title: A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest.
abstract: OBJECTIVE
  Groups such as the Institute of Medicine emphasize the importance of attention to financial conflicts of interest. Little guidance exists, however, on managing the risk of bias for systematic reviews from nonfinancial conflicts of interest. We sought to create practical guidance on ensuring adequate clinical or content expertise while maintaining independence of judgment on systematic review teams.
  
  
  METHODS
  Workgroup members built on existing guidance from international and domestic institutions on managing conflicts of interest. We then developed practical guidance in the form of an instrument for each potential source of conflict.
  
  
  RESULTS
  We modified the Institute of Medicine's definition of conflict of interest to arrive at a definition specific to nonfinancial conflicts. We propose questions for funders and systematic review principal investigators to evaluate the risk of nonfinancial conflicts of interest. Once risks have been identified, options for managing conflicts include disclosure followed by no change in the systematic review team or activities, inclusion on the team along with other members with differing viewpoints to ensure diverse perspectives, exclusion from certain activities, and exclusion from the project entirely.
  
  
  CONCLUSIONS
  The feasibility and utility of this approach to ensuring needed expertise on systematic reviews and minimizing bias from nonfinancial conflicts of interest must be investigated.
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA. Electronic address: viswanathan@rti.org.
authors.forename: Meera
authors.initials: M
authors.lastname: Viswanathan
authors.affiliation: Cecil G Sheps Center for Health Services Research, CB 7590, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC 27599, USA.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Carey
authors.affiliation: Blue Cross Blue Shield Association, 225 N. Michigan Ave, Chicago, IL 60601, USA.
authors.forename: Suzanne E
authors.initials: SE
authors.lastname: Belinson
authors.affiliation: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Berliner
authors.affiliation: Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850, USA.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Chang
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Graham
authors.affiliation: Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
authors.forename: Jeanne-Marie
authors.initials: JM
authors.lastname: Guise
authors.affiliation: 1828 L St, NW, Ste 900 Washington, DC 20036, USA.
authors.forename: Stanley
authors.initials: S
authors.lastname: Ip
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
authors.forename: Margaret A
authors.initials: MA
authors.lastname: Maglione
authors.affiliation: Duke University, Department of Medicine, 2301 Erwin Road, Durham, NC 27710, USA.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: McCrory
authors.affiliation: Vanderbilt University Medical Center, Suite 600, 2525 West End Avenue Nashville, TN 37203, USA.
authors.forename: Melissa
authors.initials: M
authors.lastname: McPheeters
authors.affiliation: RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
authors.forename: Sydne J
authors.initials: SJ
authors.lastname: Newberry
authors.affiliation: Social, Statistical, and Environmental Sciences, RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
authors.forename: Priyanka
authors.initials: P
authors.lastname: Sista
authors.affiliation: University of Connecticut, School of Pharmacy, 69 North Eagleville Road, Unit 3092, Storrs, Connecticut 06269, USA.
authors.forename: C Michael
authors.initials: CM
authors.lastname: White
mesh_terms: D015982:Bias; D016265:Conflict of Interest; D030881:Disclosure / Q000941:ethics*; D006801:Humans; D012107:Research Design; D012196:Review Literature as Topic; D014481:United States
keywords: Bias; Comparative effectiveness; Evidence-based practice; Identification and management of conflicts of interest; Nonfinancial conflicts of interest; Systematic review methods