a systematic qualitative literature review

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How to Do a Systematic Review: A Best Practice Guide for Conducting and Reporting Narrative Reviews, Meta-Analyses, and Meta-Syntheses

Affiliations.

1 Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling FK9 4LA, United Kingdom; email: [email protected].
2 Department of Psychological and Behavioural Science, London School of Economics and Political Science, London WC2A 2AE, United Kingdom.
3 Department of Statistics, Northwestern University, Evanston, Illinois 60208, USA; email: [email protected].
PMID: 30089228
DOI: 10.1146/annurev-psych-010418-102803

Systematic reviews are characterized by a methodical and replicable methodology and presentation. They involve a comprehensive search to locate all relevant published and unpublished work on a subject; a systematic integration of search results; and a critique of the extent, nature, and quality of evidence in relation to a particular research question. The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information. We outline core standards and principles and describe commonly encountered problems. Although this guide targets psychological scientists, its high level of abstraction makes it potentially relevant to any subject area or discipline. We argue that systematic reviews are a key methodology for clarifying whether and how research findings replicate and for explaining possible inconsistencies, and we call for researchers to conduct systematic reviews to help elucidate whether there is a replication crisis.

Keywords: evidence; guide; meta-analysis; meta-synthesis; narrative; systematic review; theory.

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Annual Review of Psychology

Volume 70, 2019, review article, how to do a systematic review: a best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses.

Andy P. Siddaway 1 , Alex M. Wood 2 , and Larry V. Hedges 3
View Affiliations Hide Affiliations Affiliations: 1 Behavioural Science Centre, Stirling Management School, University of Stirling, Stirling FK9 4LA, United Kingdom; email: [email protected] 2 Department of Psychological and Behavioural Science, London School of Economics and Political Science, London WC2A 2AE, United Kingdom 3 Department of Statistics, Northwestern University, Evanston, Illinois 60208, USA; email: [email protected]
Vol. 70:747-770 (Volume publication date January 2019) https://doi.org/10.1146/annurev-psych-010418-102803
First published as a Review in Advance on August 08, 2018
Copyright © 2019 by Annual Reviews. All rights reserved

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Article Type: Review Article

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Published: 15 December 2015

Qualitative and mixed methods in systematic reviews

David Gough 1

Systematic Reviews volume 4 , Article number: 181 ( 2015 ) Cite this article

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Expanding the range of methods of systematic review

The logic of systematic reviews is very simple. We use transparent rigorous approaches to undertake primary research, and so we should do the same in bringing together studies to describe what has been studied (a research map) or to integrate the findings of the different studies to answer a research question (a research synthesis). We should not really need to use the term ‘systematic’ as it should be assumed that researchers are using and reporting systematic methods in all of their research, whether primary or secondary. Despite the universality of this logic, systematic reviews (maps and syntheses) are much better known in health research and for answering questions of the effectiveness of interventions (what works). Systematic reviews addressing other sorts of questions have been around for many years, as in, for example, meta ethnography [ 1 ] and other forms of conceptual synthesis [ 2 ], but only recently has there been a major increase in the use of systematic review approaches to answer other sorts of research questions.

There are probably several reasons for this broadening of approach. One may be that the increased awareness of systematic reviews has made people consider the possibilities for all areas of research. A second related factor may be that more training and funding resources have become available and increased the capacity to undertake such varied review work.

A third reason could be that some of the initial anxieties about systematic reviews have subsided. Initially, there were concerns that their use was being promoted by a new managerialism where reviews, particularly effectiveness reviews, were being used to promote particular ideological and theoretical assumptions and to indirectly control research agendas. However, others like me believe that explicit methods should be used to enable transparency of perspectives driving research and to open up access to and participation in research agendas and priority setting [ 3 ] as illustrated, for example, by the James Lind Alliance (see http://www.jla.nihr.ac.uk/ ).

A fourth possible reason for the development of new approaches is that effectiveness reviews have themselves broadened. Some ‘what works’ reviews can be open to criticism for only testing a ‘black box’ hypothesis of what works with little theorizing or any logic model about why any such hypothesis should be true and the mechanisms involved in such processes. There is now more concern to develop theory and to test how variables combine and interact. In primary research, qualitative strategies are advised prior to undertaking experimental trials [ 4 , 5 ] and similar approaches are being advocated to address complexity in reviews [ 6 ], in order to ask questions and use methods that address theories and processes that enable an understanding of both impact and context.

This Special Issue of Systematic Reviews Journal is providing a focus for these new methods of review whether these use qualitative review methods on their own or mixed together with more quantitative approaches. We are linking together with the sister journal Trials for this Special Issue as there is a similar interest in what qualitative approaches can and should contribute to primary research using experimentally controlled trials (see Trials Special Issue editorial by Claire Snowdon).

Dimensions of difference in reviews

Developing the range of methods to address different questions for review creates a challenge in describing and understanding such methods. There are many names and brands for the new methods which may or may not withstand the changes of historical time, but another way to comprehend the changes and new developments is to consider the dimensions on which the approaches to review differ [ 7 , 8 ].

One important distinction is the research question being asked and the associated paradigm underlying the method used to address this question. Research assumes a particular theoretical position and then gathers data within this conceptual lens. In some cases, this is a very specific hypothesis that is then tested empirically, and sometimes, the research is more exploratory and iterative with concepts being emergent and constructed during the research process. This distinction is often labelled as quantitative or positivist versus qualitative or constructionist. However, this can be confusing as much research taking a ‘quantitative’ perspective does not have the necessary numeric data to analyse. Even if it does have such data, this might be explored for emergent properties. Similarly, research taking a ‘qualitative’ perspective may include implicit quantitative themes in terms of the extent of different qualitative findings reported by a study.

Sandelowski and colleagues’ solution is to consider the analytic activity and whether this aggregates (adds up) or configures (arranges) the data [ 9 ]. In a randomized controlled trial and an effectiveness review of such studies, the main analysis is the aggregation of data using a priori non-emergent strategies with little iteration. However, there may also be post hoc analysis that is more exploratory in arranging (configuring) data to identify patterns as in, for example, meta regression or qualitative comparative analysis aiming to identify the active ingredients of effective interventions [ 10 ]. Similarly, qualitative primary research or reviews of such research are predominantly exploring emergent patterns and developing concepts iteratively, yet there may be some aggregation of data to make statements of generalizations of extent.

Even where the analysis is predominantly configuration, there can be a wide variation in the dimensions of difference of iteration of theories and concepts. In thematic synthesis [ 11 ], there may be few presumptions about the concepts that will be configured. In meta ethnography which can be richer in theory, there may be theoretical assumptions underlying the review question framing the analysis. In framework synthesis, there is an explicit conceptual framework that is iteratively developed and changed through the review process [ 12 , 13 ].

In addition to the variation in question, degree of configuration, complexity of theory, and iteration are many other dimensions of difference between reviews. Some of these differences follow on from the research questions being asked and the research paradigm being used such as in the approach to searching (exhaustive or based on exploration or saturation) and the appraisal of the quality and relevance of included studies (based more on risk of bias or more on meaning). Others include the extent that reviews have a broad question, depth of analysis, and the extent of resultant ‘work done’ in terms of progressing a field of inquiry [ 7 , 8 ].

Mixed methods reviews

As one reason for the growth in qualitative synthesis is what they can add to quantitative reviews, it is not surprising that there is also growing interest in mixed methods reviews. This reflects similar developments in primary research in mixing methods to examine the relationship between theory and empirical data which is of course the cornerstone of much research. But, both primary and secondary mixed methods research also face similar challenges in examining complex questions at different levels of analysis and of combining research findings investigated in different ways and may be based on very different epistemological assumptions [ 14 , 15 ].

Some mixed methods approaches are convergent in that they integrate different data and methods of analysis together at the same time [ 16 , 17 ]. Convergent systematic reviews could be described as having broad inclusion criteria (or two or more different sets of criteria) for methods of primary studies and have special methods for the synthesis of the resultant variation in data. Other reviews (and also primary mixed methods studies) are sequences of sub-reviews in that one sub-study using one research paradigm is followed by another sub-study with a different research paradigm. In other words, a qualitative synthesis might be used to explore the findings of a prior quantitative synthesis or vice versa [ 16 , 17 ].

An example of a predominantly aggregative sub-review followed by a configuring sub-review is the EPPI-Centre’s mixed methods review of barriers to healthy eating [ 18 ]. A sub-review on the effectiveness of public health interventions showed a modest effect size. A configuring review of studies of children and young people’s understanding and views about eating provided evidence that the public health interventions did not take good account of such user views research, and that the interventions most closely aligned to the user views were the most effective. The already mentioned qualitative comparative analysis to identify the active ingredients within interventions leading to impact could also be considered a qualitative configuring investigation of an existing quantitative aggregative review [ 10 ].

An example of a predominantly configurative review followed by an aggregative review is realist synthesis. Realist reviews examine the evidence in support of mid-range theories [ 19 ] with a first stage of a configuring review of what is proposed by the theory or proposal (what would need to be in place and what casual pathways would have to be effective for the outcomes proposed by the theory to be supported?) and a second stage searching for empirical evidence to test for those necessary conditions and effectiveness of the pathways. The empirical testing does not however use a standard ‘what works’ a priori methods approach but rather a more iterative seeking out of evidence that confirms or undermines the theory being evaluated [ 20 ].

Although sequential mixed methods approaches are considered to be sub-parts of one larger study, they could be separate studies as part of a long-term strategic approach to studying an issue. We tend to see both primary studies and reviews as one-off events, yet reviews are a way of examining what we know and what more we want to know as a strategic approach to studying an issue over time. If we are in favour of mixing paradigms of research to enable multiple levels and perspectives and mixing of theory development and empirical evaluation, then we are really seeking mixed methods research strategies rather than simply mixed methods studies and reviews.

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Gough, D. Qualitative and mixed methods in systematic reviews. Syst Rev 4 , 181 (2015). https://doi.org/10.1186/s13643-015-0151-y

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Methodology

Systematic Review | Definition, Example, & Guide

Systematic Review | Definition, Example & Guide

Published on June 15, 2022 by Shaun Turney . Revised on November 20, 2023.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question “What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?”

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

What is a systematic review, systematic review vs. meta-analysis, systematic review vs. literature review, systematic review vs. scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, other interesting articles, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce bias . The methods are repeatable, and the approach is formal and systematic:

Formulate a research question
Develop a protocol
Search for all relevant studies
Apply the selection criteria
Extract the data
Synthesize the data
Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesizing all available evidence and evaluating the quality of the evidence. Synthesizing means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

Prevent plagiarism. Run a free check.

Systematic reviews often quantitatively synthesize the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesize results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimize bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
If you’re doing a systematic review on your own (e.g., for a research paper or thesis ), you should take appropriate measures to ensure the validity and reliability of your research.
Access to databases and journal archives. Often, your educational institution provides you with access.
Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

They minimize research bias by considering all available evidence and evaluating each study for bias.
Their methods are transparent , so they can be scrutinized by others.
They’re thorough : they summarize all available evidence.
They can be replicated and updated by others.

Systematic reviews also have a few cons .

They’re time-consuming .
They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

Allow you to more effectively communicate your research to other researchers and practitioners
Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

Population(s) or problem(s)
Intervention(s)
Comparison(s)

You can rearrange these four components to write your research question:

What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fifth component, the type of study design . In this case, the acronym is PICOT .

