Reporting of Financial and Non-financial Conflicts of Interest in Systematic Reviews on Health Policy and Systems Research: A Cross Sectional Survey

Perspectives on non-financial conflicts of interest in health-related journals: A scoping review

The objective of this scoping review was to systematically review the literature on how non-financial conflicts of interest (nfCOI) are defined and evaluated, and the strategies suggested for their management in health-related and biomedical journals. PubMed, Embase, Scopus and Web of Science were searched for peer reviewed studies published in English between 1970 and December 2023 that addressed at least one of the following: the definition, evaluation, or management of non-financial conflicts of interest. From 658 studies, 190 studies were included in the review. nfCOI were discussed most commonly in empirical (22%; 42/190), theoretical (15%; 29/190) and "other" studies (18%; 34/190) - including commentary, perspective, and opinion articles. nfCOI were addressed frequently in the research domain (36%; 68/190), publication domain (29%; 55/190) and clinical practice domain (17%; 32/190). Attitudes toward nfCOI and their management were divided into two distinct groups. The first larger group claimed that nfCOI were problematic and required some form of management, whereas the second group argued that nfCOI were not problematic, and therefore, did not require management. Despite ongoing debates about the nature, definition, and management of nfCOI, many articles included in this review agreed that serious consideration needs to be given to the prevalence, impact and optimal mitigation of non-financial COI.

Education and learning: potential methodological and ethical issues in systematic reviews containing a meta-analysis: some critical reading suggestions for junior doctors

Junior doctors make clinical decisions regularly; therefore, they need to adequately interpret the evidence supporting these decisions. Patients can be harmed if clinical treatments are supported by biased or unreliable evidence. Systematic reviews that contain meta-analyses of randomized controlled trials are a relatively low-biased type of evidence to support clinical interventions. Therefore, it is reasonable to think that doctors will likely select this type of study to answer clinical questions. In this article, doctors are informed about potential methodological and ethical issues in systematic reviews that contain a meta-analysis that are sometimes not easily identified or even overlooked by the current tools developed to assess their methodological quality or risk of bias. The article presents a discussion of topics related to data extraction, accuracy in reporting, reproducibility, heterogeneity, quality assessment of primary studies included in the systematic review, sponsorship, and conflict of interest. It is expected that the information reported will be useful for junior doctors when they are reading and interpreting evidence from systematic reviews containing meta-analyses of therapeutic interventions, mainly those doctors unfamiliar with methodological principles.

The Commercial Determinants of Health and Evidence Synthesis (CODES): methodological guidance for systematic reviews and other evidence syntheses

BACKGROUND

The field of the commercial determinants of health (CDOH) refers to the commercial products, pathways and practices that may affect health. The field is growing rapidly, as evidenced by the WHO programme on the economic and commercial determinants of health and a rise in researcher and funder interest. Systematic reviews (SRs) and evidence synthesis more generally will be crucial tools in the evolution of CDOH as a field. Such reviews can draw on existing methodological guidance, though there are areas where existing methods are likely to differ, and there is no overarching guidance on the conduct of CDOH-focussed systematic reviews, or guidance on the specific methodological and conceptual challenges.

METHODS/RESULTS

CODES provides guidance on the conduct of systematic reviews focussed on CDOH, from shaping the review question with input from stakeholders, to disseminating the review. Existing guidance was used to identify key stages and to provide a structure for the guidance. The writing group included experience in systematic reviews and other forms of evidence synthesis, and in equity and CDOH research (both primary research and systematic reviews).

CONCLUSIONS

This guidance highlights the special methodological and other considerations for CDOH reviews, including equity considerations, and pointers to areas for future methodological and guideline development. It should contribute to the reliability and utility of CDOH reviews and help stimulate the production of reviews in this growing field.

