Background: Clinicians often rely on review material rather than analysis of primary research to guide therapy. Systematic reviews use methods to insure thoroughness and to minimize bias, but many clinicians are not familiar with systematic reviews and continue to rely on narrative reviews.
Objectives: To determine whether a traditional narrative review or a systematic review is perceived to be more useful.
Methods: A clinical scenario (patient with chronic Crohn's disease considered for azathioprine therapy) was circulated to gastroenterologists, along with a narrative review of therapy (including azathioprine) for inflammatory bowel disease written by an acknowledged expert, or with a systematic Cochrane review of the use of azathioprine for this disease. Whether knowledge of authorship and journal source influences the perception of usefulness of a narrative review was investigated.
Results: The Cochrane review was rated significantly more highly than the narrative review on a 100 mm visual analogue scale (21.3 mm; 95% CI 14.5 to 28 mm). The proportion of respondents who considered the review to be a useful guide was also higher in the group that received the Cochrane review (91%) than in the group that received the narrative review, with author and journal concealed (62%) or identified (70%) (P<0.001 for both comparisons). Ratings from the two groups that received the narrative review were not significantly different.
Conclusions: The focused systematic review was perceived to be more useful than a traditional broad narrative review as a guide to making a decision concerning the use of specific therapy. The possible strengths of systematic reviews should be more fully investigated. If there is additional evidence supporting their greater value to clinicians, they should be made more widely available to clinicians and their strengths should be publicized.