Background: The aim of this research was to develop and present a framework for setting priority questions in evidence synthesis. Cochrane Oral Health (COH), an international research group tasked with the production of systematic reviews in oral health was used as a case study to test the framework. Methods: The priority setting literature was examined for themes to form the framework. Five phases of the research were established from the literature: information gathering, stakeholder consultation, mapping and ranking the results, implementation, and evaluation. The information gathered in phase one included data on how COH's existing reviews were being used, areas where new studies were being registered that might go into new systematic reviews, and an analysis of guidelines to look for evidence gaps. Stakeholders were consulted in an open survey, and the results of the James Lind Alliance Priority Setting Partnership in Oral Health were also incorporated. The priority questions established by these phases of the research were mapped against COH's existing reviews to establish which reviews might be updated and where there may be scope for a new review. An international panel of stakeholders was convened to rank the final priorities so that the number of priority topics was congruent with COH's resources. An implementation plan was written in consultation with COH, using an established tool to guide decision-making. Finally, an evaluation of the priority setting process was undertaken using an existing best practice checklist and the mandatory standards for priority setting set by Cochrane. Results: The information gathering phase provided important context to the priority setting process, revealing that caries prevention and management were the most prevalent topics in terms of usage of existing reviews. Examination of new studies registered showed that there may be some new priority areas for COH to explore, although most of the studies identified would fit into COH's existing reviews. The examination of evidence gaps found a large number of uncertainties identified by guideline developers, and once again, the prevention of oral disease, particularly caries, was an important theme. The information gathering phase also identified some weaknesses in the evidence-base in oral health however, which called into question whether some of the uncertainties were genuine evidence gaps. The stakeholder consultation phase found that the prevention and treatment of oral disease were the priorities, and stakeholders were interested in evidence which supports their day-to-day oral hygiene regime. They were also concerned with vulnerable groups that may be at high risk of developing oral disease. Mapping the data from these two phases onto COH's existing reviews resulted in 26 new topic areas and 51 priority reviews to update. These were ranked by an international panel convened to produce a top 15 new reviews and a top 30 to be updated, in line with COH's business plan. The implementation phase produced an implementation plan, to integrate the identified priorities into COH's workflow, and the tool used to guide implementation proved to be a useful and pragmatic. The final evaluation of the priority setting process found that the framework directed a priority setting process that met all of Cochrane's mandatory standards and generally performed well against the existing good practice checklist. Conclusion: The framework developed during the course of this research was pragmatic and flexible, and produced a manageable number of systematic reviews for COH to undertake. The research also revealed some issues with the evidence base in oral health, which may be resolved by evidence producers working more closely with guideline developers and other stakeholders.
- priority setting
- evidence synthesis
- systematic review methodology
- oral health