Type of study design(s)
The population of patients with eczema
The intervention of probiotics
In comparison to no treatment, placebo , or non-probiotic treatment
The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
Randomized control trials, a type of study design

Their research question was:

What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

Background information : Provide the context of the research question, including why it’s important.
Research objective (s) : Rephrase your research question as an objective.
Selection criteria: State how you’ll decide which studies to include or exclude from your review.
Search strategy: Discuss your plan for finding studies.
Analysis: Explain what information you’ll collect from the studies and how you’ll synthesize the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
Gray literature: Gray literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of gray literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of gray literature.
Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
Handsearch: Conference proceedings and reference lists of articles
Gray literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarize what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
Your judgment of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomized into the control and treatment groups.

Step 6: Synthesize the data

Synthesizing the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesizing the data:

Narrative ( qualitative ): Summarize the information in words. You’ll need to discuss the studies and assess their overall quality.
Quantitative : Use statistical methods to summarize and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analyzed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

Abstract : A summary of the review
Introduction : Including the rationale and objectives
Methods : Including the selection criteria, search method, data extraction method, and synthesis method
Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
Discussion : Including interpretation of the results and limitations of the review
Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

In their report, Boyle and colleagues concluded that probiotics cannot be recommended for reducing eczema symptoms or improving quality of life in patients with eczema. Note Generative AI tools like ChatGPT can be useful at various stages of the writing and research process and can help you to write your systematic review. However, we strongly advise against trying to pass AI-generated text off as your own work.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

Student’s t -distribution
Normal distribution
Null and Alternative Hypotheses
Chi square tests
Confidence interval
Quartiles & Quantiles
Cluster sampling
Stratified sampling
Data cleansing
Reproducibility vs Replicability
Peer review
Prospective cohort study

Research bias

Implicit bias
Cognitive bias
Placebo effect
Hawthorne effect
Hindsight bias
Affect heuristic
Social desirability bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other academic texts , with an introduction , a main body, and a conclusion .

An annotated bibliography is a list of source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a paper .

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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About Systematic Reviews

Are Systematic Reviews Qualitative or Quantitative?

Automate every stage of your literature review to produce evidence-based research faster and more accurately.

A systematic review is designed to be transparent and replicable. Therefore, systematic reviews are considered reliable tools in scientific research and clinical practice. They synthesize the results using multiple primary studies by using strategies that minimize bias and random errors. Depending on the research question and the objectives of the research, the reviews can either be qualitative or quantitative. Qualitative reviews deal with understanding concepts, thoughts, or experiences. Quantitative reviews are employed when researchers want to test or confirm a hypothesis or theory. Let’s look at some of the differences between these two types of reviews.

To learn more about how long it takes to do a systematic review , you can check out the link to our full article on the topic.

Differences between Qualitative and Quantitative Reviews

The differences lie in the scope of the research, the methodology followed, and the type of questions they attempt to answer. Some of these differences include:

Research Questions

As mentioned earlier qualitative reviews attempt to answer open-ended research questions to understand or formulate hypotheses. This type of research is used to gather in-depth insights into new topics. Quantitative reviews, on the other hand, test or confirm existing hypotheses. This type of research is used to establish generalizable facts about a topic.

Type of Sample Data

The data collected for both types of research differ significantly. For qualitative research, data is collected as words using observations, interviews, and interactions with study subjects or from literature reviews. Quantitative studies collect data as numbers, usually from a larger sample size.

Data Collection Methods

To collect data as words for a qualitative study, researchers can employ tools such as interviews, recorded observations, focused groups, videos, or by collecting literature reviews on the same subject. For quantitative studies, data from primary sources is collected as numbers using rating scales and counting frequencies. The data for these studies can also be collected as measurements of variables from a well-designed experiment carried out under pre-defined, monitored conditions.

Data Analysis Methods

Data by itself cannot prove or demonstrate anything unless it is analyzed. Qualitative data is more challenging to analyze than quantitative data. A few different approaches to analyzing qualitative data include content analysis, thematic analysis, and discourse analysis. The goal of all of these approaches is to carefully analyze textual data to identify patterns, themes, and the meaning of words or phrases.

Quantitative data, since it is in the form of numbers, is analyzed using simple math or statistical methods. There are several software programs that can be used for mathematical and statistical analysis of numerical data.

Presentation of Results

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Final Takeaway – Qualitative or Quantitative?

3 reasons to connect.

Locations and Hours
UCLA Library
Research Guides
Biomedical Library Guides

Systematic Reviews

Types of Literature Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

Planning Your Systematic Review
Database Searching
Creating the Search
Search Filters and Hedges
Grey Literature
Managing and Appraising Results
Further Resources

Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x


	Aims to demonstrate writer has extensively researched literature and critically evaluated its quality. Goes beyond mere description to include degree of analysis and conceptual innovation. Typically results in hypothesis or mode	Seeks to identify most significant items in the field	No formal quality assessment. Attempts to evaluate according to contribution	Typically narrative, perhaps conceptual or chronological	Significant component: seeks to identify conceptual contribution to embody existing or derive new theory
	Generic term: published materials that provide examination of recent or current literature. Can cover wide range of subjects at various levels of completeness and comprehensiveness. May include research findings	May or may not include comprehensive searching	May or may not include quality assessment	Typically narrative	Analysis may be chronological, conceptual, thematic, etc.
Mapping review/ systematic map	Map out and categorize existing literature from which to commission further reviews and/or primary research by identifying gaps in research literature	Completeness of searching determined by time/scope constraints	No formal quality assessment	May be graphical and tabular	Characterizes quantity and quality of literature, perhaps by study design and other key features. May identify need for primary or secondary research
	Technique that statistically combines the results of quantitative studies to provide a more precise effect of the results	Aims for exhaustive, comprehensive searching. May use funnel plot to assess completeness	Quality assessment may determine inclusion/ exclusion and/or sensitivity analyses	Graphical and tabular with narrative commentary	Numerical analysis of measures of effect assuming absence of heterogeneity
	Refers to any combination of methods where one significant component is a literature review (usually systematic). Within a review context it refers to a combination of review approaches for example combining quantitative with qualitative research or outcome with process studies	Requires either very sensitive search to retrieve all studies or separately conceived quantitative and qualitative strategies	Requires either a generic appraisal instrument or separate appraisal processes with corresponding checklists	Typically both components will be presented as narrative and in tables. May also employ graphical means of integrating quantitative and qualitative studies	Analysis may characterise both literatures and look for correlations between characteristics or use gap analysis to identify aspects absent in one literature but missing in the other
	Generic term: summary of the [medical] literature that attempts to survey the literature and describe its characteristics	May or may not include comprehensive searching (depends whether systematic overview or not)	May or may not include quality assessment (depends whether systematic overview or not)	Synthesis depends on whether systematic or not. Typically narrative but may include tabular features	Analysis may be chronological, conceptual, thematic, etc.
	Method for integrating or comparing the findings from qualitative studies. It looks for ‘themes’ or ‘constructs’ that lie in or across individual qualitative studies	May employ selective or purposive sampling	Quality assessment typically used to mediate messages not for inclusion/exclusion	Qualitative, narrative synthesis	Thematic analysis, may include conceptual models
	Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research	Completeness of searching determined by time constraints	Time-limited formal quality assessment	Typically narrative and tabular	Quantities of literature and overall quality/direction of effect of literature
	Preliminary assessment of potential size and scope of available research literature. Aims to identify nature and extent of research evidence (usually including ongoing research)	Completeness of searching determined by time/scope constraints. May include research in progress	No formal quality assessment	Typically tabular with some narrative commentary	Characterizes quantity and quality of literature, perhaps by study design and other key features. Attempts to specify a viable review
	Tend to address more current matters in contrast to other combined retrospective and current approaches. May offer new perspectives	Aims for comprehensive searching of current literature	No formal quality assessment	Typically narrative, may have tabular accompaniment	Current state of knowledge and priorities for future investigation and research
	Seeks to systematically search for, appraise and synthesis research evidence, often adhering to guidelines on the conduct of a review	Aims for exhaustive, comprehensive searching	Quality assessment may determine inclusion/exclusion	Typically narrative with tabular accompaniment	What is known; recommendations for practice. What remains unknown; uncertainty around findings, recommendations for future research
	Combines strengths of critical review with a comprehensive search process. Typically addresses broad questions to produce ‘best evidence synthesis’	Aims for exhaustive, comprehensive searching	May or may not include quality assessment	Minimal narrative, tabular summary of studies	What is known; recommendations for practice. Limitations
	Attempt to include elements of systematic review process while stopping short of systematic review. Typically conducted as postgraduate student assignment	May or may not include comprehensive searching	May or may not include quality assessment	Typically narrative with tabular accompaniment	What is known; uncertainty around findings; limitations of methodology
	Specifically refers to review compiling evidence from multiple reviews into one accessible and usable document. Focuses on broad condition or problem for which there are competing interventions and highlights reviews that address these interventions and their results	Identification of component reviews, but no search for primary studies	Quality assessment of studies within component reviews and/or of reviews themselves	Graphical and tabular with narrative commentary	What is known; recommendations for practice. What remains unknown; recommendations for future research

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Systematic Review: Home

Systematic Reviews using PubMed
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Literature search
Referencing tools
Recommended books on Systematic Review

Systematic Reviews

What is a systematic review.

A systematic literature review is a method of synthesising scientific evidence and ensuring the quality of this evidence to answer a particular research question transparently and reproducibly. An accurate Systematic review includes all available published outputs on the topic (Guillaume, 2019).

Types systematic review

1. Scoping review A scoping review is a preliminary assessment of the potential size and scope of available research literature. It aims to identify the nature and extent of research evidence (usually including ongoing research).

2. Rapid review Rapid reviews assess what is already known about a policy or practice issue. They use systematic review methods to search for and critically appraise existing research.

3. Narrative review Also called a literature review. It synthesises primary studies and explores this through description rather than statistics. Library support for literature review can be found in this guide.

4. Meta-analysis A meta-analysis statistically combines the results of quantitative studies to provide a more precise effect on the results. This type of study examines data from multiple studies on the same subject to determine trends.

5. Mixed methods/mixed studies Refers to any combination of methods where one significant component is a literature review (usually systematic review).

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Systematic Review
Open access
Published: 14 August 2024

Experiences of informal caregivers supporting individuals with upper gastrointestinal cancers: a systematic review

Melinda Furtado ORCID: orcid.org/0000-0001-5472-4707 1 ,
Dawn Davis 1 ,
Jenny M. Groarke 1 , 2 &
Lisa Graham-Wisener 1

BMC Health Services Research volume 24 , Article number: 932 ( 2024 ) Cite this article

143 Accesses

Metrics details

Upper gastrointestinal cancers (UGICs) are increasingly prevalent. With a poor prognosis and significant longer-term effects, UGICs present significant adjustment challenges for individuals with cancer and their informal caregivers. However, the supportive care needs of these informal caregivers are largely unknown. This systematic review of qualitative studies synthesises and critically evaluates the current evidence base on the experience of informal caregivers of individuals with UGIC.

A Joanna Briggs Institute systematic review was conducted. Searches were performed in four databases (MEDLINE, PsycINFO, Embase, CINAHL) from database inception to February 2021. Included studies explored experiences of informal caregivers of individuals diagnosed with primary cancer of the oesophagus, stomach, pancreas, bile duct, gallbladder, or liver. Studies were independently screened for eligibility and included studies were appraised for quality by two reviewers. Data were extracted and synthesised using meta-aggregation.

19 papers were included in this review, and 328 findings were extracted. These were aggregated into 16 categories across three findings: (1) UGIC caregiver burden; UGIC caregivers undertake extensive responsibilities, especially around patient diet as digestion is severely impacted by UGICs. (2) Mediators of caregiver burden; The nature of UGICs, characterised by disruptive life changes for caregivers, was identified as a mediator for caregiver burden. (3) Consequences of caregiver burden: UGIC caregivers’ experiences were shaped by unmet needs, a lack of information and a general decline in social interaction.

