Abstract
BackgroundModern standards for evidence-based decision making in clinical care and public health still rely solely on eminence-based input when it comes to normative ethical considerations. Manuals for clinical guideline development or health technology assessment (HTA) do not explain how to search, analyze, and synthesize relevant normative information in a systematic and transparent manner. In the scientific literature, however, systematic or semi-systematic reviews of ethics literature already exist, and scholarly debate on their opportunities and limitations has recently bloomed.MethodsA systematic review was performed of all existing systematic or semi-systematic reviews for normative ethics literature on medical topics. The study further assessed how these reviews report on their methods for search, selection, analysis, and synthesis of ethics literature.ResultsWe identified 84 reviews published between 1997 and 2015 in 65 different journals and demonstrated an increasing publication rate for this type of review. While most reviews reported on different aspects of search and selection methods, reporting was much less explicit for aspects of analysis and synthesis methods: 31 % did not fulfill any criteria related to the reporting of analysis methods; for example, only 25 % of the reviews reported the ethical approach needed to analyze and synthesize normative information.ConclusionsWhile reviews of ethics literature are increasingly published, their reporting quality for analysis and synthesis of normative information should be improved. Guiding questions are: What was the applied ethical approach and technical procedure for identifying and extracting the relevant normative information units? What method and procedure was employed for synthesizing normative information? Experts and stakeholders from bioethics, HTA, guideline development, health care professionals, and patient organizations should work together to further develop this area of evidence-based health care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0688-1) contains supplementary material, which is available to authorized users.
Highlights
Modern standards for evidence-based decision making in clinical care and public health still rely solely on eminence-based input when it comes to normative ethical considerations
Against this background it is surprising that modern standards for evidence-based decision making in clinical care and public health still rely on eminence-based input alone regarding normative ethical information, even though review methodology has been increasingly used in various disciplines and fields
The search had to be intentionally broad in order to capture any review done related to topics of medical ethics or bioethics, even if this included reviews that solely analyzed and synthesized empirical literature
Summary
Modern standards for evidence-based decision making in clinical care and public health still rely solely on eminence-based input when it comes to normative ethical considerations. Systematic reviews (SRs) aim to identify and process information from published material in a systematic, transparent, and Decision making in medicine, research, and health policy often explicitly or implicitly includes normative ethical considerations. It is known that scholars can come to contrasting but well-argued conclusions on what is normatively right or wrong, or more or less appropriate [1,2,3] Against this background it is surprising that modern standards for evidence-based decision making in clinical care and public health still rely on eminence-based input alone regarding normative ethical information, even though review methodology has been increasingly used in various disciplines and fields
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