Future of evidence synthesis in Cochrane - FAQs

These questions and answers have been compiled based on feedback and questions received in 2021 throughout the Community Engagement Workshop Series and subsequently since the Governing Board approved the proposal to revise Cochrane’s evidence synthesis production model. Questions have been organised into categories, that broadly reflect the elements of the new model but also covers questions about how current ways of working could change.


Global challenges

Why not to keep the clinical granularity of the current Cochrane Review Groups (CRGs) as a way of addressing global challenges and building new partnerships for the future?

Retaining the clinical expertise that Cochrane currently has within the evidence synthesis unit structure is important, however keeping granularity at our current level – 52 individual CRGs – creates significant challenges as we look to streamline our systems and processes. Our current structure does not illustrate how interdisciplinary, collaborative, and nimble we can be. From an external point of view, the siloed approach of creating evidence syntheses via many different and seemingly segregated groups makes Cochrane a complex organization to understand and partner with. In creating a new production model, we need to think how best to preserve all that is good in Cochrane’s current structures whilst striving to make the organization more outward- looking, and to foster new partnerships and funding opportunities. In seeking to achieve this balance, we are mindful of the rich, subject-specific knowledge that CRGs have and want to work with them to ensure that Cochrane’s fundraising strategy does not endanger their local funding arrangements.

CRGs act as hubs to help Cochrane cover almost all healthcare topics including common but overlooked topics. Loss of these hubs could mean these topics will go back to being overlooked. How can Cochrane avoid this?

We hope that, with a broad range of funders, we will be able to identify funding for a wide range of healthcare topics.

Will Evidence Synthesis Units be topic-related like current CRGs/Networks? How will this affect the topics that Cochrane covers in terms of health evidence?

The way we prioritise topics within CRGs has been very challenging to explain and share with people outside Cochrane. We hope that a global challenges framework will provide an overarching structure to the units and provide us with a way to respond to global health and care challenges in an agile way. Adjustments to the framework have been made as a result of feedback received in Q4, 2021, about the key areas that Cochrane should be engaged in. Chronic conditions, Cancer, Climate Change, Maternal & Child Health and Infectious Diseases came out on top during the community engagement process. The absence of Mental Health & Wellbeing from the framework was noted but will be added going forward. Further consideration of the framework and discussion with the wider community will occur as the new model evolves..

Cochrane is a global organization and so must be conscious of global health priorities, whereas some partners are country-focused (e.g., NICE in the UK). How will this be reconciled to ensure effective collaboration?

Organizations such as the NIHR and NICE in the UK or NHMRC in Australia are important, however Cochrane’s has many key partners and stakeholders. We are a global organization and thus must consider global priorities and partners when thinking about how best to collaborate and restructure.

If health equity could be embedded more into regional priority setting, could this help to better address global challenges?

The fact that we are an international organization with centres all around the world makes this challenging. Equity at the local level and equity at the global level are very different things. We likely need to be looking at equity at the local level (within countries) as well as internationally when relevant. We need to work with our local partners in countries all over the world to better define what ‘equity’ means and looks like both regionally and globally.

Evidence Synthesis Units

Structure

Why are Evidence Synthesis Units important and what impact will they have?

The Evidence Synthesis Units are designed to play a pivotal role in the new model by improving product consistency and accountability, alongside the expanded Central Editorial Service. Early indications are that they will be attractive to funders, who are increasingly signalling they would like to see a change to the way that Cochrane’s organizational structure responds to their priorities In setting up the Units we hope to enhance Cochrane’s image as a fundable organization at a time when funds are becoming scarcer. The fact that the Units are interdisciplinary will allow them flexibility to deliver evidence synthesis on a range of health and care areas, and draw on the topic and methods expertise in the Thematic Groups. The Units are also important because they are outward facing, enabling Cochrane to be responsive to global challenges, and are not topic specific and therefore able to respond to funder needs. We will work toward tripartite contracts (Cochrane, funder, host organization), and codify service standards and accountability. By creating Units that are accountable to Cochrane centrally we plan to coordinate and speed up production of the highest priority topics. This means that the ultimate impact will be more timely, relevant information available and accessible more quickly to those who need.

What impact will an Evidence Synthesis Units have?

