Selection Process
Definition:
The selection process defines how each candidate primary study is included in or excluded from the set of primary studies used in a systematic review, mapping study, tertiary study, or rapid review.
Goal:
To ensure that each and every candidate primary study is correctly classified as suitable or not for inclusion in the primary study.
Input:
A list of candidate primary studies including citation information and abstracts.
The protocol, in particular the inclusion and exclusion criteria, should specify methods for handling documents that report two or more different empirical studies, methods for handling documents authored by review team members, methods used for assessing candidate studies and the process steps to be adopted.
Methods:
Several different methods of assessing candidate studies have been used in systematic reviews. The process recommended by SR guidelines is to use two or more members of the review team working independently to assess each candidate primary stage in each stage.
Other methods can also used:
- A less rigorous procedure that can be adopted by graduate students with only a supervisor as another reviewer, is for both reviewers to assess a random sample of the candidate primary studies, apply the eligibility criteria and assess their agreement statistics. Any disagreements are discussed and clarified, and then the student assesses all the remaining candidate studies. In this case additional processes can be used to reduce some of the inherent risks. For example, the supervisor can be asked to confirm the exclusion decision of any studies that were excluded after reviewing the full text.
- If only a single reviewer is available, a test-retest method can be used. The reviewer assesses each study. Then they wait for several days and repeat their assessments (preferably changing the order in which they assess specific studies). Agreement statistics can then be assessed and problems with the clarity of eligibility criteria identified. Any candidate studies where consecutive assessments disagree need to be assessed in more detail until a final decision is made. Note this approach can also be used when a graduate student assesses the majority of the candidate primary studies.
Healthcare SR guidelines also suggest the use of text analysis tools[1]. Such tools need to be trained on a random selection of candidate primary studies. This method is a good fit for reviews where a supervisor only has time to review or assess a subset of the candidate primary studies. Tools are useful to improve consistency with assessment decisions if there are a large number of candidate primary studies and to reduce the risks that arise errors when single researchers assess studies.
Methods of resolving disagreements include:
- Discussions between the reviewers until an agreement is reached.
- Allocating the disputed candidate primary study to another independent reviewer and accepting the consensus decision.
- Trialing the data collection process on the paper – if it does not contain the required information it can be excluded from the review.
Usually option 1 is adopted and if the original reviewers cannot come to an agreement, the team leader needs to activate options 2 or 3.
Process:
The selection process recommended in systematic review guidelines is usually performed in two stages:
- Each candidate primary study is assessed based on its title, abstract and key words. It is classified as excluded or not excluded (both those studies that the assessor believes should be included and those studies where the assessor is unsure should be assigned to this category). The reason for exclusion should be reported.
- Each remaining candidate primary study is re-assessed based on the full text of the article. In this step, assessors need to specify whether a candidate primary study should be excluded or included. Occasionally, a preliminary stage is used to eliminate studies based upon only the title and key words.
Usually two assessors are allocated to each candidate primary study in each stage. If the assessors disagree, the disagreement must be resolved. In the first stage, if there is no consensus for eliminating the study it should progress to the second stage. In the second stage, there should be consensus either for including or excluding the study.
In most cases, tools are needed to organize the process effectively. They are used to maintain information about the status of each candidate systematic review, and monitor its progress. The larger the number of candidate primary studies and review team members the more important it is:
- To employ database tools rather than spreadsheets and bibliographic tools to help manage the process.
- To have a team leader responsible for reviewing the progress of the selection process and organizing the process used to resolve disagreements.
Iteration:
If the main search process is based on snowballing, the entire process is iterative, with each iteration of the selection process, followed by an iteration of the search process. If automated searches are used, and a snowballing activity is being used as a secondary method to reduce the risk of missing relevant studies, this process will first be invoked for the results of the automated searchers. Then the primary studies identified among the automated search results will be subjected to a round of snowballing and the selection process will be re-activated to assess any new candidate primary studies.
Outputs:
The final inclusion/exclusion decision about each candidate primary. The reason for excluding a candidate primary study and the stage in the process at which it was excluded should be recorded.
Agreement statistics should be reported for the first time that assessments from different review members are compared for each different each stage in the process.
The section process may be represented graphically as a flow chart showing the number of candidate studies entering each stage of the process and the number excluded by that stage.
Verification:
Verification methods include:
- Monitoring agreement statistics and responding to poor or declining agreement statistics.
- Tools that maintain records of the assessment status and final classification of each candidate primary and ensure that all candidate primary studies are properly assessed.
- Additional assessments of all candidate studies excluded after the full text has been assessed by team members
- Using text analysis tools to provide an independent method of assessing study eligibility to compare with assessment made by team members.
- Using citation and visualization tools to investigate the relationships among studies and the final classification of the studies. These can be used to identify studies that are assessed differently to other related studies and that should then be re-assessed.
Risks of Systematic Review Bias:
The main risk of bias during selection is one of misclassifying studies that should be included as excluded. Including a study that should be excluded is also a risk but not quite as serious because it is likely to be detected during data collection. Misclassification is mainly due to:
- Human error caused by fatigue, misunderstandings or mis-transcription[2], or misleading reporting by the authors of primary studies (e.g., misleading titles, unclear abstracts, invalid keywords, or unjustified claims).
- Personal biases on the part of team members
- Ambiguities or errors in the inclusion/exclusion criteria.
- The complexity involved in managing a multi-step, multi-person process.
Risk Mitigation:
Risk associated with human errors are addressed by requiring two or more team members to independently assess each candidate primary study and a well-defined procedure for handling disagreements.
Risk associated with personal biases are addressed by ensuring that team members do not assess studies that they themselves authored.
Ambiguities or errors in the eligibility criteria can lead to inconsistent eligibility decisions by different review team members. Problems can be identified by monitoring agreement statistics at various times during the process. If agreement statistics are poor, the reasons should be investigated and then either refining the eligibility criteria or giving team members given additional help with interpreting them. Team members should be encouraged to report any problems with the eligibility criteria, since it is possible that some aspects of eligibility were not anticipated when the protocol was developed.
Administering a process of multiple assessments and agreement activities with different stages is difficult and error prone without tool support. For small-scale reviews a spreadsheet or bibliographic tool may be sufficient, but for large-scale reviews with many reviewers, a special purpose systematic review tool may be needed.
[2] Any software engineers who have been involved in pair-programming will have realized how frequently mistakes and transcription errors occur.