. While each method suggests inclusion of published reviews, the scope of an umbrella review would result in a broader perspective of published reviews than an overview study. The endpoint for overviews and umbrella reviews is to produce a narrative summary of published reviews; considered more feasible than a meta‐synthesis review study.5,9 The narrative summary provides decision makers and practitioners with a clearing house resource, which can assist them to make informed decisions efficiently on topics where multiple primary reviews exist and to locate eligible reviews for further reference as needed.5,9 In our search of review of published reviews methods, we were unable to find literature describing methods for conducting a scoping review of reviews (SRRs). Since our aim was to systematically and comprehensively map concepts within a field of literature and identify research gaps,15-18 an overview research method was not appropriate because we were interested in reviews beyond those focused on clinical trials. The umbrella review method was not available at that time. We noted that in Arksey and O′Malley's15 seminal article, they challenged other researchers to extend scoping review methodology beyond their original ideas. Since then scoping review methods has been refined in response to criticisms and endorsements of the method.16,17,19,20 While these discussions have moved our understanding of scoping reviews beyond Arksey and O′Malley's15 initial article, to date, these discussions have not ventured into methods for reviewing published reviews. From our perspective, adapting this review method supports a descriptive approach to mapping the breadth of evidence within a specified body of published review literature. In the next section, we present our experiences with the utility of a scoping review method to review of published reviews.

3 | S C O P I N G RE V I E W M E T H O D A D A P T A T I O N S AN D RECOMMENDATIONS Over the last 4 years, progression of the three scoping reviews of published reviews (SRRs) has varied and each

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came with diverse challenges. Our intention for the 3 SRRs was to map the key concepts and research areas over the last decade to inform a research agenda in primary prevention. Through this mapping approach, an outcome is demonstrating various trends, such as topics with a larger volume of published reviews suggests relative greater interest in the field, which then may support an additional review study with different questions. Conversely, where there is an absence of peer‐reviewed publications may lead to questions about available evidence and future studies. Each of these discoveries can be beneficial to advance a field of study. While the 3 SRRs share the common overarching aim of mapping the breadth of topics, the current state of science for each differed and this influenced study design. For example, primary prevention within tobacco control focuses on preventing behavior and risk of exposure to tobacco smoke, whereas within mental health promotion is often about building resilience, thus, slightly different points on the prevention continuum. Specific protocol details can be accessed in our published SRR protocols for tobacco control12 and physical activity,11 and the published SRR findings for mental health promotion.13 Working through various design challenges benefited from Daudt et al's,19 along with Levac et al's16 experiences with scoping review methods. We present our experiences with SRRs in a table and a discussion of recommendations. Table 1 displays relevant insights from scoping reviews of primary research literature,16,19 along with our related experiences with SRR and recommendations to adapt scoping review methods to review published reviews. In addition to the details outlined in the table, we provide a discussion of 6 recommendations: study design as an iterative process, team composition and engagement, quality assessment criteria, data extraction source, time, and consultation with stakeholders.

3.1 | Study design as an iterative process In conducting our SRRs, we noticed that structure of the SRR design needed to follow function. While having a sound and well‐argued starting point is important, familiarity with the data (published review articles) clarifies the scope of purpose/question(s) and reveals unanticipated new directions. This type of design alignment requires an iterative and reflective process to ensure the SRR is rigorous and defensible.21 As an example, with the tobacco SRR our initial list of search terms produced results with significant gaps, this lead us to reconsider how to define tobacco related interventions. While as a team, we could generate additional search terms, we decided to integrate a relevant framework known within the field of tobacco control. We adopted the Framework