We believe that the Evidence Synthesis Units will signal to funders and users of our evidence that Cochrane is responsive to important global health and social care needs. For funders in particular the impact will be to improve Cochrane’s image as a fundable organization at a time when funds are becoming scarcer. By creating Units that are accountable to Cochrane centrally we plan to coordinate and speed up production of the highest priority topics. This means that the ultimate impact will be more timely, relevant information available and accessible more quickly to those who need.

Is there a risk that the Evidence Synthesis Units will fail?
Our current funding model is under significant pressure. Cochrane Review Groups are losing funding and this risks our review publication pipeline and the viability of the Cochrane Library, and therefore the wider organisation. This issue has to be addressed, and conversations with funders already indicate interest in funding the ESU model. There is a degree of uncertainty but we do need to be enterprising in tackling this existential challenge, and we are confident this can be delivered with the stepwise approach set out.

The stepwise approach – not just in developing ESUs, but all the components of the model – means we will be able to test, learn and revise if we need to. The Executive Leadership Team and various project teams involved in implementing the model, fully understand the magnitude of the task and will make every effort to realise the model as it was presented to and approved by the Board. The Governing Board will monitor and maintain oversight through the advisory group to be set up

Will Cochrane Evidence Synthesis Units replace the current Cochrane Review Group (CRG) structure and when will this happen?

The original proposal was for CRGs to be replaced by the larger Evidence Synthesis Units. As a result of the community engagement process in 2021 the proposal was revised to include the creation of Thematic Groups which will sit alongside the Evidence Synthesis Units. It is too early to say that, or when, CRGs will be “decommissioned”. Implementation planning is underway and we will share information with the wider community as soon as we can, however we have a clear timeframe for when the Department of Health and Social Care (DHSC) will cease to provide infrastructure funding for the NIHR-funded, UK-based Cochrane Review Groups (CRGs) – the end of March 2023. We know that some CRGs are beginning to wind down now, and alongside Cochrane UK, we are looking at ways to support the UK groups through the transition phase.

Will the Evidence Synthesis Units be geographically or thematically organized?

The model as originally proposed presented the Evidence Synthesis Units as geographically organized, multi-topic and interdisciplinary. Throughout the community engagement process, we heard clearly and consistently – from all sections of the Cochrane community – that keeping Cochrane’s content expert volunteer community was vital to the new model. As a result, the new model now includes Thematic Groups, which would sit alongside the Evidence Synthesis Units. The Thematic Groups will help to provide the right topic expertise to the Units, which will be organised geographically.

How will we manage contracts with Evidence Synthesis Units and Thematic Groups?

Managing multi-stakeholder contracts certainly needs careful thought. This will be a key component of ESU implementation planning and we will work with the Head of Finance & Corporate Services on this matter. There is already work taking place to develop contract or terms & conditions template. The team is aware that it’s a challenge; one which also relates to the set-up of the Thematic Groups. As we establish ESUs we will keep contract management firmly under review.

Will the staff of the Evidence Synthesis Units will be employees of Cochrane centrally or will the units be based in a range of institutions, as is the case currently with CRGs?

Staff of the ESUs might be employees of Cochrane or of host institutions, particularly as we do not want to lose any funding that we currently have. We will need to be flexible as we develop our fundraising effort, so there may be different models of funding that are implemented in different units. However, accountability from these units must be three-fold: to Cochrane, to the funder, and to the host institution itself. We have seen problems where current relationships between the funder and the group have undermined the accountability to Cochrane, and this causes issues for the way we work together and interact.

Will the process for identifying the host institutions for the new Cochrane Evidence Synthesis Units be via a public tender process?

A tender process is our preferred approach, however the process is likely to depend on the wishes of both the funders and Cochrane. The ‘proof-of concept’ Evidence Synthesis Units may not follow a strict tender process. Discussions with funders are at a very early stage and as we are taking a staged approach to implementation, the practical possibilities and constraints of funding arrangements are yet to be fully explored.

What is the likely timeline for the setting up new Evidence Synthesis Units?

We do not expect change of this magnitude to happen quickly; there will inevitably be a period of transition, where the model takes shape, new funding opportunities emerge, and our open access plans solidify. We are currently at the implementation planning stage and are proposing that two ‘proof-of-concept’ ESU be set up in the next 18-24 months.

What evidence is there that moving Evidence Synthesis Units is going to be more efficient/effective than the current model of CRGs?

