Why are Cochrane hepato-biliary reviews undervalued by physicians as an aid for clinical decision-making?

Background: Cochrane systematic reviews are of higher quality than reviews published in scientific journals, yet are used less than other sources for clinical decision-making. Aim: To assess whether the characteristics of the Cochrane systematic reviews can account for their scant use by physicians. Materials and methods: We analysed the 87 Cochrane hepato-biliary reviews dealing with therapeutic topics posted in the Cochrane Database of Systematic Reviews through December 2008, which we classified according to four characteristics: empty reviews; outdated reviews; content of reviews; implications for practice. Results: Six empty reviews found no eligible randomised trials and six found one trial, precluding a systematic review; some empty reviews investigated irrelevant topics. Twenty-one reviews investigated outdated interventions, and thirteen of them were posted ten or more years after the publication of the most recent trial included. Most reviews were too lengthy (median: 40 pages) and their consultation was time-consuming with respect to clinical content. They generally compared two treatments, disregarding other options, and usually did not report any non-randomised (although convincing) evidence of potential use in clinical decision-making. Conclusions: If generalized to the entire Cochrane Database of Systematic Reviews, these characteristics may largely explain why physicians undervalue the Cochrane reviews as a source of evidence for clinical decision-making. (C) 2009 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.