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Convention for Tobacco Control (FCTC),22 which outlines 7 action areas that informed our search terms. The FCTC action areas also guided data extraction categories and presentation of results. Alternately, searching for mental health promotion reviews proved difficult and produced small numbers. With this SRR study, key word terms from relevant articles informed our search strategy, and the framing of results emerged from our review of the eligible review articles. The current state of evidence within each of these topics guided our SRR design. Iterative processes requires that with every decision, one must circle back to ensure the decision is systematically applied. This runs contrary to the notion of setting a clearly defined protocol before searching the literature thereby decreasing bias in findings. While a predefined approach is defensible when conducting meta‐analysis to draw conclusions about efficacy, it is not useful to meet the aim to systematic and comprehensive map a body of literature. Breaking with this review tradition is necessary to realize the unique contribution of scoping approaches and SRRs, which we suggest will increase the translation of research evidence necessary to address questions beyond what is most efficacious. Given this reality, transparent presentation of the study design is essential to demonstrate rigorous adherence to a systematic process.

3.2 | Team composition and engagement strategies A second recommendation is to work with a multidisciplinary team. In particular, to support rigorous database searches, inclusion of a health sciences librarian is essential.23 Navigation of diverse databases requires expertise to develop comparable search strategies for each database, as they use unique terms and processes for searching. Beyond this, diversity across disciplines and sectors involved in designing a study and interpretation of findings supports generation of results that reach across diverse audiences and settings. A difficulty of working with large teams is keeping team members engaged. In the early stages of a large review study, the team members' interest is high. However, over time, busy team members with multiple priorities may result in diminishing engagement. With our studies, we have consistently held bimonthly meetings, even though attendance has waxed and waned over the years. A strategy used to involve team members has been to develop simple tasks specific to SRR study design or interpretation decisions. For example, data extraction refinement benefited from the full team's review of a small sample and then we meet to deliberate on a series of questions. While the strategy aided study process, team member interest and engagement also benefitted. Additionally, in our case,

Review of published reviews: Methodological challenges identified and adaptations developed by our team Recommendations for future SRRs

Our beginning broad objectives were refined as familiarity with the literature grew. Each of the three SRRs developed unique sub‐objectives. We also adopted a relevant framework to guide SRR protocol design, i.e. the World Health Organization's Framework Convention on Tobacco Cessation Designing the protocols required an appreciation for reflexive and iterative processes.

• Integrating a framework relevant to the topic field, can guide study design decisions and set parameters for study scope • Original research question may be refined as team becomes familiar with the literature

We agree with Daudt et al,19 and Levac et al's16 adaptations, and have two additional points: Inclusion of a health library specialist is essential to guide search of diverse databases that use unique terms and parameters. We acknowledge the importance of record keeping. The early stages of strategy development will require backtracking, which can become overwhelming without proper records.

Selection process development requires an iterative and reflexive process. Team meetings useful to refine and guide inclusion/ exclusion criteria development. Suggest an assessment of study quality for inclusion to enhance the scoping review rigor

We agree that the nature of inclusion and exclusion criteria development is reflexive and iterative. This may be an artifact of aiming to map the breadth of a body of literature; familiarity of the literature is necessary to set parameters for the SRR study. We struggled with the lack of guidance to determine quality reviews across diverse review methods and recommend transparent reporting for this area. We also struggled with poorly defined review methods (eg, a published review is not always rigorous nor systematic).

• Be prepared to spend the time required to develop meaningful inclusion and exclusion criteria, which are based on collective team knowledge and what is found in the literature. • Consider adopting criteria for assessing the quality of studies to be included, which enhances rationale for inclusion and exclusion of articles. • A 2‐step approach using a well‐defined process for title review followed by abstract review makes article selection more efficient. (Continues)

• Multidisciplinary team that includes a health library specialist • Develop a process to keep all team members engaged, particularly when working with a large team • Key concepts will emerge as the breadth of literature becomes familiar; reflexive process to possibly refine research questions and search terms are essential

Step 3: Article selection—steps for reviewing results from the final search: eligibility criteria to guide a systematic process for selecting articles of most relevance

Search strategy design requires balancing processes to support comprehensive search with resources. Diversity among team members supports strategy development and rationalizing limits to ensure feasibility. This stage requires a reflexive approach to inform iterative decision‐making.