Conclusions

The findings of this review suggest the need for a cultural shift within health services. Caregiving for UGIC patients is suggested to adversely affect caregivers’ quality of life, similarly to other cancer caregiving populations and therefore they should be better incorporated as co-clients in care-planning and execution by including them in discussions about the patient’s diagnosis, treatment options, and potential side effects.

Peer Review reports

The National Institute for Clinical Excellence (NICE) [ 1 ] define upper gastrointestinal cancers (UGICs) as cancers of the oesophagus, stomach, pancreas, bile duct/gallbladder, or liver. Of all new cancer diagnoses in 2020 globally, 16.6% were UGICs [ 2 ]. Incidence of UGICs is increasing in countries under economic transition, and in Western countries due to heightened exposure to certain risk factors [ 3 ]. Overall prevalence of UGICs is also expected to rise annually with growing life expectancy and improved diagnostics [ 4 ]. Despite this, UGICs still have a uniquely poor prognosis in comparison to other cancer populations [ 5 ]. UGICs do not typically benefit from screening programmes and individuals are more likely to present at diagnosis with advanced disease [ 6 ]. This is compounded by a high rate of recurrence for individuals able to receive curative treatment [ 7 , 8 , 9 ]. As a result, UGICs persistently account for a significant proportion of global cancer deaths; 27.1% in 2020 [ 2 ]. Poor prognosis contributes significantly to the heightened disease burden of UGIC, alongside increased utilisation of health services due to the complexity of the treatment trajectory and symptom management [ 10 , 11 ]. In comparison to other cancer populations, having UGIC is associated with late consultation with palliative care services [ 12 ] meaning patients and their families have delayed access, if any, to supportive interventions such as counselling, psycho-education, financial advice and structured family meetings [ 13 ].

The supportive care needs of the sizeable population of individuals with UGIC are considerable, with sustained late and longer-term effects. In addition to the common sequalae from cancer diagnosis and treatment, disruption to the digestive system presents problems with swallowing, nausea and keeping food down, a modified diet, extreme changes in weight, chronic pain and living with a stoma [ 14 , 15 ]. The poor prognosis and longer-term effects present a challenge in adjustment both for the individual with UGIC and their informal caregiver, defined as “close persons” who may be related to the diagnosed individual (siblings, relatives, or spouses) or not (friends, neighbours). A caregiver is anyone identified as such by the patient to provide unpaid ongoing care and support [ 16 ]. Examples of challenges for caregivers include learning new practical skills such as managing negative responses to foods, providing a new diet, monitoring weight changes, chronic pain management and stoma management [ 17 , 18 ]. With biomedical advances leading to a reduction in hospital stay length [ 19 ], there is increasing emphasis placed on the role of the UGIC caregiver to provide support to the individual with cancer in the community.

This unique caregiver population face distinct challenges which contribute to caregiver burden which reflects the need for further research into their experiences. For example, due to changes in the diet of the individual with UGIC, the social aspect of dining for both is compromised and can lead to feelings of loneliness, anxiety, and shame [ 20 , 21 ]. Evidence of caregiver burden is suggested by high levels of anxiety and depression. In caregivers of post-treatment oesophageal cancer patients, 30% of caregivers reported moderate-high levels of anxiety and 10% reported moderate-high levels of depression, alongside a significant fear of recurrence [ 22 ]. Research suggests that UGIC caregivers may experience higher levels of psychological distress than the individual with UGIC, and that clinical levels of anxiety and depression may be sustained in the longer-term [ 22 , 23 ]. However it is worth noting that a lot of the effects of UGIC caregiving acknowledged in the literature are consistent with the general experience of informally providing care and as such there is scope to apply the beneficial practices from other settings (both extra-GI cancer and non-cancer).

It is crucial that we recognise the role of caregivers as co-clients and understand the experiences of this significant caregiver population. Caregivers’ personal experiences are inherently subjective, and due to this subjective nature, a qualitative research approach is optimal [ 24 ]. A synthesis of existing qualitative studies will help to establish a knowledge base on the experience of informal caregivers of individuals with UGIC and will help to inform the provision for supportive care. An initial search of PROSPERO, MEDLINE, the Cochrane Database of Systematic Reviews and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports was conducted and no current or underway systematic reviews on the topic were identified.

This qualitative systematic review aims to synthesise the best available evidence on the experiences of informal caregivers supporting individuals diagnosed with UGIC.

This systematic review was conducted following the JBI approach to qualitative systematic reviews [ 25 ]. A protocol was pre-registered in PROSPERO (registration number CRD42021235354). The systematic review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) statement [ 26 ].

Search strategy

An initial limited search of MEDLINE (Ovid) and PsycINFO (Ovid) was undertaken using the following keywords: Oesophageal cancer OR Stomach cancer OR Gastrointestinal cancer OR pancreas cancer OR gallbladder cancer OR liver cancer AND caregiver AND Qualitative. The text words contained in the titles and abstracts of relevant articles, and the index terms used to describe the articles were used to develop a full search strategy for MEDLINE and adapted for the other databases.

The final search strategy (Additional information 1 ) was then employed against four databases: MEDLINE (Ovid), PsycINFO (Ovid), Embase (Elsevier) and CINAHL (EBSCOhost). Each database was searched on 12th February 2021.

Study selection

Following the formal searches, all identified citations were collated and uploaded into Endnote [ 27 ] to identify and remove duplicates. Rayyan reference management software [ 28 ] was then used by independent two reviewers (DD, MF) to screen titles and abstracts against the eligibility criteria. Potentially relevant articles were retrieved in full and screened against the eligibility criteria by two independent reviewers (DD, MF). Reasons for exclusion of papers at full text review were recorded. Any disagreements that arose between the reviewers at each stage of the selection process was resolved through discussion (DD, MF), or with an additional reviewer (LGW). The reference list and citation list of all eligible articles was searched for additional studies.

Inclusion and exclusion criteria

This review included studies exploring experiences of adults (≥ 18 years of age) who are informal caregivers of individuals diagnosed with UGIC at any stage within the disease process. This included those diagnosed with cancer of the oesophagus, stomach, pancreas, bile duct, gallbladder, or liver [ 1 ]. This diagnosis must be the primary cancer site. Studies involving informal caregivers of individuals who had secondary gastrointestinal system metastases were not included.

A caregiver is anyone identified as such by the patient to provide unpaid ongoing care and support [ 16 ]. Paid professional caregivers were not included. The caregivers included provided various services, such as practical (providing transport, overseeing meals) or emotional support roles in caring for the patient. Caregivers with any gender or ethnicity were considered for inclusion. Both active and bereaved caregivers were eligible, if discussing their pre-bereavement experience.

Studies which reviewed experiences of multiple groups (e.g., patients, caregivers, healthcare professionals) or multiple cancers beyond the remit of UGIC were included, provided the data pertaining to informal caregivers and UGICs was clearly delineated and could be extracted separately. Where data was hard to distinguish regarding participant-type or cancer-type, the study was only included if at least 50% of the sample size was drawn from the target population.

Phenomena of interest

The review included qualitative studies that looked at caregivers’ experiences of caring for an individual with UGIC.

Studies for inclusion were based in any geographic location or setting. All care contexts were considered relevant (e.g., primary care, secondary, tertiary, community, or home settings).

Types of studies

Research studies considered for inclusion were focused on qualitative data including, but not limited to; designs such as phenomenology, grounded theory, ethnography, action research and feminist research. Mixed method studies were considered relevant if data from the qualitative component could be clearly extracted. Only English language studies were included.

Only empirical studies published in peer-reviewed journals were included. There was no restriction on publication year. Systematic reviews were not included, however relevant studies were harvested from them, when relevant. Editorials, opinion papers, case studies and any articles without relevant, original data were excluded, alongside grey literature.

Quality Appraisal

Subsequently, two independent reviewers (DD, MF) critically appraised the included studies to evaluate the strength of the evidence for methodological quality using the JBI Critical Appraisal Checklist for Qualitative Research [ 29 ]. All studies, regardless of the results of their methodological quality, underwent data extraction and synthesis. One of the included studies employed use of free-test questionnaires [ 30 ], the robustness of which has been called into question by qualitative researchers as the data generated from these responses is rarely rich enough to provide the necessary strong insights [ 31 ]. However, the reviewers felt the robustness of this study was upheld by the fact that the researchers conducted a comprehensive search on existing literature prior to data collection, thus allowing questionnaire findings to be scaffolded onto existing conceptual frameworks.

Data extraction

Data were extracted using standardized JBI data extraction tool [ 32 ] by two independent reviewers (DD, MF). Each undertook data extraction for half of the articles and then checked the other reviewer’s data extraction. The extracted data included specific details about the population, context, study methods and the phenomena of interest relevant to the review objective. Disagreements between the reviewers were resolved through discussion. Four authors of papers were contacted to request missing or additional data for clarification mainly regarding breakdown of participant populations by cancer type of which no new information arose.

A finding is defined by the JBI as “a verbatim extract of the author’s analytic interpretation accompanied by either a participant voice, or fieldwork observations or other data.” [ 33 , p40]. Findings were identified through repeated reading of the text, and extraction of findings included any distinct analytic observation reported by authors with an accompanying illustration (Additional information 2 ).

Data synthesis

Each finding was identified by an alphanumeric code (e.g., A1, A2, B1, etc.). Each letter corresponded to a study and each number to a unique finding. The progressive numbers indicate the order of the findings within the original article. Each finding was rated with one of three levels of credibility as per the ConQual system [ 34 ]:

Unequivocal - findings accompanied by an illustration that is beyond reasonable doubt and therefore not open to challenge.

Credible - findings accompanied by an illustration lacking clear association with it and therefore open to challenge.

Not Supported - findings are not supported by the data.

Qualitative research findings were pooled with the meta-aggregation approach and captured in a Microsoft Excel spreadsheet [ 33 ]. Findings were aggregated by assembling the findings and categorizing these findings based on similarity in meaning, then labelling the categories accordingly. Categories were then synthesised to produce a comprehensive set of synthesized findings. Two reviewers (DD, MF) repeatedly read the findings and developed a set of categories. To assess the quality and confidence of each qualitative finding synthesised within this review, authors utilised the ConQual system (Additional information 3 ), a tool used to assign ratings of confidence in synthesised qualitative research findings [ 34 ]. Only unequivocal and credible findings were included in the synthesis.

The combined database searches yielded 5465 records. After removing duplicates and screening studies against eligibility criteria (Fig. 1 ), the review included 19 studies [ 18 , 30 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Additional information 4 displays the characteristics of the 19 included studies.

PRISMA flowchart of study selection process

Description of included studies

All included studies were published between 2004 and 2021. Most commonly, studies focused on caregivers of individuals with oesophageal cancer ( N = 7), or pancreatic ( N = 7), including one study of pancreatic and bile duct cancer. Other studies included caregivers of individuals with liver cancer ( N = 2), gastric cancer ( N = 1) and the gastrointestinal tract generally ( N = 2). Geographically, studies were conducted in eight regions. The largest group ( N = 6) were conducted in the US [ 35 , 37 , 38 , 39 , 40 , 41 ], followed by Denmark ( N = 3) [ 42 , 43 , 44 ]. Most samples included a variety of within-family caregivers ( N = 13), generally spouses/partners, children, and siblings. Others ( N = 3) looked specifically at spouses and three did not specify the caregiver-patient relationship. Most studies included a semi-structured interview format ( N = 12), others used focus groups ( N = 4), secondary analysis of existing data ( N = 2) or questionnaires ( N = 1).