Cochrane’s current structure of fifty-two CRGs creates a complex and challenging operating model. Providing consistent support for all CRGs is difficult, the lines of accountability are blurred, and the way we work is not easy to understand from an outside perspective. We cannot say with complete certainty that the ESU model will be more efficient/effective than the current model of CRG; however, talks with some funders indicates that there is support for this model. It is important to acknowledge that a new model of production alone cannot solve all our current issues; a cultural change and new ways of working must happen in parallel with any structural changes. We welcome input from the community about how we can make our production processes more efficient, accountable, and sustainable for the long-term future of Cochrane.

Where will the new Evidence Synthesis Units be based?

It is too early to confirm where the Units might be based; this depends very much on discussions with funders, though we are committed to locating one of the ‘proof-of-concept’ Units in a low-and-middle-income country. It is often the case that funding of this type is available mainly in high-income countries, however we are very mindful that for Cochrane to be valued globally, it must reflect the health and care needs and perspectives of low- and middle-income countries as well.

How will the new Unit structure streamline processes which aren’t just related to inconsistency between groups, but complexity of process?

It is true that the increasing complexity of Cochrane methods and changes to tools, processes and polices have contributed to the challenges we face as an organization. It is very difficult historically to implement change smoothly in model that is based on 52 individual CRGs, however we are clear that the proposed structural changes must be accompanied by a critical evaluation of our evidence synthesis tools and the way that these integrate with methods, policy, and process. A separate area of work, consisting of multiple projects, to streamline our systems and processes is currently being planned.

What is the advantage of the evidence synthesis unit model compared to the direct submission pathway?

In the proposed model, the Evidence Synthesis Units and the direct submission pathway have been envisaged as complementary. Having the ESUs provides a way of creating content that ensures stakeholder needs are addressed in a structured and co-ordinated way. The shift toward multi-topic, interdisciplinary units increase Cochrane’s attractiveness to the international global donor market. They also function as hubs to which some of Cochrane’s existing pool of expert contributors can gravitate. The direct submission pathway allows us to remain flexible and open to high-quality submissions that may not fit neatly within a global challenges framework. The direct pathway also represents a way of ensuring that the Cochrane Library publication pipeline remains stable

Funding & Open Access

How will the ongoing infrastructure costs new Cochrane Evidence Synthesis Units be funded? What external funders are being approached to fund these?

We have been working on a fundraising strategy that will enable us to diversify our funding streams and support the units and other strategic activities in the coming years. Early indications are that some current national funders are interested in at least partially funding Evidence Synthesis Units within their jurisdiction but no firm commitments have been made and we also want to explore funding opportunities with international partners. A close relationship between Cochrane and the funders will be critical to the success of these Units, not least in securing funding in the medium- and long-term.

How much are funders prepared to pay for Cochrane reviews?

That is uncertain but what we do know is that funders want to pay for the evidence synthesis that fits their local context and needs, and that they want those syntheses to be of high quality and delivered quickly.

If we move away from large national funders like the NIHR funding, toward other donors, should we pause the move to Open Access (OA)?

Many funders and stakeholders have pressed Cochrane to adopt an Open Access (OA) model and the Governing Board has emphasised the importance of responding to this challenge well before the NIHR announcement was announced. In the global donor market place the OA model also has a great deal of currency, so OA is a challenge the organization must face, regardless of funding diversification. To that end Cochrane has prioritized the creation of a sustainable OA plan as part of the Cochrane Strategy for Change.

Is Cochrane willing to accept funding from well-funding from reputable charities in return for a relatively high level of visibility on the Cochrane Library/Cochrane.org?

Cochrane could certainly focus on better ways of working with donors that are beneficial to both Cochrane and donor organizations.

Various business models that Cochrane has explored have failed in the past, so how can we be . confident that we can replace the lost revenue from going Open Access?

It is true that previous initiatives have not been as successful as we’d have hoped, therefore it is now vital that we learn from the past and make significant and lasting changes that will enable us to respond to global health and care challenges and demonstrate Cochrane’s value to external stakeholders. The major difference in this point in our history is the sense of urgency arising from the many challenges we are facing – insecure funding, Open Access pressure, and a structure and processes that are no longer fit for purpose. Cochrane’s leadership is working on a fundraising strategy that will support whatever new, sustainable operating model is chosen by the Governing Board.

Is there a risk, with funding bodies having more of a say in the review priorities, that the reviews will be focused on the types of interventions that are cheap enough to be recommended in guidelines?