Protocol for the development of guidance for collaborator and partner engagement in health care evidence syntheses

BACKGROUND

Involving collaborators and partners in research may increase relevance and uptake, while reducing health and social inequities. Collaborators and partners include people and groups interested in health research: health care providers, patients and caregivers, payers of health research, payers of health services, publishers, policymakers, researchers, product makers, program managers, and the public. Evidence syntheses inform decisions about health care services, treatments, and practice, which ultimately affect health outcomes. Our objectives are to: A. Identify, map, and synthesize qualitative and quantitative findings related to engagement in evidence syntheses B. Explore how engagement in evidence synthesis promotes health equity C. Develop equity-oriented guidance on methods for conducting, evaluating, and reporting engagement in evidence syntheses METHODS: Our diverse, international team will develop guidance for engagement with collaborators and partners throughout multiple sequential steps using an integrated knowledge translation approach: 1. Reviews. We will co-produce 1 scoping review, 3 systematic reviews and 1 evidence map focusing on (a) methods, (b) barriers and facilitators, (c) conflict of interest considerations, (d) impacts, and (e) equity considerations of engagement in evidence synthesis. 2. Methods study, interviews, and survey. We will contextualise the findings of step 1 by assessing a sample of evidence syntheses reporting on engagement with collaborators and partners and through conducting interviews with collaborators and partners who have been involved in producing evidence syntheses. We will use these findings to develop draft guidance checklists and will assess agreement with each item through an international survey. 3.

CONSENSUS

The guidance checklists will be co-produced and finalised at a consensus meeting with collaborators and partners. 4.

DISSEMINATION

We will develop a dissemination plan with our collaborators and partners and work collaboratively to improve adoption of our guidance by key organizations.

CONCLUSION

Our international team will develop guidance for collaborator and partner engagement in health care evidence syntheses. Incorporating partnership values and expectations may result in better uptake, potentially reducing health inequities.

Development processes for e-cigarette public health recommendations lacked transparency in managing conflicts of interest

OBJECTIVES

To investigate how guideline development groups collect and manage conflicts of interest (COI) when producing electronic cigarette (e-cigarette) recommendations.

STUDY DESIGN AND SETTING

Public health bodies that had produced e-cigarette recommendations were identified from four purposively selected jurisdictions (World Health Organization, United Kingdom, Australia, and United States). We analysed their COI policies and conducted 15 interviews with guideline methodologists, policymakers, and academics in guideline development groups.

RESULTS

Only five of 10 public health bodies had a publicly available COI policy. Participants discussed the importance of those involved in the development process declaring COI. However, there were differences in who had to report COI, the time period asked about, and what and how declarations are made. COI policies and participants discussed a range of approaches for managing COI, from limiting involvement to disqualification from the recommendation development process. Participants considered the current processes for collecting and managing COI insufficient due to their open interpretation and possibility for partial declarations of interest.

CONCLUSION

The management of COI varies across public health bodies, with little standardization and lack of transparency. To improve the collection and management of COI, and ultimately increase the trustworthiness of recommendations, guideline development groups should draw upon a comprehensive and accessible COI policy.

Baseline Assessment of Health Research Systems in Saudi Arabia: Harnessing Efforts and Mobilizing Actions

Major transformations are taking place in the Kingdom of Saudi Arabia (KSA) to achieve the 2030 vision for the health sector. A key component in strengthening the health system is a strong research governance strategy that can support the decision-making process by providing timely and accurate evidence that reflects local context and needs. This paper sought to better understand governance structures and policies for health research systems and support clusters so that they function effectively. This paper outlines the findings of an in-depth baseline assessment of existing health research efforts, activities, and plans of eight research clusters in the KSA and identifies key gaps and strengths in health research governance and capabilities. A cross-sectional design was used to survey research clusters in KSA. A six-part survey was developed to better understand the research clusters' health research governance and capacities. The survey was sent to all KSA clusters and was completed in a group setting during meetings. Findings clearly show strong efforts to support research governance initiatives in health clusters in KSA. While some clusters are more advanced than others, there are plenty of opportunities to share knowledge and combine efforts to help achieve the goals set out for KSA health transformation. This baseline assessment also reflects the first attempt of its kind to understand the KSA experience and provide much-needed lessons on country-wide efforts to support the health system given the trickling effect of this sector on all others, enhancing and advancing national growth.

