Background: prior to the development of a series of Cochrane Reviews for CSOM (chronic suppurative otitis media), Cochrane ENT conducted a scoping process. Part of the process included a consultation with stakeholders (Ear, Nose and Throat (ENT) specialists and primary care practitioners) taking care of people with CSOM across the world in different settings, and also a patient representative. The scoping process helped to identify high priority clinical questions and outcomes.
Objectives: to demonstrate how the high priority clinical questions, outcomes and methodology identified during the scoping process can inform the 'Implications for research' section of Cochrane systematic reviews.
Methods: we revisited the findings of the scoping process when the 'Implications for research' section was formulated. We compared the clinical questions and outcomes rated as top priorities against the findings from the Cochrane Reviews, and noted areas where evidence was lacking. We also compared the prioritized outcomes and ideal methodology against what was done in studies included in the reviews. We formulated suggestions for future research on the basis of this information.
Results: out of the 10 clinical questions considered as most important in the treatment of CSOM, no evidence (i.e. no study reported any outcomes of interest in the reviews) was found for two clinical questions; one question had moderate to very low-quality evidence for different types of interventions compared, and the rest (seven clinical questions) had very low- or low-quality evidence. These areas were noted in the 'Implications for research' section.
One of the key factors affecting the quality of evidence was the methodology of trials, especially in the measurement and reporting of outcomes. Important outcomes, such as hearing and risk of ototoxicity, were not well measured or reported. In addition, 'recurrence' of ear discharge in patients who achieved 'dry ears' was rarely reported and lacked definitions.
Therefore, the 'Implications for research' sections of these reviews emphasized the importance of prioritizing research and standardization of outcome measures (e.g. developing a core outcome set) for CSOM before further trials are conducted. We also noted other key limitations in design and reporting of existing trials, and suggested potential solutions.
Conclusions: the addition of a consultation process with a diverse group of stakeholders during scoping strengthens the prioritization of clinical questions and outcomes. In addition to helping us to formulate the protocol, the scoping process helped us to formulate the 'Implications for research' in a more systematic way. Therefore, the scoping process and consultation with a diverse group of stakeholders could reap important, wide-ranging benefits, which include formulating research recommendations.
Patient or healthcare consumer involvement: a CSOM patient was involved in the scoping and consultation process.