To remain relevant and make Cochrane a sustainable organization for the future, we must diversify our sources of funding. It is not clear at this stage that this imperative will lead to a conflict between the needs of funders and the needs of clinicians. Nevertheless, we are mindful of the possibility, which it is why we are focused on ensuring that we retain Cochrane’s clinical expertise, and that the clinician “voice” is integrated into the Evidence Synthesis Unit structure.

What about the Cochrane groups that have stable funding?

The importance of not jeopardizing the stable funding that some groups have is well understood. One possible approach might be for groups with stable funding to become affiliated research groups working with Cochrane as the Evidence Synthesis Units are set up. Alternatively, they may choose to join with other Cochrane Groups (Reviews Groups, Fields, etc.) and apply to become a Thematic Group.

How do we ensure that Cochrane Groups don’t compete for funding?

For any new production model to be efficient and sustainable it must be coordinated and collaborative. It is possible to imagine situations where the Evidence Synthesis Units may be eligible to bid for the same the funds, indeed there may be cases in which competition is healthy, helping to drive excellence. However, as an organization we must guard against putting too much energy into internal competition. Cochrane’s fundraising strategy, as it matures over time, will hopefully give the groups producing reviews the financial stability they need to avoid excessive competition. Cochrane’s central team will likely have an important role to play, not only in leading fundraising activities to identify infrastructure funding, but also to manage and coordinate programme grant funding in a way that supports the groups but maximizes organizational efficiency.

Do we know if NIHR would help to fund Cochrane evidence synthesis units? Do you anticipate that the Evidence Synthesis Units will apply for funding through the forthcoming NIHR call?

It is important to understand that there are two distinct types of evidence synthesis units. The “Cochrane evidence synthesis units” which have been mentioned in several earlier answers, and the proposed “NIHR evidence synthesis units” that NIHR have signalled it is planning to fund in the UK. It is our clear understanding that these will be funded primarily to undertake commissioned non-Cochrane evidence syntheses. We would like to see NIHR encourage these units to submit the evidence syntheses they produce for publication in the Cochrane Library. However, we know that NIHR will want these syntheses to be published Open Access. We also realize that these evidence syntheses will not necessarily be (and are unlikely to be) classic Cochrane-style reviews. It is important for Cochrane to broaden and expand the types of the evidence syntheses published in the Cochrane Library, and this may therefore be a route to do so. We are continuing in a regular dialogue with the NIHR.

Is our commitment to Open Access a done deal, and if so, why?

Our commitment to Open Access is longstanding, and Cochrane has committed to be fully open access by 2025. Undoubtedly, there challenges to going Open Access, but we have learned the importance of making the evidence that we generate accessible to all over the past 2 years with our response to the COVID-19 pandemic. The open science movement is rapidly gaining momentum and if we don’t make all our content Open Access in a reasonable timeframe, we may experience reputational risk. Making the change is a complex proposition and there are various paths that Cochrane could take, all of which come with risks. We must balance our commitment to Open Access and the speed of transition, with our sustainability as an organization. The Governing Board is very focussed on this issue and we have been looking at how other organizations are managing the transition. We will share plans with the community as soon as decisions are made.

People & expertise

Do you know yet how many MEs, ISs, etc will make up each Cochrane evidence synthesis unit?

Wherever possible we would want to see existing Cochrane staff find roles within the new Units, however, it is too early to answer this question. During the community engagement period we heard some of the community’s views on how the current CRG roles could be adapted to new ways of working in the future and this will be considered as the new model evolves.

How much influence will the CET have over the composition of Evidence Synthesis Units, if some of them are funded through an open NIHR process to which various institutions will be bidding?

The Evidence Synthesis Units (ESUs) proposal recommends that each unit is composed by diverse author teams with sufficient knowledge and expertise to guarantee high-quality, timely delivery and that they are supported by a skilled and experienced core team. The ESUs would be multi-topic and interdisciplinary and there will be scope for sharing content and methods expertise between units. It is important that all ESUs use consistent standards and processes wherever they are based. The units will need to follow the strategic direction of the organization, have a governance structure with clear lines of accountability for meeting key performance indicators. In terms of how much influence the CET will have over who will be appointed to the ESU’s that would probably have to be devolved. To preserve Cochrane’s gold standard for evidence synthesis a clearer distinction between authorship and editorial review must be established as well as a good process for quality assurance. In the new model we envisage the editorial process for all evidence syntheses to be managed centrally to ensure that all reviews follow the same independent editorial process and adhere to quality standards.

