How to Read a Systematic Review and Meta-analysis and Apply the Results to Patient Care: Users’ Guides to the Medical Literature
Open accessAbstract
Clinical decisions should be based on the totality of the best evidence and not the results of individual studies. When clinicians apply the results of a systematic review or meta-analysis to patient care, they should start by evaluating the credibility of the methods of the systematic review, ie, the extent to which these methods have likely protected against misleading results. Credibility depends on whether the review addressed a sensible clinical question; included an exhaustive literature search; demonstrated reproducibility of the selection and assessment of studies; and presented results in a useful manner. For reviews that are sufficiently credible, clinicians must decide on the degree of confidence in the estimates that the evidence warrants (quality of evidence). Confidence depends on the risk of bias in the body of evidence; the precision and consistency of the results; whether the results directly apply to the patient of interest; and the likelihood of reporting bias. Shared decision making requires understanding of the estimates of magnitude of beneficial and harmful effects, and confidence in those estimates.
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It may not be excluded that the type of information provided largely determines the final patient decision.
“It may not be excluded that the type of information provided largely determines the final patient decision (26,59,60).”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [26]
A strong relationship seems to exist between the characteristics of specific centers of expertise and the treatment chosen (medical or surgical) by patients referred to those centers.
“because a strong relationship seems to exist between the characteristics of specific ''centers of expertise'' and the treatment chosen (i.e., medical or surgical) by patients referred to those centers.”
From A stepped-care approach to symptomatic endometriosis management: A participatory research initiative (2018) · cites this paper as [26]
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- Authors
- Murad, M. H., Montori, V. M., Ioannidis, J. P. A., Jaeschke, R., Devereaux, P. J., Prasad, K., Neumann, I., Carrasco-Labra, A., Agoritsas, T., Hatala, R., Meade, M. O., Wyer, P., Cook, D. J., & Guyatt, G.
- Affiliations
- Mayo Clinic (US)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota
- Stanford Medicine (US)
- McMaster University (CA)
- Population Health Research Institute (CA)
- All India Institute of Medical Sciences (IN)
- Pontificia Universidad Católica de Chile (CL)
- Evidence-Based Dentistry Unit, Faculty of Dentistry, Universidad de Chile, Santiago, Chile, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- University of British Columbia (CA)
- McMaster University Medical Centre (CA)
- Columbia University Irving Medical Center (US)
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2014-07-09
- Volume
- 312
- Issue
- 2
- Pages
- 171
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2129163850
- Cited by
- 454
- References
- 59
- Citations by year
- 2026: 16 · 2025: 33 · 2024: 41 · 2023: 31 · 2022: 31 · 2021: 38 · 2020: 40 · 2019: 36 · 2018: 48 · 2017: 49 · 2016: 42 · 2015: 38 · 2014: 11
- FWCI
- 45.51
- Type
- journal article
- Language
- en
- Open access
- Licence
- cc-by-nc-nd
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Universidad de Chile (submittedVersion, cc-by-nc-nd)
- Funders
- Canadian Institutes of Health Research
- Topics
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Meta-analysis and systematic reviews
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- systematic reviews, meta-analysis, evidence-based medicine, credibility assessment, quality of evidence, risk of bias, reporting bias, shared decision-making, patient care
- MeSH terms
- Systematic Reviews as Topic, Decision Making, Patient Care, Humans, Meta-Analysis as Topic, Reproducibility of Results, Bias, Evidence-Based Practice
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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