One of the goals of The Cochrane Collaboration's Strategy to 2020 is to make Cochrane evidence accessible and to put the needs of users at the heart of content design and delivery. The Cochrane derivatives programme is a key element of this knowledge translation initiative, aimed at making Cochrane evidence available via a range of content platforms so it resonates with and meets the needs of different audiences.
Cochrane Clinical Answers (CCAs; cochraneclinicalanswers.com) are evidence-based answers to clinical questions based on Cochrane Reviews and have been created to support health professionals in decision making (Figure 1). They are not simply summaries of reviews; value is added by starting with a clinical question, mimicking the way doctors approach information at the point of care, and curating and filtering the data so that the most clinically relevant aspects of the review are brought to the forefront.
CCAs are comparable with previous evidence-based question and answer services, but differ in that they also provide a deeper, focused dive into the review content on which the 'answers' are based, within a highly structured and layered format.
Figure 1. Example of a Cochrane Clinical Answer
The process of creating a CCA starts with an automated data extraction process that gathers information from the data and analysis section of each Cochrane Review. This is then thoroughly checked and edited by the CCA editors, who add additional information from the main text of the Cochrane Review and the characteristics of included studies. To give prominence to the most clinically relevant data from the review, there is a strong focus on the PICO elements: population, intervention, comparator, outcomes (Figure 2). The full population details (e.g. age, gender, severity and stage of disease) enable the clinician to check the applicability of the bottom-line message to the patient in front of them, while the intervention (drug dose, length and intensity of treatment) and comparators help the clinician and patient choose the best treatment option.
Looking at the key outcomes that matter to the patient enables the clinician and patient to balance benefits and harms of the intervention, supporting shared decision-making. Also provided is a summary of the risk of bias of studies or, if there is a Summary of Findings table, a quality of evidence assessment. Following the approach taken by the GRADE working group (gradeworkinggroup.org), and to aid ease of use, CCAs aim to report no more than seven outcomes. This means our clinical experts have to make challenging decisions about which outcomes to exclude. Links to forest plots and safety alerts (if any have been issued about a particular intervention) are also provided.
Once the data have been extracted and supplemented, a CCA Associate Editor, a practising clinician, ensures that patient-relevant comparisons and clinical outcomes are covered and writes the clinical answer, putting the data into clinical context and providing an interpretation of the take-home message. CCAs are then edited and signed off by the CCA editorial team.
Figure 2. Detail of the PICO (population, intervention, comparator, outcomes)
from a Cochrane Clinical Answer
More information about the editorial process and how we choose Cochrane Reviews to create CCAs can be found at cochraneclinicalanswers.com/aboutus. In June 2014 we reached 373 CCAs in 13 specialities, and our target is 600 CCAs covering 17 specialities by January 2015 (Figure 3). To take a closer look at what we have developed, why not sign up for a free trial at cochraneclinicalanswers.com/subscribe.
Figure 3. Total number of published and target CCAs by speciality
Some features of Cochrane Reviews are particularly useful for creating good CCAs. Summary of Findings tables are particularly helpful to identify the most important outcomes assessed and to provide overall statements about the quality of the evidence for each outcome. A well-organised data and analysis section is also critical. Other elements relate to thinking 'clinically' when writing Cochrane Reviews. Providing a clear description of populations, including information on the median, as well as the range, of age and disease severity (e.g. Were women well represented in the studies? Were most patients at home or hospitalised?) and a thorough description of interventions (e.g. Did the exercise intervention involve walking the dog once a week or aerobics for half an hour every day?) and comparators (e.g. What exactly was the 'control'?) makes the reviews much more usable in clinical practice and makes the task of creating the CCAs easier.
The priority for this year is to build the number of CCAs in main areas of care, but future challenges include: developing mechanisms for creating CCAs based on narrative reviews; creating broader CCAs summarising the content of several Cochrane Reviews; creating CCAs based on diagnostic reviews; keeping CCAs updated in line with Cochrane Review updates; and probably more challenges we have not yet thought of. Meanwhile, we would love to hear from you and we very much welcome your feedback.
Karen Pettersen1, Sera Tort2, David Tovey3
1Sera Tort (firstname.lastname@example.org), Clinical Editor, Cochrane Collaboration, London, UK; 2Karen Pettersen (email@example.com), Clinical Editor, John Wiley & Sons, Chichester, UK; 3David Tovey (firstname.lastname@example.org), Editor in Chief, Cochrane Collaboration, London, UK.
How to cite: Tort S, Pettersen K, Tovey D. Cochrane Clinical Answers: putting Cochrane Reviews in clinical context [editorial]. Cochrane Database of Systematic Reviews 2014;(7):ED000087.
1. The Cochrane Collaboration. Cochrane Strategy to 2020. www.cochrane.org/community/organisation-administration/cochrane-strategy-2020 (accessed 12 July 2014).
Competing interests: The authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available upon request). Cochrane Clinical Answers are developed by Cochrane Innovations and John Wiley & Sons. Cochrane Innovations is a trading company of The Cochrane Collaboration. Karen Pettersen is an employee of John Wiley & Sons. Sera Tort and David Tovey are employees of The Cochrane Collaboration. The authors declare no other interests.