What is ideal range of expertise needed in the Evidence Synthesis Units?

There is not a one-size-fits-all approach to this; the driving force for these units needs to be production of the highest quality, gold standard reviews. Each ESU will depend on its own funding, leadership, etc., and whether it will be feasible to have separate experts on various methodological topics in each ESU. It may be necessary to share this expertise across ESUs depending on resources. Some ESUs may have specific topic experts, however others may be involved across various ESUs. Ultimately, this will be a question about leadership and funding for the ESUs.

How will volunteer review authors be integrated into the Cochrane evidence synthesis units?

This new model of Cochrane Evidence Synthesis Units is built around professional and experienced reviewers doing the high-quality Cochrane reviews and other evidence syntheses that funders require in a timely fashion. Teams of review authors working anywhere in the world will be able to undertake Cochrane reviews and submit them directly to the Central Editorial Service. If they are of high-quality, on important topics, they will be published in the Cochrane Library.

Is there a proposal to move to accepting other types of reviews, and has consideration been given as to how to develop / ensure methodological quality across a wide range of different types of reviews?

To meet the needs of our stakeholders, we may need to address different types of questions in the future. Cochrane has a history of methodological innovation, but we will need to develop expertise in other methodologies to retain our relevance. In Cochrane’s response to the COVID-19 pandemic, we had to tackle questions that relied on study designs that we have not traditionally worked with. In responding to COVID and in the future, we will look to our own community of methods experts, bearing in mind that there will inevitably be a period of transition in which Cochrane builds on existing expertise to deliver new types of evidence syntheses. We acknowledge the risk of ‘spreading ourselves too thin’ methodologically, but we have confidence in the network of individuals who have shown in the past how willing they are to rise to methodological challenges.

How do we ensure authors who obtain funding to do reviews, publish in the Cochrane Library rather than other journals?

Detail relating to contractual obligations of authors who receive funding to conduct Cochrane evidence syntheses is something that we would need to consider carefully when we have settled on a new model. One important way that Cochrane can ensure that authors remain committed to publishing with us to ensure a good author experience, based on clear, timely processes and the availability of support when it is needed.

The Evidence Synthesis Units will take time to get established - during which time, could our reputation for producing high quality reviews substantially diminish?

Whatever the timeframe for establishing the evidence synthesis units, only high-quality Cochrane reviews and related evidence syntheses will be published in the Cochrane Library. We do want to find a way to preserve the clinical and patient expert knowledge and expertise that resides in the members of the different CRGs, as noted in prior answers.

With this model, how are we planning to preserve the clinical, methodological & patient expertise that rests in the current CRGs?

We recognise that our biggest asset is our people and that there is a tremendous amount of expertise – clinical, methodological, patient and carer – within Cochrane. We want to recognize this as we go through this process of change, with the goal of retaining this expertise. We have discussed this with Cochrane members throughout the Community Engagement Workshop Series, and recordings of these workshops are available here. Collaboration is central to Cochrane’s identity, and we hope to continue to work together to ensure we preserve this expertise.

What will Cochrane do to address any racism or biases that are affecting people involved in Cochrane? Are we ensuring that the new Cochrane can be built with mechanisms to hold people accountable when they are discriminatory in all forms?

While Cochrane acknowledges that there are societal issues beyond our control, our role is to help authors have a good, and consistent experience. Identifying which steps of the review process are more susceptible to this type of bias and establishing a mechanism to pre-empt language, or any other bias would help to tackle some of the issues that are affecting people in Cochrane. Cochrane is actively working developing a set of recommendations on how to improve diversity and inclusion for the organization as a whole.

Collaboration

Can the community contribute to the development of the Evidence Synthesis Units?

The proposal introduced in September 2021 is one proposal only; we were clear that it could either be modified or that alternative approaches could have emerged during the community engagement period. We welcomed feedback and ideas from the community which was solicited input through a workshop series and via a survey on the Future Cochrane website. We also received a number of formal written responses which can be viewed here. We understand how important it is to communicate with the wider Cochrane community, other stakeholders and our funders after the Governing Board has reached a decision and as the project evolves throughout 2022.

Thematic Groups

How will the Thematic Groups fit with other Cochrane groups (geographic groups, fields, CRGS, etc.)?

