title: Is There a Consensus when Physicians Evaluate the Relevance of Retrieved Systematic Reviews?
abstract: BACKGROUND
  A significant challenge associated with practicing evidence-based medicine is to provide physicians with relevant clinical information when it is needed. At the same time it appears that the notion of relevance is subjective and its perception is affected by a number of contextual factors.
  
  
  OBJECTIVE
  To assess to what extent physicians agree on the relevance of evidence in the form of systematic reviews for a common set of patient cases, and to identify possible contextual factors that influence their perception of relevance.
  
  
  METHODS
  A web-based survey was used where pediatric emergency physicians from multiple academic centers across Canada were asked to evaluate the relevance of systematic reviews retrieved automatically for 14 written case vignettes (paper patients). The vignettes were derived from prospective data describing pediatric patients with asthma exacerbations presenting at the emergency department. To limit the cognitive burden on respondents, the number of reviews associated with each vignette was limited to three.
  
  
  RESULTS
  Twenty-two academic emergency physicians with varying years of clinical practice completed the survey. There was no consensus in their evaluation of relevance of the retrieved reviews and physicians' assessments ranged from very relevant to irrelevant evidence, with the majority of evaluations being somewhere in the middle. This indicates that the study participants did not share a notion of relevance uniformly. Further analysis of commentaries provided by the physicians allowed identifying three possible contextual factors: expected specificity of evidence (acute vs chronic condition), the terminology used in the systematic reviews, and the micro environment of clinical setting.
  
  
  CONCLUSIONS
  There is no consensus among physicians with regards to what constitutes relevant clinical evidence for a given patient case. Subsequently, this finding suggests that evidence retrieval systems should allow for deep customization with regards to physician's preferences and contextual factors, including differences in the micro environment of each clinical setting.
authors.forename: Dympna
authors.initials: D
authors.lastname: O'Sullivan
authors.affiliation: Szymon Wilk, Institute of Computing Science, Poznan University of Technology, Piotrowo 2, 60 - 965 Poznan, Poland, E-mail: szymon.wilk@cs.put.poznan.pl.
authors.forename: Szymon
authors.initials: S
authors.lastname: Wilk
authors.forename: Craig
authors.initials: C
authors.lastname: Kuziemsky
authors.forename: Wojtek
authors.initials: W
authors.lastname: Michalowski
authors.forename: Ken
authors.initials: K
authors.lastname: Farion
authors.forename: Bartosz
authors.initials: B
authors.lastname: Kukawka
mesh_terms: D016000:Cluster Analysis; D032921:Consensus; D006801:Humans; D015201:Meta-Analysis as Topic; D010820:Physicians
keywords: Evidence-based medicine; evaluation study; information storage and retrieval; pediatric asthma; systematic review