A framework is proposed for defining, categorizing, and assessing conflicts of interest in health research

OBJECTIVE

We propose an operational definition of conflicts of interest (COI), a framework for categorizing interests, and an approach to assessing whether an interest qualifies as a COI.

STUDY DESIGN AND SETTING

We reviewed the literature and conducted methodological studies to inform the development of a draft framework for classifying interests.

RESULTS

We developed the following operational definition: "a conflict of interest exists when a past, current, or expected interest creates a significant risk of inappropriately influencing an individual's judgment, decision, or action when carrying out a specific duty". Interest refers to a benefit (e.g., money received from industry) or to an attribute of the individual (e.g., having specific religious beliefs). The proposed framework includes seven types of interests relating to individuals (direct financial benefit, benefit through professional status, intellectual, and personal) or their institution (direct financial benefit to the institution, benefit through increasing services provided by the institution, and nonfinancial). When assessing whether an interest qualifies as a COI, one could consider its relevance, nature (e.g., cash vs. educational support), magnitude, and recency.

CONCLUSION

The proposed operational definition and categorization framework may help journals, guideline organizations, professional societies, and healthcare institutions enhance transparency in health research.

Evaluating the relationship between industry sponsorship and conflicts of interest among systematic review authors on treatments for cannabis use disorder

Background: Cannabis is the most commonly used illicit drug worldwide. In addition to potential adverse effects, an estimated 9% consistent cannabis users are likely to become dependent and may develop a cannabis use disorder (CUD). Methods: This cross-sectional study developed a search strategy using Ovid, MEDLINE, and Ovid Embase for systematic reviews and meta-analyses focused on CUD treatment in June 2020. These reviews were evaluated for conflicts of interest (COIs) per previously developed classification scheme. Our primary objectives were to (1) evaluate the presence of disclosed or undisclosed COI of systematic review authors, regarding treatment of CUD; and (2) determine whether overall summary effect estimates, narrative results and conclusions were influenced by the presence of disclosed or undisclosed COIs among systematic review authors. Results: Our systematic search returned 560 articles which 9 systematic reviews were eligible for data extraction. We found 77.8% (7/9) contained at least one author with a COI. From the 51 authors included, 29.4% (15/51) were found to have a COI. Forty-four percent (4/9) were funded, 22.2% (2/9) were not funded, and 33.3% (3/9) had no funding statements. Out of the 7 systematic reviews with one or more authors containing COI, 14.2% (1/7) included results favoring the treatment group and 28.6% (2/7) included conclusions favoring the treatment group. Our results showed no significance between funding source and results (p = 0.429) or conclusions. Additionally, we found no significance between the presence of COIs with the favorability of results (p = 0.56) or conclusions. Conclusion: Multiple studies favored the treatment of cannabis-containing products, even though COIs were found in the majority of the systematic reviews. COIs have the ability to sway results of a study, which can affect clinical decision-making. Stricter guidelines should be enforced among authors displaying COIs in systematic reviews studying CUD treatment.

Characteristics and quality of clinical practice guidelines addressing acupuncture interventions: a systematic survey of 133 guidelines and 433 acupuncture recommendations

OBJECTIVE

To systematically summarise acupuncture-related Clinical Practice Guidelines (CPGs)'s clinical and methodological characteristics and critically appraise their methodology quality.

DESIGN

We summarised the characteristics of the guidelines and recommendations and evaluated their methodological quality using the Appraisal of Guidelines Research and Evaluation II (AGREE II) instrument.

DATA SOURCES

Nine databases were searched from 1 January 2010 to 20 September 2020.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

We included the latest version of acupuncture CPGs, which must have used at least one systematic review addressing the benefits and harms of alternative care options to inform acupuncture recommendations.

