Step 10: Translate science into action

This steps includes the activities that you should do after you have done a systematic review

What happens after synthesis

Scientific knowledge needs to be translated into action. It is the decision makers who take the decisions and not the scientific people.

What is important for decision makers

  • conceptual utility
  • instrumental utility
  • political utility

Who to include für translating science

  • You could include a group of experts using a DELPHI Method to come up with consensus
  • You could include stakeholders

Frameworks

GRADE

GRADE also has a say in evidence to decision framework

Framework: Evidence-informed polidy and practice framework (EIPP)

Original article: EIPP

  1. Prolbem identification
  2. evidence synthesis
  3. stakeholder engagement
  4. policy development
  5. impemantaion
  6. evaluation

Framework: Knowledge to action framework (KTA)

Original article Medium-article: KTA

Framework: Policy triangle framework

Original article

Contextual evidence-informed policy framework (CEIP)

Original article - It is propageted by WHO

Public health decision-making framework

Original article

  1. Identification: Identify relevant alternatives.
  2. Distinguishing: Distinguish relevant empirical differences between alternatives, including contingencies.
  3. Ranking: Rank, as far as possible, alternatives from best to worst.
  4. Evaluation: Make explicit, as far as possible, in what sense some alternatives are better than others.
  5. Documentation: Submit the result of the evaluation to a designated oversight institution.

Delibarative processes and citizen engagement models

Rapid evidence synthesis models (RES)

Relevance of reviews

Importance of end points

There is a hierarchy of outcomes for example for UAW for phosphate lowering drugs Mortality > Myocardial infaction > Flatulence

“Need to treat”

  • The number needed to treat is easy to grasp
  • For example: Treating 10 patients with tissue plasmoinogen activator within three hours will save one patient.

External validity

  • It is essential to consider if we can generalise the reviews findings to the “real world”

Evidence to decision conceptual map workflow

Moberg J et al. 2018: The GRADE Evidence to Decision (EtD) framework for health system and public health decisions

Criteria for health systems and public health decisions:

1. Priority of the problem

  • is the problem a priority? Are the consequences of the problem serious (that is, severe or important in terms of the potential benefits or savings)?
  • Is the problem urgent? [Not relevant for coverage decisions]
  • Is it a recognised priority (such as based on a political or policy decision)?

2. Benefits and harms (desirable and undesirable anticipated effects)

  • Judgments for each outcome for which there is a desirable effect/undesirable effect – big challenge in public health: even if the certainty of a “harm” is low, health authorities should act

3. Certainty of the evidence - What is the overall certainty of the evidence of effects?

  • “GRADE quality of evidence” framework; more difficult to access on reviews with qualitative, gray sources of evidence

4. Outcome importance

  • how much people value each of the main outcomes?

5. Balance

  • Judgments regarding each of the four preceding criteria
  • People’s values outcomes in future compared to outcomes in present
  • People’s attitudes towards undesirable or desirable effects (how risk averse/risk seeking population is)

6. Resource use

  • Consider implementing alternatives; use of (public) funds; cost effectiveness

7. Equity - Consideration of impacts on equity (horizontal and vertical) with the introduction of a policy

  • groups or settings that might be disadvantaged or will turn to be disadvantaged?
  • different baseline conditions across groups or settings that affect the effectiveness of the intervention?
  • ensure that inequities are reduced/are not increased

8. Acceptability - In public health, consider multiple stakeholders and public opinion!

  • Acceptance of distribution of the benefits, harms and costs, and of trade of costs or undesirable effects in the short term for desirable effects (benefits) in the future
  • importance (value) attached to effects affect people’s autonomy?
  • disapprove of the intervention due moral principals (no maleficence, beneficence, or justice)

9. Feasibility - Is the intervention or option sustainable?

  • Are there important barriers that are likely to limit the feasibility of implementing the intervention (option) or require consideration when implementing it
  • For coverage decisions:
    • Is coverage of the intervention sustainable?
    • Is it feasible to ensure appropriate use for approved indications, or is inappropriate use (indications that are not approved) an important concern?
    • Is access to the intervention an important concern?
    • Are there important legal or bureaucratic or legal constraints that that make it difficult or impossible to cover the intervention?

Ethical considerations

  • Usually synthesis dont need an ethical clearence
  • Work with IJCME authorship
  • Avoid doing redundant reviews
  • Its unethical to produce rubbish

Four ethical considerations in medicine

  • Autonomy - you respect the wish of the patients
  • Justice - everybody has the same rights
  • Benevolence - you are actively trying to do good
  • Non-maleficiance - you are trying not to do bad things

Dissemination

Plan you dissemination upfront

Possible ways to disseminate

  • Journal
  • Conferences
  • Policy dialogues
  • Press release
  • Social media

Policy brief

  • Many journals now want a policy brief
  • Big organisations now publish directly policy briefs

Graphs

Policy dialogue

  • Go to panels