Quality of included studies

The JBI Critical Appraisal Checklist [ 25 ] was used to establish the quality of the research. The included studies were generally of good quality, with all 19 papers achieving at least 60% across the ten JBI quality assessment criteria (Additional information 5 ). Within the JBI checklist there are five questions assessing study dependability, where the studies performed at a lower satisfactory level. Of the included papers, two achieved a 5/5 score on dependability questions, seven achieved 4/5, nine scored 3/5 and one scored 2/5. Only 26% of studies could adequately locate the researcher(s) culturally or theoretically and only 37% of papers addressed the influence of the researcher on the research and vice-versa. Conversely, nearly all papers adequately addressed the research methodology’s congruity on objectives, data collection, data representation and analysis.

Meta-aggregation findings

Across the 19 studies, 328 supported findings were extracted, of which 239 were unequivocal and 89 were credible. Findings could be aligned into 23 categories with unique core meanings, which were then synthesised into three findings: (1) UGIC caregiver burden; (2) Mediators of caregiver burden; (3) Consequences of caregiver burden (Additional information 6 ). Figure 2 outlines how the categories relate to the overarching synthesised findings. To remain grounded in the data, the actual participants’ words are used throughout the narrative and double quotation marks illustrate a direct caregiver quote. References given after a quotation links the quote to the study as outlined in Additional information 2 .

Structural arrangement of categories and synthesised findings

Synthesised finding 1: UGIC caregiver burden

As caregivers began supporting those with UGIC, they faced numerous challenges to adjustment. This largely stemmed from efforts to integrate a broad and complex caregiving role within their existing routine. Difficulties such as disruption to daily routines and meals impacted caregivers’ psychological wellbeing. Caregivers were often unprepared for this life disruption, leading them to seek out information from which to learn and distribute to others.

1. Breadth of the caregiver role

The extent of responsibilities on UGIC caregivers was perceived as broad and complex, with an ‘all encompassing’ focus on patient outcomes. UGIC caregivers ‘assume different roles’ [ 42 ].

“The food thing is omnipresent. We have been told that he is not allowed to have further weight loss (K23).

Specific responsibilities included working around reduced appetite and oral intake; monitoring physical signs e.g., patient weight; perioperative management such as care of surgical wounds and organising medical appointments and treatments.

“We’d have to keep. . .going with all the medical appointments and surgery and treatment” (B11).

2. Challenges around patients’ meals

Treatment for and progression of UGIC severely impacts the patient’s relationship with food; with diet quantity and content at times significantly altered. Adaption for the caregiver involved learning about dietary modifications and management of digestive symptoms such as dysphagia. Several studies found that the new dietary restrictions were a source of worry for caregivers regarding the patients’ weight [ 44 , 45 , 46 , 47 ]. The social importance of food was a common theme throughout the included studies, with interruption to established social norms perceived as distressing. Mealtimes are considered a ‘unifying family ritual’ [ 49 ], but when mealtimes constantly serve to remind caregivers of their responsibility of monitoring, they became a potential source of distress.

“I can’t get Bernard out of the small meals. . I have to ring him every day from work to tell him to eat” (A7).

3. Life disruption

UGIC was experienced as coming unexpectedly into caregivers’ lives, intruding on their existing routines, for instance, as working professionals or parents. Caregivers described their responsibilities as time and energy-consuming. This conflict caused caregivers to feel a loss of control [ 44 ]. Caregiving responsibilities for UGICs demanded commitment over a long-time frame, impacting caregivers’ employability and their ‘own social life’ [ 35 ]:

“It’s changed my daily routine. It totally disrupted my life. I have to rearrange a lot of things such as my kids , my work , and getting help for my house cleaning” (J4).

4. Unpreparedness

Caregivers expressed being ill-equipped and unqualified to manage the needs of the UGIC patient. Caregivers reported feeling out of their depth, partially attributed to the lack of available support, relating to patients’ medical requirements:

“I went , ‘You’re not supposed to call 911? What am I supposed to do? What if he just dies right here?’ I mean , it seems they should have somebody say , ’OK , if he’s with you , then here’s the procedure…[The nurse] gave me really no support about what to do” (R21).

Caregivers sometimes felt misled about the extent of their new responsibilities, as while the patient was cared for in hospital by medical staff, they could not gauge what caregiving at home would involve.

“I wish they would have talked to me about it as well… it was a bit of a shock. …but the next morning it all dawned on me that I had just replaced a whole team” (E10).

5. Information manager

Caregivers perceived a key responsibility was to make executive decisions in the dissemination of information, for instance symptomatology, treatment plans and prognosis. Caregivers felt they were the ‘conduit’ [ 18 ] through which medical details were communicated to members of the extended social circle, a time-consuming role where they spent “hours on the phone telling everyone what is happening” (I32).

The caregivers also viewed their role as giving healthcare providers (HCPs) valuable insight into how the patient was coping outside of the medical setting:

“[describing a discussion during a clinical consultation , contradicting the patient] It is not correct that you almost eat as usual. You are eating food of more liquid substance than you usually do and your drinks are high-protein” (C1).

Synthesised finding 2: mediators of caregiver burden

While supporting patients with UGIC, caregivers are exposed to mediators which could increase or reduce caregiver burden, including their use of coping strategies, financial and social resources, and their caregiving context. For instance, higher levels of social support helped alleviate some caregiver burden. Similarly, how excluded a caregiver felt in the medical setting influenced the burden experienced.

1. Degree of inclusion in medical settings

Many studies reported that caregivers perceived they are often kept at a distance in medical settings, increasing caregiver burden. Although some caregivers felt this was fitting and chose to take a ‘subordinate position’ [ 44 ], others struggled with a sense of exclusion, which commonly left unresolved questions:

“…my husband could ask questions , but I didn’t have the space to ask questions , not unless my husband allowed it” (K39).

In such cases, caregivers relied on HCPs’ judgement. Caregivers described only being ‘seen’ if they actively called attention to themselves [ 41 ]. Caregivers experienced being left out of important decisions.

Caregivers expressed wanting to ask questions without the patient present but felt they had no opportunity to directly communicate with HCPs. This pervasive, default invisibility was perceived as disempowering:

“No health professionals involved me in this decision” (K38).

2. Social resources

The degree and quality of support received by caregivers varied and shaped their overall caring experience. The support network is especially beneficial for normalisation of caregivers’ experiences, providing hope and reducing feelings of isolation.

“it was only when I came here that I started talking to people … it was just like a breath of fresh air. . this dumping syndrome , he [the patient] wasn’t the only one” (A10).

Support could be from spiritual groups ( “I have a lot of people that stand behind me…” (B19), empathetic HCPs ( “It’s easier to talk with a nurse when it concerns important questions. You may receive quite good and reassuring answers” (H22) or peers who have undergone a similar caregiving experience, and therefore could reliably address and empathise with caregivers’ challenges.

3. Financial resources

Caregivers reported financial pressure as they had to consider the dyad’s financial situation while one or both members may not be able to work. Providing full-time care was a drain on caregivers’ resources, time, and money. Caregivers struggled with financial planning for the future in the face of prognostic ambiguity.

“We talked about if we should stay on at the house or sell it” (K6).

There were additional pressures on dyads living in countries where utilisation of private health services is the norm.

“Now my grandmother is sick and I can understand how high is the cost of the disease” (D5).

4. Patient-caregiver relationship

The caregiving experience was shaped by the inter-dyad relationship. Some caregivers reported having an emotionally distant relationship with the patient before the diagnosis which led to poor attachment during the cancer trajectory. Others reported a decline in the relationship quality due to cancer-related pressures.

“When I got upset , I would say to my husband , ‘You got cancer because you didn’t listen to me! You deserve it!” (F35).

Others noted a shift within the relationship, transitioning from ‘caregiver’ to ‘curer’ or from a spousal role to a parental one [ 45 ] especially where the caregiver was actively involved in delivering treatment:

“Sometimes I felt like a mother talking to a child: ‘Remember to do this and that’ ” (K29).

Caregivers experienced reciprocal suffering when seeing the patient suffer, especially if an established close relationship existed:

“up when the patient is up and down when the patient is down” (I21).

5. Emotion-focused coping

The cancer experience was perceived to result in significant distress for caregivers. To address this challenge, caregivers engaged in positive emotion-focused coping strategies to directly regulate distress. Many caregivers reported trying to maintain positive thinking. One participant recalled using humour:

“Sometimes you can’t believe what happens and the only thing you can do is laugh” (I41).

Maintaining a positive outlook was perceived to involve “looking for the good in every situation” and by being selective about what news caregivers received through ‘denial’ and “choosing what to hear” (I44). Conversely, another study described positivity as an open-minded reflection on the conflict between current suffering and spiritual beliefs [ 38 ]. Caregivers described how formally addressing their feelings through therapy was also helpful.

Individuals were limited in their opportunity for emotional expression. Caregivers described hiding their own negative thoughts from the patient and took practical measures to divert the patient’s attention by doing “normal things like [going] for a drive and [having] visits from our children and grandchildren” (C15).

6. Information seeking

Caregivers perceived challenges around a lack of information from HCPs regarding UGIC’s pathology and related management options. The experiences of caregivers included difficulties in accessing information.

“We have little information in these areas. When we go to the physician’s office for treatment , the doctor is too busy to give us information in this regard and he merely visits the patients. When we see that nobody could survive from such diseases , we get worried more” (D9).

Caregivers addressed the information challenge by persistently seeking information relating to the disease itself, namely cancer-related symptomatology, prognosis, and treatment options (including alternative therapies). Caregivers referred to sources like medically knowledgeable peers, the internet and print (e.g., encyclopaedias). HCPs were trusted for honest information, with their word choices and body language carefully analysed:

“When my husband and I visit the doctor together , you see when he opens the door that there is no good news today” (H6).

Caregivers were especially empowered when they could differentiate between symptoms due to disease progression and treatment-related adverse effects.

Synthesised finding 3: consequences of caregiver burden

There were consequences of caregiver burden such as feelings of helplessness, distress, anger, guilt and a strong fear of losing the patient. Conversely, there was potential for positive outcomes as caregivers experienced growth and feelings of hope.

1. Distress and helplessness

When recounting the most involved phase of providing care, active treatment, many caregivers reported experiencing heightened distress. One caregiver perceived gastric cancer a ‘death sentence’ [ 49 ], and seeing the patient struggle with the effects of disease and treatments an unbearably ‘ challenging experience’ [ 40 ]. This distress also affected children with one spouse noting their child’s “grades dropped disastrously during his first term” (H14).

Helplessness originates from a lack of control over the disease progression. A particular source of distress were the delays along the cancer trajectory, especially at diagnosis due to the ambiguous presentation of UGICs and lack of control over symptom management.

“It is distressing seeing him in pain all the time” (E6).

2. Anger and guilt

Caregivers experienced a sense of guilt and anger because they perceived stigma from society towards certain cancers. Others may assume that the diagnosis was caused by the patient’s behaviours and therefore indirectly the caregiver may also have been involved. A few studies described this judgement from society towards the patient, with caregivers fearing that others would see the diagnosis as a justified fate:

“You know , when you say cirrhosis of the liver , they think , ‘Oh , you drank yourself’” (R7).

Caregivers also harboured anger at being forced to take on caregiving responsibilities, describing they had “been dealt a bad hand” (I39); however, they felt guilty for feeling this way.

3. Fear of cancer progression and recurrence

Due to the unpredictability of UGICs, caregivers described living in constant dread of the patient’s health declining, and the potential for disease progression or recurrence:

“I am not sure I am going to like the answers I get. Maybe it is better not to know so very much but to do like the ostrich , to bury your head in the sand and hope for the best and keep your fingers crossed” (H41).