DATA EXTRACTION AND SYNTHESIS

Reviewers, working in pairs, independently screened and extracted data. When there are statistical differences among types of CPGs, we reported the data by type in the text, but when not, we reported the overall data.

RESULTS

Of the 133 eligible guidelines, musculoskeletal and connective tissue diseases proved the most commonly addressed therapeutic areas. According to the AGREE II instrument, the CPG was moderate quality in the domain of clarity of scope and purpose, clarity of presentation, the rigour of development, stakeholder involvement and low quality in editorial independence, and applicability. The study identified 433 acupuncture-related recommendations; 380 recommended the use of acupuncture, 28 recommended against the use of acupuncture and 25 considered acupuncture but did not make recommendations. Of the 303 recommendations that used Grading of Recommendations Assessment, Development and Evaluation to determine the strength of recommendations, 152 were weak recommendations, 131 were strong recommendations, of which 104 were supported by low or very low certainty evidence (discordant recommendations).

CONCLUSION

In the past 10 years, a large number of CPGs addressing acupuncture interventions exist. Although these guidelines may be as or more rigorous than many others, considerable room for improvement remains.

Watching the watchers: A report on the disclosure of potential conflicts of interest by editors and editorial board members of dental journals

Reporting potential conflicts of interest (COIs) by all parties involved in the publication process is of pivotal importance to increase trust in research. The present study assessed the disclosure of potential COIs of editors and editorial board members of high-ranked dental journals. From 28 April 2021 to 05 May 2021, the websites of 91 dental journals classified by impact factor (IF) were scrutinized to obtain information on the reporting of COI forms of editors and board members, and whether these individuals reported their detailed curriculum vitae (CV). The COI forms were assessed to understand the potential financial and non-financial COIs of editors and board members. Only 11 (12.1%) journals reported COI forms of editors-in-chief (EICs) and associate editors (AEs). No journal reported a COI form of the editorial board members. Of the 100 editors (EICs plus AEs), 25 (25.%) declared connections to for-profit organisations, and seven (7%) to not-for-profit organisations. Five (5%) editors (all AEs) reported non-financial COIs, and 35 (35%) editors reported nothing to declare. Nine (9.9%) journals reported a short CV of editors, which were not informative regarding potential COIs. Editors and editorial board members of high-ranked dental journals should report in more detail their potential COIs.

Conflicts of interest among authors of systematic reviews regarding the management of chronic non-cancer pain with opioids analgesics

OBJECTIVE

We sought to determine whether author conflict of interest (disclosed or undisclosed) or industry sponsorship influenced the favorability of reporting of systematic reviews and meta-analyses investigating the use of opioid analgesics for the management of chronic non-cancer pain.

METHODS

Our search included the MEDLINE (Ovid) and Embase (Ovid) databases. Study sponsorship was determined using the funding statement provided in each systematic review. Author COI information was extracted from the COI disclosure statement. This information was cross-referenced with information available on the CMS Open Payments Database, Dollars for Profs, Google Patents, the United States Patent and Trademark Office (USPTO), and previously published COI disclosures.

RESULTS

Eight systematic reviews authored by 83 authors were included. Of these authors, 19 (23.0%) were found to have a COI, of which the majority (17/19; 89.5%) had at least one undisclosed COI. Despite nearly one-quarter of authors having a COI, we found no association between the presence of a COI and the favorability of results (p = 0.64) or conclusions (p = 0.07).

CONCLUSION

COI are common and frequently undisclosed among systematic review authors investigating opioid analgesics for the management of chronic non-cancer pain. Despite a high prevalence of COI, we did not find that these author-industry relationships had a significant influence on the favorability of results and conclusions; however, our findings should be considered a lower bound estimate of the true influence author COI have on outcomes of pain medicine systematic reviews secondary to the low sample size included in the present study.