Step 2: Identify relevant studies—make decisions about which sources to search (databases, reference lists, and gray literature) and develop a list of search terms to guide a systematic search of all sources

Difficult working with broad research questions to examine the extent, range and nature of primary research. 1) use a relevant framework to guide the review; 2) remember this is an iterative process and some aspects will only become known once the team is more familiar with the literature

Step 1: Identify the research question—as scoping reviews aim to map the literature, the research questions encompass the breadth of a topic

Review of primary research: Methodological challenges identified and adaptations developed by Daudt et al19 and Levac et al16

TABLE 1 Adapting Arksey and O′Malley's 6‐step scoping review methods: Adaptations and recommendations

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Review of published reviews: Methodological challenges identified and adaptations developed by our team

The framework chosen to guide the SRR was instrumental in creating data extraction categories. Remain focused on the aim to map the literature by describing the breadth and not specific details. The three SRRs differed at this stage; two reviewed abstracts and the third SRR reviewed full articles. The decision to extract data from abstracts was twofold: the volume of eligible articles and feasibility to answer mapping questions based on details covered in the abstracts. In the third SRR, full articles were reviewed as the data categories required more depth of detail.

This stage was identified as optional by Arksey and O'Malley.15 Suggest consultation with stakeholders could be useful earlier on with study design decisions and also at the end to guide dissemination strategies.

Step 6: Consult with stakeholders

Reconnect with overall study purpose to ensure the question is answered. A 3‐step process offered: Collate the data extracted, consider study questions and reflect finding meanings, and then develop a dissemination strategy for diverse audiences. Refinement of data extraction categories occurred here – As the team had additional suggestions.

The team membership served to partially address input from stakeholders. Conference workshops have also assisted with gathering stakeholder input.

We agree with Daudt et al,19 and Levac et al's16 adaptations, and have 3 additional points: At this stage, we designed two secondary analysis SRRs, which focused on questions addressed through more in depth review of a subset of eligible articles. Some team members struggled with the descriptive nature of this approach. At times, they were looking for effectiveness outcomes, which is not possible with a scoping approach. This team tension became an underlying reason for one of the secondary SRR manuscripts. What to report—our discussions focused on what will summarize current state of research as well as move the research agenda forward

Step 5: Collate, summarize and report results of the review—what will be summarized and reported

Development of the data extraction categories will be an iterative process. A helpful exercise was to give the team a handful of articles from which to review and extract data, which was then collectively used to inform categories. Need for ongoing team meetings to guide unanticipated decisions to ensure relevant data extract to inform mapping the literature.

Step 4: Charting the data—development of a data extraction table to guide systematic retrieval of details from the selected articles

Review of primary research: Methodological challenges identified and adaptations developed by Daudt et al19 and Levac et al16

TABLE 1 (Continued)

• Our multidisciplinary team involves individuals with clinical and academic experience, which proved to be valuable. • Findings from one SRR became foundational to conduct an environmental scan

• There will be tensions between reporting specific details, and remaining broad and descriptive with reporting. • Frequencies of populations, approaches, key concepts can suggest possible gaps or areas not as well researched. • We were able to carry out more specific queries with secondary SRRs with subsets of eligible articles

• An iterative process helped to create more nuanced extraction categories specific to each SRR. • Data extraction categories must reflect the research objective(s) • The breadth of the data (review concepts) may be gleaned from review of abstracts. • Team exercise to develop categories useful to engage large teams in this process.

Recommendations for future SRRs

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working on multiple parallel projects within the same team with the overarching goal of support of the research chair also bolstered team engagement.