Caregivers were fearful of any new physical or psychological symptoms in patients, especially weight-loss, as caregivers saw this as a marker of recurrence. Further, caregivers feared the cancer would progress to a terminal stage which meant they were afraid of the means through which the bereavement would occur and their own subsequent reaction.

“the fear of not being sure of how it’s going to happen and how I’m going to react…I’m afraid of losing him” (L1).

The high mortality associated with most UGICs caused several caregivers to experience acceptance, with the realisation of the long-term impact of their loved one’s cancer and possibility of bereavement.

“The possibility is there for one of us dying quickly” (K5).

4. Isolation and loneliness

Caregivers commonly reported experiencing isolation within their unique role, feeling unable to share their anxieties. As patients were burdened already, caregivers did not want to unload their own worries on to the patient.

“And I had nobody to talk to…There was just nobody. I couldn’t let myself down , my guard down and I found the isolation terrible” (A3).

Loneliness was not only an ongoing concern, but a future threat as spousal caregivers relayed their fear of life post-bereavement.

5. Personal growth

Caregivers reflected that they saw the experience of caregiving as a catalyst for personal change, resulting in positive outcomes such as personal growth and appreciation for life, individually and within the relationship. Caregivers recounted that this unexpected, immense challenge had given them ‘ new perspectives about life’ [ 35 ]. Couples got to spend time together that they would not have had otherwise which led to an improved quality of relationship.

“We’ll talk three or four times a month. Where 10 years ago it might be 6 months or 10 months you know between phone calls” (B14).

The current study presents the first comprehensive synthesis of qualitative research on the experiences of caregivers of individuals with UGICs. This review is the first to systematically identify and synthesise the current evidence base on the experiences of informal caregivers of individuals with UGIC. Given the emergence of this prominent caregiver population, this review contributes to advancing cancer caregiver literature as a whole, an important area of study recognised by individuals with cancer, their family and healthcare professionals [ 52 ]. The review included 19 studies, presented synthesised findings, and identified aspects of caregiving experiences that UGIC caregivers have in common with other cancer caregivers, and aspects more distinct to UGICs. UGIC caregivers experience significant challenges contributing to high levels of burden which are mediated by social, psychological, and practical resources, as well as aspects of health service delivery. The consequences of caregiver burden are primarily negative, including distress, anger, fear, and loneliness.

Caregivers of UGIC patients experienced burden due to the breath and complexity of their role for which they felt unprepared. Caring involved incorporating novel skills into existing responsibilities, causing significant life disruption. Caregivers perceive burden in providing multifaceted care with demands that shift along the illness trajectory. For example, in the beginning caregivers felt it necessary to partake in provision of care, and due to UGIC treatment and disease progression, many responsibilities evolved to monitor and maximise physical health, such as diligent weight monitoring and meal preparation [ 45 , 46 , 47 ]. These findings align to the general cancer caregiver literature [ 53 ], with caregivers recognised in having steep initial learning curves to rapidly acquire skills to provide care. Only one of the 19 studies evaluated data over an extended period [ 45 ]. An extended review is needed to map supportive care resources available across the disease path and longitudinal studies tracking UGIC caregiver support needs across the illness trajectory is warranted.

One of the most reported findings in this review was informal caregivers’ continuous search for information related to their role. Many struggle to satisfy their informational needs at different stages of the disease trajectory contributing to caregiver burden. This corresponds with systematic review findings of Wang et al. [ 54 ] that informational needs were the most common unmet need of informal caregivers. To begin addressing this need, caregivers could be signposted to existing sources of general caregiver support information and interventions, such as Cancer Caring Coping [ 55 , 56 ]. These supports could be used to develop informational resources tailored for UGIC caregivers. A core information set has been developed to aid HCPs at consultation with UGIC patients, to ensure key information is being delivered [ 57 , 58 ] and now the focus of improving patient-carer education should be raising awareness of this key information toolkit to HCPs who commonly interact with this population. A similar approach could be utilised by identifying informational needs of UGIC caregivers at consultations and developing standardised information points delivered by HCPs to caregivers within those consultations. There is also potential to expand the pool of reliable sources of information to individuals outside of the HCP cohort, such as peer networks or psychologists in providing longitudinal support without necessarily adding to the cost burden required for the development of additional personnel and resources.

This review found caregivers experienced exclusion in the medical setting, suggesting enhanced communication between HCPs and caregivers could improve caregivers’ experience. Indeed, a qualitative study by Reblin et al. [ 59 ] identified communication within health services as a key driver for improving cancer caregiver support. One potential avenue to bridge the gap between HCPs and patient-caregiver dyad is incorporating better the clinical nurse specialist (CNS) [ 60 ] as these professionals can be a key contact for bi-directional communication between HCPs and caregivers. That is, caregivers support and help the clinical team to understand the patient’s progress and through this process HCPs acknowledge and include caregivers in the patient’s care. However, the current issue of under resourcing in cancer nursing would need to be addressed as it presently limits the amount of CNS time available to support caregivers [ 61 ].

One review finding specific to UGIC caregiver burden was the challenge around preparing meals. Taleghani and colleagues [ 62 ] mirror this, highlighting gastric caregivers experienced inadequate education in managing patient’s dietary requirements appropriately, resulting in feeling inefficient, uncomfortable, and fearful. Dietician-led interventions are typically patient focused [ 63 , 64 , 65 ]. However, this review highlights an opportunity for HCPs to include caregivers in dietician-led interventions as many caregivers assume responsibility over meal preparation and grocery shopping. The challenge around meals also has social consequences as meals are important social settings. Changes in eating behaviours can lead to both dyad members feeling isolated and lonely [ 18 , 66 ]. Loneliness is prevalent among people living with cancer and is influenced by cancer-specific and non-cancer specific risk factors, such as lack of social support [ 67 ]. There is less of an understanding of loneliness among UGIC caregivers compared to general cancer caregivers [ 68 ]. This is of concern as negative physical and mental health impacts of loneliness are well-established [ 69 , 70 ]. Peer support is the most used intervention to reduce caregivers’ loneliness, with strategies of psychoeducation and emotional support featuring prominently [ 71 ]. Research is needed to identify risk and protective factors for loneliness among UGIC caregivers.

In addition to loneliness, distress and negative affect were identified as consequences of UGIC caregiver burden. There is evidence of heightened distress and reduced physical and mental health among UGIC caregivers relative to UGIC patients [ 72 , 73 ]. This review also found that caregivers engage in emotion-focused strategies to cope with their caregiving role. A review by Teixeira et al. [ 74 ] found that among cancer caregivers, emotion-focused coping was related to higher distress, whereas problem-focused coping was related to better adjustment and reduced burden. There is a need to develop targeted theory-based psychosocial interventions for this caregiver group. The Transactional Theory of Stress and Coping (TTSC) framework could be utilised to understand how mediating processes specific to coping strategies influence distress and negative affect among UGIC caregivers [ 75 , 76 , 77 ], similar to how Bowan et al. [ 78 ] used a Baltes and Baltes [ 79 ] coping framework to develop interventions for cancer patients’ families. Candidate interventions could involve problem-solving and coping skills training [ 80 , 81 ], which could in turn ameliorate the negative consequences of caregiver burden. If effective with UGIC caregivers, such interventions could be extended to all caregivers as part of a standard care pathway. This review recommends further research to develop an understanding of adjustment in UGIC caregivers.

In contrast to the many negative consequences described by informal caregivers, there were a small group of findings which indicated some positive outcomes. These findings align with a review of the positive aspects of caregiving, which reported improved relationship quality, reward, fulfilment, and personal growth [ 82 ]. The review concluded that positive aspects of caregiving are interconnected and suggested, in addition to interventions reducing negative burden, that interventions could be developed to enhance positive outcomes, such as personal growth. Tedeschi and Calhoun’s Transformational Model (TM) [ 83 ] proposes that potentially traumatic stressors, such as caring for an individual diagnosed with cancer, cause a disruption in one’s worldview triggering attempts to make meaning in response to the stressor. Cognitive disruptions also lead to distress, which in turn can act as a catalyst for post-traumatic growth (PTG). Studies have found that caregivers of people with advanced cancer and early-stage breast cancer experience PTG in relation to their caregiving role [ 84 , 85 ], and that PTG was positively associated with greater social support and perceived hope [ 86 ]. Additional research is needed to understand how the challenging UGIC caregiver role may facilitate growth and help the caregiver adjust to their role.

Study limitations

The current systematic review has several strengths. Firstly, it followed an internationally recognised methodology (JBI) for the conduct of qualitative systematic reviews. This helped ensure methodological approach rigour and subsequently, confidence in findings should they be used to inform policy and practice. There are however several limitations. Although studies in the review are generally of good quality, only 19 studies were identified. Indeed, the UK Less Survivable Cancers Taskforce [ 87 ] advocates for more research focused on cancers with low life expectancy, two-thirds of which are UGICs. This lack of research into UGICs extends to the evidence on caregivers. Synthesised findings are therefore based on a small number of studies, largely conducted in the US and Denmark. Within the studies, caregivers of individuals with oesophageal and pancreatic cancer were well represented. However, there were a dearth of studies focused on caregivers’ experiences with gallbladder, or stomach cancer, alongside multiple studies exploring caregivers’ experiences related to dysphagia and malabsorption but fewer exploring jaundice. Therefore, more primary qualitative research is necessary to understand experiences of all UGIC caregiver populations.

Clinical implications

Of relevance for clinical practice was the finding that caregivers often felt excluded in medical settings, increasing caregiver burden. Caregivers should be seen as co-clients along with patients in the medical setting. This is very much in line with the priorities of care within palliative healthcare settings. Since the palliative care approach seeks to addresses the physical, psychological, cultural, social, and spiritual needs [ 88 ] of both individuals with life-limiting and chronic illnesses like cancer and their support networks, early referral to palliative care services could be particularly beneficial for caregivers as their needs are formally and expertly acknowledged and thus help alleviate the burden identified for informal caregivers in this study.

HCPs have an opportunity to give caregivers reliable, specific, and up-to-date information, pitched at the right level to reassure but not overwhelm. Morris and Thomas [ 89 ] mirror this suggestion and highlight its importance, as there is potential for tension in information exchange due to HCP’s lack of formal acknowledgement of caregivers. Clinical guidance and policy could be updated to include recognition of caregivers as co-clients, and with caregiver training, could formally be part of the patient support team. This could help meet the caregivers’ needs, especially post-diagnosis. On an institutional level, caregivers may be more recognised within their role if acknowledged formally, for example in NICE [ 1 ] guidelines for UGICs. In understanding the considerable role caregivers undertake supporting the care of UGIC patients outside of the healthcare system, policymakers and HCPs need to improve support for caregivers which will in turn reduce the burden on health services.

The aim of this qualitative systematic review was to synthesize evidence about the experiences of UGIC caregivers and has found that caregivers face significant challenges leading to caregiver burden which negatively impacts adjustment. Due to the nature of UGICs, caregivers experienced unique challenges such as how best to manage disruptions to mealtimes and how to monitor surrogate markers of patient health, such as weight. UGICs are a medically complex and evolving chronic condition and caregivers struggle to gain information. This review found that caregiver burden was impacted by feeling excluded in medical settings which could be improved with better communication between HCPs, patients, and their caregivers. There is a lack of data relating to the experiences of certain UGIC caregivers (e.g., gallbladder, stomach) in comparison to others (e.g., oesophageal), as well as a lack of understanding on how to manage the impact of caregiving for these types of cancer, thus providing directions for future research.

Data availability

No datasets were generated or analysed during the current study.