The Thematic Groups could perhaps be thought of as an overhaul of how the CRGs, Fields, Geographic Groups, Methods, and Consumers work together and a redefining of who can produce Cochrane evidence syntheses. A current CRG can elect to join forces with other CRGs or with other Cochrane Groups, but equally so can a current Field. We heard many times in the community engagement process that our expert volunteers find their entry point into Cochrane via a specific clinical topic or method which is why it’s important to preserve the thematic focus that Evidence Synthesis Units won’t necessarily have.

It is equally an opportunity for members of a wide range of Cochrane Groups (e.g., Fields, Methods Groups, etc) to use their considerable topic expertise to enter fully into the Cochrane evidence synthesis production process. Some Geographic Groups have expressed interest in being involved in the creation of Evidence Synthesis but they might also be involved in supporting the creation of Thematic Groups given their regional knowledge and ties to national funding bodies.

How do Thematic Groups improve content or other Cochrane processes?

The value and importance of the Thematic Groups relates to the fact that the ESUs must be multi-topic and geographic. They must respond to the different evidence needs of a national/regional funder, not just focus on a particular clinical area. No ESU is going to have all the clinical and lived experience expertise it needs to cover any topic the funder wants, but that wide range of expertise DOES exist now in the wider Cochrane community. The Thematic Groups facilitate evidence synthesis production by ensuring that ESUs have access to the right experts at the right time, and keep Cochrane’s loyal contributors engaged

If the Thematic Groups can produce evidence syntheses will they be competing with the Evidence Synthesis Units?

Thematic Groups can also produce reviews, although they don’t have to. We don’t believe this will set up competition, in fact the Thematic Groups will be an important source of content to help Cochrane maintain the publication pipeline as funding dries up and CRGs shut down. In addition, there’s scope for Thematic Groups to work in tandem with ESUs and provide expertise in the definition of a review question, choice of outcomes, and the interpretation of evidence.

Central Editorial Service

How will the new Central Editorial Service be funded?

Currently, this service is funded from the income that Cochrane (the charity) receives from Wiley (our publisher). Work on how all Cochrane’s central functions (not just the Central Editorial Service) will be part of the review of how Cochrane is funded.

What criteria are used to an accept/reject decision in the Central Editorial Service?

The Central Editorial Service team uses a basic submission checklist to ensure that the author team adheres to the Conflict of Interest policy for Cochrane Library content and Cochrane’s authorship and contributorship policy, and that the submission complies with Cochrane’s plagiarism policy. Submissions not compliant with these policies would be rejected. At the second stage an assessment by a Central Editorial Service Manging Editor is carried out using the Criteria for submission to Central Editorial Service. A decision is then made on whether to take the submission forward. If the submission appears to meet the criteria a parallel peer review (methods, search, content/clinical and consumer review) may take place instead of a sequential peer review (methods and search review before content/clinical and consumer review). An outline of the editorial process steps for the Central Editorial Service is available on the Editorial Independence and Efficiency Project webpage.

Could a review be rejected if it was not considered to address a priority topic?

Reviews submitted via the direct pathway may be rejected based on the perceived priority of the topic. It is important to note however, that the Central Editorial Service team are aware of the need to consult topic experts who can advise us on whether the review addresses a priority topic or overlaps with other reviews in the area.

Can reviews rejected on quality grounds be resubmitted?

Submissions rejected based on quality would not qualify for revision and resubmission. Authors can appeal the rejection decision and their appeal will be considered according to the Cochrane appeals policy and process. Other reasons for rejection may be that the review overlaps with another Cochrane review already published that is up to date or in the process of being updated. If a review is deemed not ready for peer review on submission but it is a high priority topic and the issues highlighted can be addressed, a major revision round would be permitted before peer review.

How are consumer referees identified and supported within the service?

We have worked with the Consumers' Executive and Cochrane’s Consumer Engagement Officer to identify consumer reviewers. For Covid reviews we would approach the Covid Consumer group. Cochrane review groups with strong consumer relationships may recommend consumer peer reviewers for the editorial process Other methods include using Cochrane’s Task Exchange and promoting these on social media, asking advocacy groups or specific patient representative groups if they can recommend someone who could be a consumer author.

How can information specialist peer reviewers be identified?

From March 2022, post-submission search peer review across Cochrane has been available from a dedicated team of information specialist (IS) peer reviewers. The team is made up of volunteer Cochrane IS who have agreed to receive requests for search peer review. The IS Search Peer Review Team performs post-submission search peer review for any Cochrane editorial team in Editorial Manager, replacing the previous arrangement of searches being peer reviewed by an IS within the same Network as the Cochrane Review Group where the article was registered. For more information about search peer review for Cochrane, please see FAQs for Information Specialist Search Peer Reviewers.