3.3 | Quality assessment criteria Once searches of databases are completed, the next step is systematic evaluation of retrieved reviews to determine eligibility. While fit with topic area is important, another criterion to consider is the quality of retrieved reviews. Given our SRRs aimed to map the breadth of research topics, key concepts, and theories, our quality criteria were unrelated to level of evidence generated in a published review. Rather with an aim of mapping the breadth of a topic that warranted a published peer‐reviewed article, we assumed published topics meant a degree of importance within the field. Therefore, the key quality criterion needed to inform a decision about the review method; that is was it a systematically conducted review and not an opinion piece, nonsystematic literature review, or a review of other documents (ie, polices or industry documents); this aligns with JBI umbrella reviews.8 As we reflected on this decision, we agreed that evidence of the type of systematic review along with key indicators of the systematic design would be retrievable from an abstract. This of course, meant we trusted that a journal's peer‐review assessed the systematic methodology of articles they published along with requiring method details in the abstract. We determined rigor, based on details outline in the abstracts, using a multiple step process. Initially, we noted named systematic review methods, along with description of search strategy and number of articles reviewed, ie, identification of PRISMA documentation, which is an evidence‐based minimum set of items that guide reporting systematic review searches.24 Sometimes, the named method was vague or absent; here, we looked for mention of a comprehensive review or search, or systematic review or search along with description of search strategy and number of articles retrieved. If the two reviewers disagreed or they were uncertain based on abstract details, full article review informed the final decision regarding eligibility. Interestingly, through our SRRs, we gained an appreciation for the diversity in the content and formatting among the abstracts, along with a desire for greater uniformity of the content required in an abstract.

3.4 | Data extraction source As the team reflected on data extraction categories for the 3 SRRs, we designed slightly different study processes. Commonly with review methods, data extraction involves a review of the full article; yet, two of our SRRs the team

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discerned that review of the full article would not be necessary. For example, given our aim to map key tobacco control concepts in the review literature, data were retrievable from abstracts. Beyond publication identifiers, the two main categories were FCTC actions and target population; relevant data was retrievable from eligible abstracts. Conversely, with the mental health promotion SRR, full article review was conducted, which supported an inductive approach to inform an emergent framing to present SRR findings. Although our decision to extract data from abstracts challenges common review methods, given the SRR aim, we believe it is a defensible position. Tracking broad concepts was possible from abstract review, which revealed areas of greater research concentration and gaps. Moreover, findings from the tobacco control SRR resulted in the group designing a secondary SRR study that analyzed a subset of review articles. Given the level of data detail required to address the secondary SRR study objectives, we conducted a full article review to extract data. Through our work with the SRRs, we suggest abstracts can be a defensible option for data extraction, in particular, when the review study aim is to map a broad view of the literature rather than focusing on specific details.

3.5 | Time As other authors have noted, the belief that scoping reviews are quick is a myth.23,25 As noted earlier in our discussion paper, we have met as a team for over 4 years primarily focused on decisions concerning the 3 SRRs, and the secondary SRR. While time‐consuming, this has been a rich and productive endeavor guided by an iterative process that requires the team to be thoughtful. In particular, as we worked on the 3 SRRs over this time, decisions made for one study were considered for the other two SRRs. Thus, a decision for one SRR was not simply adopted nor rejected for the other SRRs; rather, the team reflected and generated a rationale as to why or why not the decision was relevant for the other SRRs. Our recommendation is to anticipate the SRR is going to take time to be iterative and systematic; the process is not quick.

3.6 | Consultation with stakeholders The sixth and final step suggested for scoping review studies is to consult with stakeholders. The reasons for this is to extend interpretation of study findings, thereby enhancing relevance to practice context. With our 3 SRRs the team, our various connections with knowledge end user stakeholders, and opportunities to present at a number of conferences, we made the decision to not actively

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consult with local stakeholders by holding meetings as part of the SRR process with one exception. The physical activity SRR was completed, and the results were presented but to date, not published due to unfortunate circumstances with the lead research assistant. An opportunity arose through provincial health authorities to lead a 1‐day workshop (with frontline clinicians and health decision makers; stakeholders) to generate an environmental scan of primary prevention physical activity programs in Manitoba. We shared our results with the group as part of the workshop, and we have just completed a manuscript to address the environmental scan outcomes and the SRR study. For the other two SRR topic areas, we have presented workshops in a variety of international and national conference settings that included decision makers and clinicians, who provided valuable feedback on our process and findings. For example, through post‐presentation discussions, we either had our topic areas confirmed or learned of new areas to consider as we moved forward with an SRR. These discussions were a way to gain insights from another stakeholder group perspective.