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Furtado, M., Davis, D., Groarke, J.M. et al. Experiences of informal caregivers supporting individuals with upper gastrointestinal cancers: a systematic review. BMC Health Serv Res 24 , 932 (2024). https://doi.org/10.1186/s12913-024-11306-3

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Systematic and other reviews: criteria and complexities

Robert t. sataloff.

1 Editor-in-Chief, Journal of Voice, Philadephia, USA

2 Editor Emeritus, Ear, Nose and Throat Journal, Philadephia, USA

Matthew L. Bush

3 Assistant Editor, Otology & Neurotology, Lexington, USA

Rakesh Chandra

4 Editor-in-Chief, Ear, Ear, Nose and Throat Journal, Nashville, USA

Douglas Chepeha

5 Editor-in-Chief, Journal of Otolaryngology – Head & Neck Surgery, Toronto, Canada

Brian Rotenberg

6 Editor-in-Chief, Journal of Otolaryngology – Head & Neck Surgery, London, Canada

Edward W. Fisher

7 Senior Editor, Journal of Laryngology and Otology, Birmingham, UK

David Goldenberg

8 Editor-in-Chief, Operative Techniques in Otolaryngology – Head and Neck Surgery, Hershey, USA

Ehab Y. Hanna

9 Editor-in-Chief, Head & Neck, Houston, USA

Joseph E. Kerschner

10 Editor-in-Chief, International Journal of Pediatric Otorhinolaryngology, Milwaukee, USA

Dennis H. Kraus

11 Co-Editor-in-Chief, Journal of Neurological Surgery Part B: Skull Base, New York, USA

John H. Krouse

12 Editor-in-Chief, Otolaryngology – Head and Neck Surgery, Philadelphia, USA

13 Editor-in-Chief, OTO-Open, Philadelphia, USA

14 Editor-in-Chief, Journal for Oto-Rhino-Laryngology, Head and Neck Surgery, Philadelphia, USA

15 Editor-in-Chief, World Journal of Otorhinolaryngology – Head and Neck Surgery, Philadelphia, USA

Michael Link

16 Co-Editor-in-Chief, Journal of Neurological Surgery Part B: Skull Base, Rochester, USA

Lawrence R. Lustig

17 Editor-in-Chief, Otology & Neurotology, New York, USA

Samuel H. Selesnick

18 Editor-in-Chief, The Laryngoscope, New York, USA

Raj Sindwani

19 Editor-in-Chief, American Journal of Rhinology & Allergy, Cleveland, USA

Richard J. Smith

20 Editor-in-Chief, Annals of Otology, Rhinology & Laryngology, Iowa City, USA

James Tysome

21 Editor-in-Chief, Clinical Otolaryngology, Cambridge, UK

Peter C. Weber

22 Editor-in-Chief, American Journal of Otolaryngology, Boston, USA

D. Bradley Welling

23 Editor-in-Chief, Laryngoscope Investigative Otolaryngology, Boston, USA

Review articles can be extremely valuable. They synthesize information for readers, often provide clarity and valuable insights into a topic; and good review articles tend to be cited frequently. Review articles do not require Institutional Review Board (IRB) approval if the data reviewed are public (including private and government databases) and if the articles reviewed have received IRB approval previously. However, some institutions require IRB review and exemption for review articles. So, authors should be familiar with their institution’s policy. In assessing and interpreting review articles, it is important to understand the article’s methodology, scholarly purpose and credibility. Many readers, and some journal reviewers, are not aware that there are different kinds of review articles with different definitions, criteria and academic impact [ 1 ]. In order to understand the importance and potential application of a review article, it is valuable for readers and reviewers to be able to classify review articles correctly.

Systematic reviews

Authors often submit articles that include the term “systematic” in the title without realizing that that term requires strict adherence to specific criteria. A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative or quantitative. However, if adequate and comparable quantitative data are available then a meta-analysis can be performed to assess the weighted and summarized effect size of the studies included. Depending on the research question and the data collected, systematic reviews may or may not include quantitative meta-analyses; however, meta-analyses should be performed in the setting of a systematic review to ensure that all of the appropriate data were accessed. The components of a systematic review can be found in an important article by Moher et al. published in 2009 that defined requirements for systematic reviews and meta-analyses [ 2 ].

In order to optimize reporting of meta-analyses, an international group developed the Quality of Reporting of Meta-Analyses (QUOROM) statement at a meeting in 1996 that led to publication of the QUOROM statement in 1999 [ 3 ]. Moher et al. revised that document and re-named the guidelines the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PRISMA statement included both meta-analyses and systematic reviews, and the authors incorporated definitions established by the Cochrane Collaboration [ 4 ]. The PRISMA statement established the current standard for systematic reviews. To qualify as a systematic review, the methods section should acknowledge use of the PRISMA guidelines, and all PRISMA components should be incorporated strictly in all facets of the paper from the research question to the discussion. The PRISMA statement includes a checklist of 27 items that must be included when reporting a systematic review or meta-analysis [ 2 ]. A downloadable version of this checklist can be used by authors, reviewers, and journal editorial staff to ensure compliance with recommended components [ 5 ]. All 27 will not be listed in this brief editorial (although authors and reviewers are encouraged to consult the article by Moher et al. and familiarize themselves with all items), but a few will be highlighted.

The research question, as reflected in the title, should be a hypothesis-based specific research inquiry. The introduction must describe the rationale for the review and provide a specific goal or set of goals to be addressed. The type of systematic review, according to the Cochrane Collaboration, is based on the research question being asked and may assess diagnostic test accuracy, review prognostic studies evidence, evaluate intervention effect, scrutinize research methodology, or summarize qualitative evidence [ 6 ].

In the methods section, the participants, interventions, comparisons, outcomes and study design (PICOS) must be put forward. In addition to mentioning compliance with PRISMA, the methods section should state whether a review protocol exists and, if so, where it can be accessed (including a registration number). Systematic reviews are eligible for registration in the International Prospective Register of Systematic Reviews (PROSPERO) as established at the University of York (York, UK). When PROSPERO is used (it is available but not required for systematic reviews), registration should occur at the initial protocol stage of the review, and the final paper should direct to the information in the register. The methods section also must include specific study characteristics including databases used, years considered, languages of articles included, specific inclusion and exclusion criteria for studies; and rationale for each criterion must be included. Which individuals specifically performed searches should be noted. Electronic search strategy (with a full description of at least one electronic search strategy sufficient to allow replication of the search), process for article selection, data variables sought, assumptions and simplifications, methods for assessing bias risk of each individual study (such as selective reporting in individual studies) and utilization of this information in data synthesis, principal summary measures (risk ratio, hazard ratio, difference in means, etc.), methods of data management and combining study results, outcome level assessment, and other information should be reported.

The results section should include the number of studies identified, screened, evaluated for eligibility (including rationale for exclusion), and those included in the final synthesis. A PRISMA flow diagram should be included to provide this information succinctly [ 7 ]. The results also should include the study characteristics, study results, risk of bias within and across studies, and a qualitative or quantitative synthesis of the results of the included studies. This level of rigor in acquiring and evaluating the evidence of each individual study is one of the criteria that distinguishes systematic reviews from other categories. If the systematic review involves studies with paired samples and quantitative data, a summary of data should be provided for each intervention group along with effect estimates and confidence intervals for all outcomes of each study. If a meta-analysis is performed, then synthesized effect size should be reported with confidence intervals and measures of consistency (i.e. – data heterogeneity such as I 2 ) for each meta-analysis, and assessment of bias risk across studies. A forest plot, which provides a graphical presentation of the meta-analysis results, should be included.

The discussion section should summarize the main findings commenting on the strength of evidence for each outcome, as well as relevance to healthcare providers, policymakers and other key stake-holders; limitations of the study and outcomes; and conclusions highlighting the interpretation of results in the context of other research, and implications for future research.

Without adhering to of all of these criteria and the others listed in the PRISMA statement and checklist, the review does not qualify to be classified as “systematic”.

Meta-analyses

Meta-analyses, when feasible based on available and comparable quantitative data, supplement a systematic review evaluation, by adding a secondary statistical analysis of the pooled weighted outcomes of similar studies. This adds a level of objectivity in the synthesis of the review’s findings. Meta-analyses are appropriate when at least 2 individual studies contain paired samples (experimental group and control group) and provide quantitative outcome data and sample size. Studies that lack a control group may over-estimate the effect size of the experimental intervention or condition being studied and are not ideal for meta-analyses [ 8 ]. It also should be remembered that the conclusions of a meta-analysis are only as valid as the data on which the analysis is based. If the articles included are flawed, then the conclusions of the meta-analysis also may be flawed. Systematic reviews and meta-analyses are the most rigorous categories of review.

Other types of reviews

Mixed methods reviews.

Systematic reviews typically contain a single type of data, either qualitative or quantitative; however, mixed methods reviews bring together a combination of data types or study types. This approach may be utilized when quantitative data, in the setting of an intervention study, only provide a narrow perspective of the efficacy or effectiveness of the intervention. The addition of qualitative data or qualitative studies may provide a more complete picture of the knowledge, attitudes, and behaviors of clinicians, patients or researchers regarding that intervention. This type of review could involve collecting either the quantitative or the qualitative data using systematic review methodology, but often the qualitative data are gathered using a convenience sampling. Many qualitative studies provide useful insights into clinical management and/or implementation of research interventions; and incorporating them into a mixed methods review may provide valuable perspective on a wide range of literature. Mixed methods reviews are not necessarily systematic in nature; however, authors conducting mixed methods reviews should follow systematic review methodology, when possible.

Literature and narrative reviews

Literature reviews include peer-reviewed original research, systematic reviews, and meta-analyses, but also may include conference abstracts, books, graduate degree theses, and other non-peer reviewed publications. The methods used to identify and evaluate studies should be specified, but they are less rigorous and comprehensive than those required for systematic reviews. Literature reviews can evaluate a broad topic but do not specifically articulate a specific question, nor do they synthesize the results of included studies rigorously. Like mixed method reviews, they provide an overview of published information on the topic, although they may be less comprehensive than integrative reviews; and, unlike systematic reviews, they do not need to support evidence-based clinical or research practices, or highlight high-quality evidence for the reader. Narrative reviews are similar to literature reviews and evaluate the same scope of literature. The terms sometimes are used interchangeably, and author bias in article selection and data interpretation is a potential concern in literature and narrative reviews.

Umbrella reviews

An umbrella review integrates previously published, high-quality reviews such as systematic reviews and meta-analyses. Its purpose is to synthesize information in previously published systematic reviews and meta-analyses into one convenient paper.

Rapid review

A rapid review uses systematic review methodology to evaluate existing research. It provides a quick synthesis of evidence and is used most commonly to assist in emergent decision-making such as that required to determine whether COVID-19 vaccines should receive emergent approval.

Scoping, mapping, and systematized reviews

If literature has not been reviewed comprehensively in a specific subject that is varied and complex, a mapping review (also called scoping review) may be useful to organize initial understanding of the topic and its available literature. While mapping reviews may be helpful in crystallizing research findings and may be published, they are particularly useful in helping to determine whether a topic is amenable to systematic review, and to help organize and direct the approach of the systematic review or other reviews of the subject. Systematized reviews are used most commonly by students. The systematized review provides initial assessment of a topic that is potentially appropriate for a systematic review, but a systematized review does not meet the rigorous criteria of a systematic review and has substantially more limited value. Additional types of reviews exist including critical review, state-of-the-art review, and others.

