Paeds Cases · professional-practice-and-evidence
Interpreting a meta-analysis for a shared decision — OSCE
OSCE on interpreting a meta-analysis and a guideline recommendation and applying them to a shared decision with a family.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
Parents of a 4-year-old with a chronic illness are deciding whether to start a daily preventive therapy; they have read online that it 'halves the risk of a serious complication'; you have an industry-funded meta-analysis reporting a 50 percent relative pooled effect, an I-squared of 65 percent, an asymmetric funnel plot, and a guideline strong recommendation built on adult trials.
Station brief (8–10 minutes)
Help the parents decide whether to start the preventive therapy by interpreting the meta-analysis honestly and weighing the guideline recommendation for their child. Address the online 'halves the risk' figure, the review's method and its limitations, the size and precision of the effect, and its applicability to a four-year-old. Do not invent jurisdiction-specific thresholds or specific survival statistics. [10]
References6ShowHide
- [1]Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 2021.PMID 33782057
- [2]Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ, 2017.PMID 28935701
- [4]Higgins JP, Thompson SG, Deeks JJ, Altman DG Measuring inconsistency in meta-analyses. BMJ, 2003.PMID 12958120
- [7]Alonso-Coello P, Oxman AD, Moberg J, et al. GRADE Evidence to Decision (EtD) frameworks: a systematic and transparent approach to making well informed healthcare choices. 1: Introduction. BMJ, 2016.PMID 27365494
- [8]Andrews J, Guyatt G, Oxman AD, et al. GRADE guidelines: 14. Going from evidence to recommendations: the significance and presentation of recommendations. Journal of clinical epidemiology, 2013.PMID 23312392
- [10]Murad MH, Montori VM, Ioannidis JP, et al. How to read a systematic review and meta-analysis and apply the results to patient care: users' guides to the medical literature. JAMA, 2014.PMID 25005654