Will information specialist peer reviewers be expected to peer review search strategies not designed by Information Specialists?

The Information Specialist Search Peer Review Team performs post-submission search peer review for any submission, regardless of who designed the search strategies.

What are the timeframes for non-priority reviews going through the service?

The Editorial Independence and Efficiency Project will end in June 2022, so by then we hope to have more robust data about time to publication for manuscripts going through the service. The aim is for all the steps of editorial process to be completed within twelve weeks, but this may vary depending on the recommendation that we send back to authors following peer review. Reviews requiring only minor revisions are likely to go through faster than those requiring major revisions.

How will discrepancies between conclusions in reviews that partly overlap be addressed in the service?

One way of addressing this would be to do more commentaries on Cochrane Reviews and editorials to describe the differences and similarities between the reviews. Having linked commentaries to Cochrane Reviews, particularly where we have got multiple reviews in an area, is something worth pursuing.

What will the direct submission pathway for authors outside units look like?

The direct submission pathway exists already and was used as part of Cochrane’s response to Covid-19. Like any other journal focused on quality, we will expect (and require) a high standard of submissions. For our part, we will aim for speedy turn-round of decisions. Authors whose work is rejected will be able to submit to other journals.

System and tools

What role will artificial intelligence play in future review production?

Artificial Intelligence (AI) is already being used to assist review production and there are initiatives in place to improve their effectiveness. It is highly likely that AI will be used more in the future, particularly for identifying relevant studies. Using AI to annotate reviews and facilitate the linkage of ongoing and new studies with protocols and reviews will be a step in the right direction. However, there are some challenges that AI will not be able to solve and the value that we add to the review cannot be replicated by machines.

Transition

How should NIHR-funded, UK-based CRGs manage new title registration until funding ceases?

Cochrane UK have set up a Transition Support Team to help the UK-based CRGs and Cochrane Central Editorial Service through the transition period. The aim of this work will provide continuity and support to those who contribute to the work of UK-based CRG (editors, peer referees, authors, etc.) help to maintain the pipeline of review title registration, protocol and review production and publication for priority topics optimizing the use of NIHR resources thereby respecting the very significant contribution NIHR has made to Cochrane activities in the past.

It is important that CRGs do not uncritically reject all titles registrations during the transition period. New titles should be evaluated according to the skills and resources available to the author team and the importance of the questions. It is also important to understand that the Central Editorial Service offers a potential pathway to publication even if the CRG does not believe it has the resources to take a title forward.

If a review is a priority topic, and if the author team are highly competent and able to complete both the protocol and review with minimal support from the CRG then CRGs should allow registration of titles in the usual way using the current processes. They should inform authors that:

  • registration of the title will allow access to write their protocol in RevMan;
  • registration of the title does not guarantee publication of a protocol; and
  • they will only receive minimal support from CRGs, and this is “subject to availability”.

They should also make authors aware that if the work of the CRG transfers to the Transition Support Team, the support available will continue to be minimal.

Should CRGs that are losing funding prioritize ongoing protocols or reviews?

The leaders of CRGs will have to consider, with their teams, and knowing the resources that have available, what can be accomplished in the relevant timeframe. It may be helpful to think about the priority of the title rather than the stage it’s at and focus on publishing the most important reviews. It is important to remember that it is possible for authors to submit high-quality manuscripts for consideration by the Central Editorial Service. UK-based CRGs can also seek guidance from the Cochrane UK Transition Support Team.

Will reviews funded/commissioned now still have a pathway to publication, especially when some grants have a 3–5-year timeline?

If team, working with their host institution (University, hospital, etc.) are bidding for money to do a suite of Cochrane reviews, can continue. Those reviews can always be submitted directly to the Cochrane Library via the Central Editorial Service. If they are of sufficiently high quality, they will be published.

What is the vision for the Cochrane Library considering this new model?

While this has not been decided yet, one idea is to find different ways to publish other types of evidence synthesis that are likely to be shorter and less complex. We must also remember that it is extremely important that we share information in ways that people want to consume it. This will need to be done through the geographic groups, which serve their local populations and best understand their needs.