Reviews can be invaluable; but they also can be misleading. Systematic reviews and meta-analyses provide readers with the greatest confidence that rigorous efforts have attempted to eliminate bias and ensure validity, but even they have limitations based upon the strengths and weaknesses of the literature that they have assessed (and the skill and objectivity with which the authors have executed the review). Risks of bias, incomplete information and misinformation increase as the rigor of review methodology decreases. While review articles may summarize research related to a topic for readers, non-systematic reviews lack the rigor to answer adequately hypothesis-driven research questions that can influence evidence-based practice. Journal authors, reviewers, editorial staff, and should be cognizant of the strengths and weaknesses of review methodology and should consider them carefully as they assess the value of published review articles, particularly as they determine whether the information presented should alter their patient care.

Authors’ contributions

The author(s) read and approved the final manuscript.

Declarations

The authors declare no competing interests.

This article is co-published in the following journals: Journal of Voice, Otology & Neurotology, Ear, Nose and Throat Journal, Journal of Laryngology and Otology, Operative Techniques in Otolaryngology – Head and Neck Surgery, Head & Neck, International Journal of Pediatric Otorhinolaryngology, Journal of Neurological Surgery Part B: Skull Base, Otolaryngology – Head and Neck Surgery, World Journal of Otorhinolaryngology – Head and Neck Surgery, The Laryngoscope, American Journal of Rhinology & Allergy, Annals of Otology, Rhinology & Laryngology, Clinical Otolaryngology, American Journal of Otolaryngology, Laryngoscope Investigative Otolaryngology.

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The Acceptability, Engagement, and Feasibility of Mental Health Apps for Marginalized and Underserved Young People: Systematic Review and Qualitative Study

Bear ha., ayala nunes l., ramos g., manchanda t., fernandes b., chabursky s., walper s., watkins e., fazel m..

Background Smartphone apps may provide an opportunity to deliver mental health resources and interventions in a scalable and cost-effective manner. However, young people from marginalized and underserved groups face numerous and unique challenges to accessing, engaging with, and benefiting from these apps. Objective This study aims to better understand the acceptability (ie, perceived usefulness and satisfaction with an app) and feasibility (ie, the extent to which an app was successfully used) of mental health apps for underserved young people. A secondary aim was to establish whether adaptations can be made to increase the accessibility and inclusivity of apps for these groups. Methods We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19). Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases was conducted in 2021. The search yielded 18,687 results, of which 14 articles met the eligibility criteria. Results The included studies comprised a range of groups, including those affected by homelessness, having physical health conditions, living in low- and middle-income countries, and those with sexual and gender minority identities. Establishing and maintaining user engagement was a pervasive challenge across mental health apps and populations, and dropout was a reported problem among nearly all the included studies. Positive subjective reports of usability, satisfaction, and acceptability were insufficient to determine users’ objective engagement. Conclusions Despite the significant amount of funding directed to the development of mental health apps, juxtaposed with only limited empirical evidence to support their effectiveness, few apps have been deliberately developed or adapted to meet the heterogeneous needs of marginalized and underserved young people. Before mental health apps are scaled up, a greater understanding is needed of the types of services that more at-risk young people and those in limited-resource settings prefer (eg, standard vs digital) followed by more rigorous and consistent demonstrations of acceptability, effectiveness, and cost-effectiveness. Adopting an iterative participatory approach by involving young people in the development and evaluation process is an essential step in enhancing the adoption of any intervention, including apps, in “real-world” settings and will support future implementation and sustainability efforts to ensure that marginalized and underserved groups are reached. Trial Registration PROSPERO CRD42021254241; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=254241

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Hormonal influences on skeletal muscle function in women across life stages: a systematic review.

1. Introduction

Research significance, 2.1. search strategy.

Hormonal influence;
Skeletal muscle function;
Progesterone;
Adolescence;
Reproductive years;
Muscle metabolism;
Muscle strength;
Muscle recovery.

2.1.1. Inclusion Criteria

2.1.2. exclusion criteria, 2.2. selection process, 2.2.1. initial screening, 2.2.2. eligibility assessment, 2.2.3. data extraction.

Study characteristics (authors, publication year, study design);
Participant demographics (age, health status, hormonal status);
Details of hormonal measurements (types of hormones measured, measurement methods);
Outcomes related to skeletal muscle function (muscle strength, muscle mass, muscle metabolism, recovery metrics);
Intervention details, if applicable (type, duration, and outcome measures of hormonal or non-hormonal interventions);
Results and conclusions of the studies.

2.2.4. Quality Assessment

2.2.5. data synthesis.

Qualitative Synthesis: A narrative synthesis was conducted to provide a comprehensive summary of the findings from each study, highlighting common themes, differences, and gaps in the research.
Descriptive Synthesis: Where appropriate, descriptive statistics such as ranges, medians, and frequencies were used to summarize the outcomes related to hormonal influences on muscle function across different life stages.
A PRISMA checklist was used to ensure the transparency and completeness of this review process.

3.1. Study Characteristics

The selected studies comprised 20 randomized controlled trials, 15 cohort studies, and 10 cross-sectional studies. This mix of study designs provided a comprehensive view of the hormonal influences on skeletal muscle function.
The total number of participants across all included studies was approximately 2400, with ages ranging from 12 to 75 years.
The studies included both healthy individuals and those with specific health conditions that could impact muscle function, such as polycystic ovary syndrome (PCOS), menopause, and chronic diseases.
The participants were categorized into three main life stages: adolescence (12–18 years), reproductive years (19–45 years), and menopause (46 years and above).
Hormonal assessments varied among the studies, with most measuring the levels of estrogen and progesterone. Some studies also included measurements of other hormones such as testosterone, cortisol, and insulin-like growth factor 1 (IGF-1).
The methods of hormonal assessment included blood serum levels (used in 35 studies), urinary excretion (used in 7 studies), and salivary measurements (used in 3 studies).
Muscle strength was commonly assessed using grip strength tests (used in 25 studies), leg press exercises (used in 10 studies), and isokinetic dynamometry (used in 10 studies).
Muscle mass was evaluated through imaging techniques such as magnetic resonance imaging (MRI) (used in 15 studies), dual-energy X-ray absorptiometry (DEXA) (used in 20 studies), and bioelectrical impedance analysis (BIA) (used in 10 studies).
Muscle metabolism outcomes included glucose uptake rates (measured in 12 studies), fatty acid oxidation (measured in 8 studies), and metabolic enzyme activity (measured in 10 studies), often assessed through biopsy samples or metabolic testing.
Muscle recovery was assessed by examining the recovery time post-exercise and markers of muscle damage, such as creatine kinase levels (used in 12 studies).
Among the studies that included interventions, the types of interventions varied widely. Hormone replacement therapy (HRT) was used in 15 studies, exercise programs in 20 studies, and dietary supplements in 10 studies.
The duration of the interventions ranged from 8 weeks to 24 months, with outcome measures taken at multiple time points to assess the changes in muscle function.

3.2. Hormonal Influences in Adolescence

3.3. hormonal influences during reproductive years, 3.4. hormonal influences in menopause, 3.5. intervention efficacy, 4. discussion, 4.1. implications for health management.

Health Education and Monitoring: Educating adolescent girls about the importance of hormonal health and its impact on muscle function is crucial. Regular monitoring of hormonal levels and muscle health can help to identify any imbalances early on, allowing for timely interventions.
Tailored Physical Activity Programs: Implementing physical activity programs that are sensitive to hormonal changes during adolescence can optimize muscle development. Encouraging participation in resistance training and other strength-building exercises during periods of peak estrogen levels can maximize muscle gains.
Menstrual-Cycle-Based Training: Health practitioners and fitness trainers should consider the menstrual cycle when designing exercise programs for women in their reproductive years. Tailoring exercise intensity and type to different phases of the menstrual cycle can enhance muscle performance and recovery.
Pregnancy and Postpartum Care: Personalized exercise and nutritional plans during pregnancy and the postpartum period are essential. Ensuring that pregnant women receive adequate support to maintain muscle health through appropriate physical activities and dietary supplements can mitigate the adverse effects of pregnancy on muscle function.
Contraceptive Counseling: When prescribing hormonal contraceptives, healthcare providers should consider their potential impact on muscle function. Discussing the benefits and drawbacks of different contraceptive methods can help women to make informed choices that align with their muscle health goals.
Hormone Replacement Therapy (HRT): HRT can be a valuable tool for maintaining muscle health in postmenopausal women. Healthcare providers should evaluate the risks and benefits of HRT for each patient, considering factors such as family history, cardiovascular health, and bone density.
Resistance Training Programs: Developing specialized resistance training programs for postmenopausal women can help to counteract muscle atrophy and improve strength. These programs should focus on progressive resistance exercises to stimulate muscle protein synthesis and enhance metabolic function.
Nutritional Support: Adequate intake of protein, vitamin D, calcium, and omega-3 fatty acids is crucial for postmenopausal women. Healthcare providers should recommend dietary adjustments and supplements to support muscle health and overall well-being.
Personalized Medicine: The integration of hormonal assessments into routine health evaluations can help to personalize interventions for muscle health. Understanding each woman’s hormonal profile can guide the development of targeted exercise, nutritional, and therapeutic strategies.
Interdisciplinary Approach: Collaboration between endocrinologists, dietitians, physiotherapists, and fitness trainers is essential to create comprehensive health management plans. This interdisciplinary approach ensures that all aspects of hormonal health and muscle function are addressed.
Public Health Initiatives: Public health campaigns focused on the importance of hormonal health and its impact on muscle function can raise awareness and promote proactive health management. These initiatives can encourage women to seek regular hormonal assessments and adopt healthy lifestyle practices.

4.2. Clinical and Practical Relevance

Personalized Health Management: Understanding the hormonal influences on muscle function allows for the development of personalized health management plans that are tailored to the hormonal profiles and life stages of women. This approach can optimize muscle health and performance, prevent muscle-related diseases, and enhance overall well-being.
Targeted Interventions: Health practitioners can implement targeted interventions, such as phase-specific exercise programs and nutritional adjustments, to support muscle function in women during critical periods of hormonal change.
Hormonal Assessments: Regular hormonal assessments should be integrated into routine health evaluations for women, enabling the early identification of imbalances and timely interventions.
Interdisciplinary Collaboration: A collaborative approach involving endocrinologists, dietitians, physiotherapists, and fitness trainers is essential to create comprehensive health management plans that address all aspects of hormonal health and muscle function.
Public Health Initiatives: Public health campaigns focused on the importance of hormonal health and its impact on muscle function can raise awareness and promote proactive health management practices among women.

4.3. Limitations of This Study

Heterogeneity of Studies: The included studies varied widely in terms of participant demographics, study design, hormonal measurements, and outcome assessments. This heterogeneity may affect the generalizability of the findings.
Quality of Evidence: Although most studies were of high quality, some had limitations, such as small sample sizes, lack of blinding, or short follow-up periods. These factors could introduce bias and affect the reliability of the results.
Publication Bias: The potential for publication bias exists, as studies with significant findings are more likely to be published. This bias could skew the overall conclusions of this study.
Variability in Hormonal Measurements: Differences in methods of hormonal assessment (e.g., blood serum vs. urinary measurements) and timing of measurements relative to menstrual cycles or menopausal status could introduce variability in the findings.
Intervention Differences: The type, duration, and intensity of the interventions varied across the studies, making it challenging to directly compare the results. Standardizing intervention protocols in future research could improve comparability.