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ACKNOWLEDGEMENT The Manitoba Research Chair in Primary Prevention awarded to Dr Alan Katz by the Manitoba Health Research Council and the Heart and Stroke Foundation of Canada supported this work. ORCID Annette Schultz

http://orcid.org/0000-0002-7944-2180

RE FER EN CES 1. Colquohoun HL, Levac D, O'Brien KK, et al. Scoping reviews: time for clarity in definition, methods, and reporting. J Clin Epidemiol. 2014;67:1291‐1294. 2. Kastner M, Tricco A, Soobiah C, et al. What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Med Res Methodol. 2012;12:114 3. Kite J, Indig D, Mihrshahi S, Milat A, Bauman A. Assessing the usefulness of systematic review for policymakers in public health: a case study of overweight and obesity prevention interventions. Prev Med. 2015;81:99‐107. 4. Pieper D, Buechter R, Jerinic P, Eikermann M. Overviews of reviews often have limited rigor: a systematic review. J Clin Epidemiol. 2012;65:1267‐1273.

4 | CONCLUSION Scoping review methods are gaining popular interest. The central aim of the method is to systematically and comprehensively map a specified literature to inform research, policy, and practice decisions.16-20,26 The commitment to a broad view defines this approach, which was central to designing our SRR protocols and reporting parameters. The Cochrane Collaboration and JBI review of published review methods suggest some similarities with SRRs, and there are key differences. The endpoint for all 3 methods is a narrative summary from eligible review literature.5,8,14 One difference is in the scope and breadth of literature reviewed with the Cochrane Collaboration overview method resulting in the most focused scope. A key difference between the JBI umbrella review and SRRs is that SRR encourages an iterative approach to reviewing the literature. From our perspective, a benefit with an iterative approach is to work with the literature and current state of the science to inform the descriptive map or narrative, rather than having predetermined parameters that could limit the breadth of a review study. We are not suggesting that any one of these 3 methods are better than others, but there are differences that will produce unique results. The novelty of SRRs prompted our efforts to share our experiences and contribute to this important topic and the emerging discussion concerning reviews of published review methodologies.

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14. Higgins JPT, Green S. 2011. Cochrane handbook for systematic reviews of interventions Version 5.1.0. The Cochrane Collaboration, 2011, viewed 26 June 2016, www.handbook.cochrane.org

22. World Health Organization 2015. WHO framework convention on tobacco control. Geneva; World Health Organization.

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23. Morris M, Boruff JT, Gore GC. Scoping reviews: establishing the role of the librarian. Journal of Medical Library Association. 2016;104:346‐353. 24. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta‐analyses: the PRISMA statement. PLoS Med. 2009;6(7): e1000097. doi:https://doi.org/10.1371/journal.pmed1000097 25. Thomas A, Lubarsky S, Durning SJ, Young ME. Knowledge syntheses in medical education: demystifying scoping reviews. Acad Med. 2017;92:161‐166. 26. Davis K, Drey N, Gould N. What are scoping studies? A review of the nursing literature. Int J Nurs Stud. 2009;46:1386‐1400.

How to cite this article: Schultz A, Goertzen L, Rothney J, et al. A scoping approach to systematically review published reviews: Adaptations and recommendations. Res Syn Meth. 2018;9:116–123. https://doi.org/10.1002/jrsm.1272