We have an ongoing and unwavering commitment to publish high-quality reviews in the Cochrane, so any changes to the way we publish reviews (new types, for example) will not happen all at once; they will come after due consideration and user testing during the transition period.

In this model, what are the plans for updating reviews in the Cochrane Library?

There are no plans to discontinue the practice of updating, as this element of Cochrane reviews distinguishes us from many other evidence synthesis organizations. However, the proposed model presents an opportunity to re-examine all our editorial and publishing policies and practices so the Evidence Production & Methods Directorate is planning to revisit Cochrane’s updating policy.

What if current CRGs are approached directly for collaboration by the WHO or guideline makers and this funding / collaboration extends beyond the 18 months?

If the host institutions of a CRG have agreed to undertake work for the WHO or other guideline producers, and this has been properly costed, we would expect that work to be completed. But we can see difficulties if some of that work was to use – for example – NIHR resource, and those are no longer available.

Role of other Cochrane Groups

What will be the role of the Fields?

We are exploring ways in which the clinical and patient expertise within not only CRGs but also Fields can be preserved. Many Cochrane Fields have longstanding relationships with external stakeholders so could play a pivotal role in the new approach to prioritization that is being proposed in the model. Indeed, some Fields are already engaged with priority global health and care challenges that have been identified by Cochrane (e.g., healthy ageing, disability, climate change). Fields members may also contribute as authors themselves and/or as contacts points with practitioners in the field.

What will happen to Network Support Fellows and other Network staff?

The Network Support Fellows were funded for a limited term by a grant from NIHR. This is coming to an end.

Would Geographic Groups still exist alongside the evidence synthesis units?

Cochrane is a complex organization, with expertise in the CRGs, but also across our other groups. Our people are our asset; it’s what allows us to differentiate ourselves as an organization and produce and disseminate high quality reviews. Cochrane’s COVID-19 response showed us that Geographic groups can play an important role in synthesizing evidence, without having to make drastic structural changes. There are several core activities that Geographic groups should continue, such as training, knowledge translation, capacity building, and stakeholder engagement. Perhaps in time we will want to change the way Geographic groups are organized , however at this stage the proposed model does not aim to resolve all these issues, it is primarily focused on how we produce evidence syntheses. Nevertheless, we will be considering how collaborative working will happen with ESUs and other Cochrane Groups - we are all part of Cochrane and we should be working together.

What will the role of regional centres outside UK be, specifically in relation to ESUs?

As with CRGs outside the UK, we are keen not to disrupt the activities of Cochrane Geographic Groups that have stable funding. We welcome feedback from Cochrane Geographic Groups on how their local knowledge can strengthen the evidence synthesis unit structure.

Role of other Cochrane Groups

What will be the role of the Fields?

We are exploring ways in which the clinical and patient expertise within not only CRGs but also Fields can be preserved.  Many Cochrane Fields have longstanding relationships with external stakeholders so could play a pivotal role in the new approach to prioritization that is being proposed in the model. Indeed, some Fields are already engaged with priority global health and care challenges that have been identified by Cochrane (e.g., healthy ageing, disability, climate change). Fields members may also contribute as authors themselves and/or as contacts points with practitioners in the field.

What will happen to Network Support Fellows and other Network staff?

The Network Support Fellows were funded for a limited term by a grant from NIHR. This is coming to an end.

Would Geographic Groups still exist alongside the evidence synthesis units?

Cochrane is a complex organization, with expertise in the CRGs, but also across our other groups.  Our people are our asset; it’s what allows us to differentiate ourselves as an organization and produce and disseminate high quality reviews.  Cochrane’s COVID-19 response showed us that Geographic groups can play an important role in synthesizing evidence, without having to make drastic structural changes. There are several core activities that Geographic groups should continue, such as training, knowledge translation, capacity building, and stakeholder engagement. Perhaps in time we will want to change the way Geographic groups are organized , however at this stage the proposed model does not aim to resolve all these issues, it is primarily focused on how we produce evidence syntheses. Nevertheless, we will be considering how collaborative working will happen with ESUs and other Cochrane Groups - we are all part of Cochrane and we should be working together.

What will the role of regional centres outside UK be, specifically in relation to ESUs? 

As with CRGs outside the UK, we are keen not to disrupt the activities of Cochrane Geographic Groups that have stable funding. We welcome feedback from Cochrane Geographic Groups on how their local knowledge can strengthen the evidence synthesis unit structure.