title: Incorporating uncertainty regarding applicability of evidence from meta-analyses into clinical decision making.
abstract: OBJECTIVE
  Judging applicability (relevance) of meta-analytical findings to particular clinical decision-making situations remains challenging. We aimed to describe an evidence synthesis method that accounts for possible uncertainty regarding applicability of the evidence.
  
  
  METHODS
  We conceptualized uncertainty regarding applicability of the meta-analytical estimates to a decision-making situation as the result of uncertainty regarding applicability of the findings of the trials that were included in the meta-analysis. This trial-level applicability uncertainty can be directly assessed by the decision maker and allows for the definition of trial inclusion probabilities, which can be used to perform a probabilistic meta-analysis with unequal probability resampling of trials (adaptive meta-analysis). A case study with several fictitious decision-making scenarios was performed to demonstrate the method in practice.
  
  
  RESULTS
  We present options to elicit trial inclusion probabilities and perform the calculations. The result of an adaptive meta-analysis is a frequency distribution of the estimated parameters from traditional meta-analysis that provides individually tailored information according to the specific needs and uncertainty of the decision maker.
  
  
  CONCLUSIONS
  The proposed method offers a direct and formalized combination of research evidence with individual clinical expertise and may aid clinicians in specific decision-making situations.
authors: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinstr. 52, 20246 Hamburg, Germany. Electronic address: l.kriston@uke.de.
authors: Levente
authors: L
authors: Kriston
authors: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinstr. 52, 20246 Hamburg, Germany.
authors: Ramona
authors: R
authors: Meister
mesh_terms: D003657:Decision Making; D019317:Evidence-Based Medicine; D006801:Humans; D015201:Meta-Analysis as Topic; D011336:Probability; D012107:Research Design; D035501:Uncertainty
keywords: Decision making; Evidence-based medicine; External validity; Heterogeneity; Meta-analysis; Statistical data interpretation; Uncertainty