Meta-research publications in dentistry: a review

The present scoping review has the objective of providing an overview of meta-research in dentistry. A search of the PubMed database was performed for the period 11 October 2014 to 10 October 2019. Study selection and data extraction were performed independently by one author; prior to this, a random sample of 10% of the retrieved titles and abstracts were independently screened by two authors, achieving agreement of >80% on eligibility for initial inclusion, corresponding to good agreement. The following information was extracted from the full text of each article: meta-research area of interest; study design; type of studies evaluated in the meta-research; type of methodology used in assessment of the primary research; conflicts of interest reported; sponsorships reported; dental discipline; journal of publication; country of the first author; number of citations; and impact factor. A total of 7800 documents were initially retrieved. After analysis of the title/abstract and the full text of each article, and a snowballing procedure, 155 meta-research studies were identified and included. The 'methods' and 'reporting' meta-research areas were the most prevalent, with 73 (47%) and 61 (40%) studies, respectively. General dentistry, and orthodontics and dentofacial orthopaedics were the dental specialties with the greatest number/proportion of included studies with 45 (29%) and 28 (18%) studies, respectively. These findings may help to prioritize future meta-research in dentistry, consequently avoiding unnessecary investigations, and increasing the value of oral and dental research.

Identifying competing interest disclosures in systematic reviews of surgical interventions and devices: a cross-sectional survey

Background

A competing interest is an important source of bias in research and disclosure is frequently employed as a strategy to manage it. Considering the importance of systematic reviews (SRs) and the varying prevalence of competing interests in different research fields, we conducted a survey to identify the range of competing interests in SRs assessing surgical interventions or devices and explored the association between the competing interest disclosures and authors’ conclusions.

Methods

We retrieved SRs of surgical interventions and devices published in 2017 via PubMed. Information regarding general characteristics, funding sources, and competing interest disclosures were extracted. We conducted a descriptive analysis of the studies’ characteristics and compared them between Cochrane SRs (CSRs) and non-Cochrane SRs using the Chi-square test. Results were expressed as odds ratio and their 95% confidence interval.

Results

One hundred fifty-five SRs published in 2017 were included in the study. More than half of the SRs (58.7%) reported their funding sources and 94.2% reported authors’ competing interest disclosures. Among 146 SRs that stated competing interest disclosures, only 35 (22.6%) SRs declared at least one author had a competing interest. More than 40 terms were used to describe competing interests. Cochrane SRs (CSRs) were more likely to provide a detailed description of competing interests compared to those in non-CSRs (48.0% versus 25.4%, P = 0.023). No association between positive conclusions and competing interest disclosures was found (P = 0.484, OR = 0.43, 95%CI: 0.08, 2.16). In the subgroup analyses, SRs stating no competing interest disclosure were more likely to report positive conclusions than those stating at least one type of competing interest, but the difference is not significantly different (P = 0.406, OR = 1.38, 95%CI: 0.64, 2.98).

Conclusion

In surgical SRs, there is a high percentage of competing interest disclosures but without detailed information. The identification and statement of competing interests with a detailed description, particularly the non-financial ones, needs improvement. Some efficient and effective methods/tools for identifying, quantifying, and minimizing potential competing interests in systematic reviews remains valuable.

Open synthesis and the coronavirus pandemic in 2020

•Open Science principles are vital for ensuring reproducibility, trust, and legacy. •Evidence synthesis is a vital means of summarizing research for decision-making. •Open Synthesis is the application of Open Science principles to evidence synthesis. •Open approaches to planning, conducting, and reporting synthesis have many benefits. •We call on the evidence synthesis community to embrace Open Synthesis.

Reporting of conflict of interest and sponsorship in dental journals

OBJECTIVE

Detailed information on potential conflict of interest (COI) and sponsorship is pivotal for the adequate understanding and appropriate interpretation of the reported study results. The reporting of COI and sponsorship and any potential associations with study characteristics in publications of all dental journals with impact factor was examined.

