[Selective use of systematic reviews in decision making]

Area of Science:

• Medical Guidelines
• Evidence-Based Medicine
• Health Policy

Background:

• Systematic reviews (SRs) represent the highest standard of evidence for formulating clinical recommendations.
• Despite their importance, the utilization of SRs by guideline developers remains notably limited in practice.
• Previous research indicated that only 22% of newborn screening recommendations were based on SRs.

Purpose of the Study:

• To explore the reasons behind the underutilization of systematic reviews in clinical guideline development.
• To examine the potential influence of cognitive biases, such as wishful thinking, on decision-making processes within guideline formulation.
• To discuss the evolving standards of guideline development and the role of expert opinion.

Main Methods:

• This work is a commentary analyzing existing research and practices in guideline development.
• It discusses observed trends in the use of systematic reviews versus expert opinion.
• The commentary addresses the psychological factors influencing evidence interpretation.

Main Results:

• A significant gap exists between the availability of systematic reviews and their application in guideline recommendations.
• Non-use of SRs was found to correlate with positive recommendations, suggesting potential bias.
• The commentary highlights that differing methodological approaches can coexist without compromising guideline quality if transparent.

Conclusions:

• Limited use of systematic reviews in guideline development is a concern, potentially influenced by cognitive biases.
• Expert judgment remains crucial for balancing benefits and harms in management options.
• Transparency regarding conflicts of interest and decision-making processes is essential for trustworthy guidelines and policy.