4.4. Recommendations for Future Research

Longitudinal Studies: Conducting long-term longitudinal studies can provide a more comprehensive view of how hormonal changes impact muscle function over time.
Standardized Protocols: Developing standardized protocols for hormonal measurements and intervention strategies can improve the consistency and comparability of study results.
Diverse Populations: Including diverse populations in terms of age, ethnicity, and health status can help to generalize findings and identify unique hormonal influences in different groups.
Mechanistic Studies: Investigating the underlying mechanisms of hormonal effects on muscle function at the molecular and cellular levels can provide deeper insights and inform targeted therapies.
Combined Interventions: Exploring the synergistic effects of combined interventions (e.g., HRT and resistance training) in large-scale, randomized controlled trials can help to identify the most effective strategies for maintaining muscle health.

5. Conclusions

Author contributions, institutional review board statement, informed consent statement, data availability statement, conflicts of interest.

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Kodete, C.S.; Thuraka, B.; Pasupuleti, V.; Malisetty, S. Hormonal Influences on Skeletal Muscle Function in Women across Life Stages: A Systematic Review. Muscles 2024 , 3 , 271-286. https://doi.org/10.3390/muscles3030024

Kodete CS, Thuraka B, Pasupuleti V, Malisetty S. Hormonal Influences on Skeletal Muscle Function in Women across Life Stages: A Systematic Review. Muscles . 2024; 3(3):271-286. https://doi.org/10.3390/muscles3030024

Kodete, Chandra Shikhi, Bharadwaj Thuraka, Vikram Pasupuleti, and Saiteja Malisetty. 2024. "Hormonal Influences on Skeletal Muscle Function in Women across Life Stages: A Systematic Review" Muscles 3, no. 3: 271-286. https://doi.org/10.3390/muscles3030024

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IMAGES

Integrating qualitative research with trials in systematic reviews
Systematic literature review phases.
Systematic Literature Review Methodology
systematic literature review steps
Process of the systematic literature review
How to Conduct a Systematic Review

COMMENTS

A Guide to Writing a Qualitative Systematic Review Protocol to Enhance
Methodology: The key elements required in a systematic review protocol are discussed, with a focus on application to qualitative reviews: Development of a research question; formulation of key search terms and strategies; designing a multistage review process; critical appraisal of qualitative literature; development of data extraction ...
Guidance on Conducting a Systematic Literature Review
Literature reviews establish the foundation of academic inquires. However, in the planning field, we lack rigorous systematic reviews. In this article, through a systematic search on the methodology of literature review, we categorize a typology of literature reviews, discuss steps in conducting a systematic literature review, and provide suggestions on how to enhance rigor in literature ...
Qualitative systematic reviews: their importance for our understanding
A qualitative systematic review brings together research on a topic, systematically searching for research evidence from primary qualitative studies and drawing the findings together. There is a debate over whether the search needs to be exhaustive. 1 , 2 Methods for systematic reviews of quantitative research are well established and explicit ...
Guidance to best tools and practices for systematic reviews
The gray literature and a search of trials may also reveal important details about topics that would otherwise be missed ... Qualitative systematic review: Qualitative synthesis: Synthesis of qualitative data a: Qualitative synthesis: Synthesis without meta-analysis: Narrative synthesis b, narrative summary.
Literature review as a research methodology: An overview and guidelines
Provides guidelines for conducting a systematic literature review in management research. Torraco (2005) ... This is often referred to as a qualitative systematic review, which can be described as a method of comparing findings from qualitative studies (Grant & Booth, 2009). That is, a strict systematic review process is used to collect ...
How to Do a Systematic Review: A Best Practice Guide for Conducting and
The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information.
Guidelines for writing a systematic review
A preliminary review, which can often result in a full systematic review, to understand the available research literature, is usually time or scope limited. Complies evidence from multiple reviews and does not search for primary studies. 3. Identifying a topic and developing inclusion/exclusion criteria.
How-to conduct a systematic literature review: A quick guide for
Method details Overview. A Systematic Literature Review (SLR) is a research methodology to collect, identify, and critically analyze the available research studies (e.g., articles, conference proceedings, books, dissertations) through a systematic procedure [12].An SLR updates the reader with current literature about a subject [6].The goal is to review critical points of current knowledge on a ...
Why Qualitative Research Needs More and Better Systematic Review
Those doing qualitative research cannot "opt out" of knowing their relevant scholarly conversations. Undertaking a qualitative systematic review provides a vital means to know and tune into the past conversation in your topic area that allows the researcher to position themselves and their work substantively, ontologically, theoretically, and methodologically in this landscape.
A Guide to Writing a Qualitative Systematic Review Protocol to Enhance
The qualitative systematic review is a rapidly developing area of nursing research. In order to present trustworthy, high-quality recommendations, such reviews should be based on a review protocol to minimize bias and enhance transparency and reproducibility. ... critical appraisal of qualitative literature; development of data extraction ...
How to Do a Systematic Review: A Best Practice Guide for Conducting and
The best reviews synthesize studies to draw broad theoretical conclusions about what a literature means, linking theory to evidence and evidence to theory. This guide describes how to plan, conduct, organize, and present a systematic review of quantitative (meta-analysis) or qualitative (narrative review, meta-synthesis) information.
Qualitative and mixed methods in systematic reviews
This Special Issue of Systematic Reviews Journal is providing a focus for these new methods of review whether these use qualitative review methods on their own or mixed together with more quantitative approaches. ... Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8:45.
Systematic Review
Systematic review vs. literature review. A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method. ... Narrative (qualitative): Summarize the information in ...
An overview of methodological approaches in systematic reviews
1. INTRODUCTION. Evidence synthesis is a prerequisite for knowledge translation. 1 A well conducted systematic review (SR), often in conjunction with meta‐analyses (MA) when appropriate, is considered the "gold standard" of methods for synthesizing evidence related to a topic of interest. 2 The central strength of an SR is the transparency of the methods used to systematically search ...
Are Systematic Reviews Qualitative or Quantitative
A systematic review can be qualitative, quantitative, or a combination of the two. The approach that is chosen is determined by the research question and the scope of the research. When qualitative and quantitative techniques are used together in a given study, it is called a mixed method. In a mixed-method study, synthesis for the quantitative ...
Systematic reviews: Brief overview of methods, limitations, and
CONCLUSION. Siddaway 16 noted that, "The best reviews synthesize studies to draw broad theoretical conclusions about what the literature means, linking theory to evidence and evidence to theory" (p. 747). To that end, high quality systematic reviews are explicit, rigorous, and reproducible. It is these three criteria that should guide authors seeking to write a systematic review or editors ...
Qualitative Evidence Synthesis: Where Are We at?
Through a QES, evidence is synthesized from primary qualitative studies with the aim of developing new cumulative knowledge. This differs to a more traditional literature review of qualitative research which seeks to combine studies in a summary format (Flemming & Jones, 2020).Depending on the QES method selected, the process can enable researchers to "go beyond" the individual findings of ...
Research Guides: Systematic Reviews: Types of Literature Reviews
Qualitative, narrative synthesis. Thematic analysis, may include conceptual models. Rapid review. Assessment of what is already known about a policy or practice issue, by using systematic review methods to search and critically appraise existing research. Completeness of searching determined by time constraints.
Home
What is a Systematic Review? A systematic review is a literature review that gathers all of the available evidence matching pre-specified eligibility criteria to answer a specific research question. It uses explicit, systematic methods, documented in a protocol, to minimize bias, provide reliable findings, and inform decision-making.
Home
A systematic literature review is a method of synthesising scientific evidence and ensuring the quality of this evidence to answer a particular research question transparently and reproducibly. An accurate Systematic review includes all available published outputs on the topic (Guillaume, 2019). Types systematic review. 1. Scoping review
Research Guides: Research at NJAES : Literature Reviews
There are many different types of literature reviews from traditional literature reviews to rigorous systematic reviews. Each has its own methodology. Please review resources on this page and familiarize yourself with the task, commitment, and purpose of each before trying to decide on the type of review best fitting your research question.
Mental health professionals' perceived barriers and enablers to shared
Background: Risk assessment and risk management are fundamental processes in the delivery of safe and effective mental health care, yet studies have shown that service users are often not directly involved or are unaware that an assessment has taken place. Shared decision-making in mental health systems is supported by research and advocated in policy. This systematic review (PROSPERO ...
Barriers and Solutions to the Gap between Theory and Practice in
The guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Joanna Briggs Institute methodology for Qualitative Systematic Reviews were used to perform and record a systematic search of the literature . In PROSPERO, an a priori protocol has been published (Registration No. CRD42023388954). 2.1.
Qualitative systematic reviews: their importance for our understanding
In addition to evidence of effectiveness, understanding how people with pain experience both their pain and their care can help us when we are working with them to provide care that meets their needs. A rigorous qualitative systematic review can also uncover new understandings, often helping illuminate 'why' and can help build theory.
Experiences of informal caregivers supporting individuals with upper
Background Upper gastrointestinal cancers (UGICs) are increasingly prevalent. With a poor prognosis and significant longer-term effects, UGICs present significant adjustment challenges for individuals with cancer and their informal caregivers. However, the supportive care needs of these informal caregivers are largely unknown. This systematic review of qualitative studies synthesises and ...
Systematic and other reviews: criteria and complexities
A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative ...
The Acceptability, Engagement, and Feasibility of Mental Health Apps
Methods We conducted 2 sequential studies, consisting of a systematic literature review of mental health apps for underserved populations followed by a qualitative study with underserved young male participants (n=20; age: mean 19).
Rationale and Standards for the Systematic Review of Qualitative
Despite growing recognition of the need for qualitative methods in health services research, there have been few attempts to define quality standards for assessing the results. This article acknowl...
Muscles
Skeletal muscle function is vital for locomotion, posture, and metabolism, significantly impacting overall health and preventing falls, morbidity, and mortality, especially in elderly populations. This systematic review investigates the influence of hormonal fluctuations on skeletal muscle function across different life stages in women, including adolescence, the reproductive years, and menopause.
Advancing circular economy approaches in plastic waste ...
The Systematic Literature Review (SLR) is using ROSES (Reporting Standards for Systematic Evidence Syntheses), a set of guidelines developed by Haddaway et al. (2018). Compared to other protocols, ROSES is the most appropriate review methodology to use, given that the topic of this study is approaches for managing plastic waste.

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Systematic Reviews

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Systematic Review | Definition, Example & Guide

Table of contents

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Step 1: Formulate a research question

Step 2: Develop a protocol

Step 3: Search for all relevant studies

Step 4: Apply the selection criteria

Step 5: Extract the data

Step 6: Synthesize the data

Step 7: Write and publish a report

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Are Systematic Reviews Qualitative or Quantitative?

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Differences between Qualitative and Quantitative Reviews

Research Questions

Type of Sample Data

Data Collection Methods

Data Analysis Methods

Presentation of Results

Final Takeaway – Qualitative or Quantitative?

Systematic Reviews

What Makes a Systematic Review Different from Other Types of Reviews?

Systematic Review: Home

Systematic Reviews

Experiences of informal caregivers supporting individuals with upper gastrointestinal cancers: a systematic review

Conclusions

Search strategy

Study selection

Inclusion and exclusion criteria

Phenomena of interest

Types of studies

Quality Appraisal

Data extraction

Data synthesis

Description of included studies

Quality of included studies

Meta-aggregation findings

Synthesised finding 1: UGIC caregiver burden

1. Breadth of the caregiver role

2. Challenges around patients’ meals

3. Life disruption

4. Unpreparedness

5. Information manager

Synthesised finding 2: mediators of caregiver burden

1. Degree of inclusion in medical settings

2. Social resources

3. Financial resources

4. Patient-caregiver relationship

5. Emotion-focused coping

6. Information seeking

Synthesised finding 3: consequences of caregiver burden

1. Distress and helplessness

2. Anger and guilt

3. Fear of cancer progression and recurrence

4. Isolation and loneliness

5. Personal growth

Study limitations