METHODS

The Web of Science database was searched, in March 2019, for articles published from February 28, 2018 to March 1, 2019. A random a sample of 1000 articles in English was selected. Two independent authors extracted the following article characteristics: type of article, dental field, number of authors, country/continent affiliation of the first author, dental journal, journal impact factor, number of citations, Altmetric score, type of COI and sponsorship. Disagreements during data extraction were resolved by discussion and consensus. Descriptive statistics were calculated for the selected variables and multinomial logistic regression was implemented to assess the association between COI, sponsorship, and the other variables.

RESULTS

3% of dental publications declared a COI, whereas in 32.5% of publications the presence of COI was unclear. The most prevalent type of COI was financial (n = 26). Non-profit organizations funded 37.2% of the articles, while the sponsorship for 40.4% articles was unclear. Regression analysis showed that publications reporting COI had greater odds of receiving sponsorship from for-profit sources.

CONCLUSIONS

Sponsorship and COI information seem to be underreported in dental journals. Efforts should be made by authors, journals, and publishers to provide more comprehensive information to allow the reader to understand the potential impact of sponsorship and COI on study results.

CLINICAL SIGNIFICANCE

The underreporting of COI and sponsorship in dental articles hinders the interpretation of findings by readers. The results of the present study bring attention to this important topic as well as guide further improvements on the reporting of COI and sponsorship in dental articles.

Reporting of conflicts of interest by authors of primary studies on health policy and systems research: a cross-sectional survey

OBJECTIVES

The objective of this study was to assess the frequency and types of conflict of interest (COI) disclosed by authors of primary studies of health policy and systems research (HPSR).

DESIGN

We conducted a cross-sectional survey using standard systematic review methodology for study selection and data extraction. We conducted descriptive analyses.

SETTING

We collected data from papers published in 2016 in 'health policy and service journals' category in Web of Science database.

PARTICIPANTS

We included primary studies (eg, randomised controlled trials, cohort studies, qualitative studies) of HPSR published in English in 2016 peer-reviewed health policy and services journals.

OUTCOME MEASURES

Reported COI disclosures including whether authors reported COI or not, form in which COI disclosures were provided, number of authors per paper who report any type of COI, number of authors per paper who report specific types and subtypes of COI.

RESULTS

We included 200 eligible primary studies of which 132 (66%) included COI disclosure statements of authors. Of the 132 studies, 19 (14%) had at least one author reporting at least one type of COI and the most frequently reported type was individual financial COI (n=15, 11%). None of the authors reported individual intellectual COIs or personal COIs. Financial and individual COIs were reported more frequently compared with non-financial and institutional COIs.

CONCLUSION

A low percentage of HPSR primary studies included authors reporting COI. Non-financial or institutional COIs were the least reported types of COI.

Use of publication procedures to improve research integrity by addiction journals

BACKGROUND AND AIMS

The credibility crisis evident in many academic disciplines has led peer-reviewed journals to implement procedures to reduce use of flexible data analysis practices and selective reporting of results. This exploratory study examined the adoption of six of these procedures by addiction journals.

METHODS

Thirty-eight high-impact addiction journals were identified using the 2018 Clarivate Analytics Journal Citation Report for 2017 ranks. The online instructions for authors were reviewed for references to six publication procedures: conflict of interest disclosure, reporting guidelines, clinical trial registration, registration of other study designs, data-sharing and registered reports. The webpages of the Center for Open Science and Consolidated Standards of Reporting Trials (CONSORT) were also reviewed for data pertaining to registered reports and reporting guidelines, respectively.

RESULTS

The range of procedures adopted by the addiction journals was 0-5, with a mean of 2.66. Conflict-of-interest disclosure was required by all but one journal. Encouraging data-sharing was the next most commonly required procedure. Fewer than half the journals recommended specific reporting guidelines or required registration of clinical trials, and only four required procedures to pre-specify hypotheses and analytical methods.

CONCLUSIONS

While many addiction journals have adopted publication procedures to improve research integrity, these can be limited by their voluntary nature and monitoring difficulties. More stringent requirements that lock researchers into specific hypotheses and analyses have not been widely adopted.