Lesley Uttley

Experts and their opinions can play a pivotal role in research for decision-making, particularly where empirical data are limited or uncertain. However, the methods by which expert input is solicited, synthesised, and applied in research often lack consistency and transparency. The absence of cross-disciplinary guidelines for how expert opinion should be gathered, integrated into research, and utilised in decision-making leaves the process vulnerable to conflicts of interest, interpersonal dynamics, and researcher discretion. Using health technology assessment (HTA) as a case study, we conducted a systematic review of empirical studies examining the use of expert opinion in research for decision-making. Twenty-three studies were included, from which six broad categories of expert consultation methods were identified, ranging from informal individual consultation to structured expert elicitation protocols. Considerable variation was observed in both the methodological rigour and transparency with which expert consultation was conducted and reported. Drawing on the review findings, we propose a preliminary conceptual framework (INTEGRITY) that synthesises psychosocial, methodological and reporting factors to promote transparency, rigour, inclusivity and objectivity when incorporating expert consultation into research. For low-stakes exploratory judgements, informal consultation may be sufficient. For high-stakes policy or resource-allocation decisions that require quantitative estimates, structured and transparent approaches such as formal elicitation protocols should be considered to support inclusive, objective, rigorous, and transparent use of expert judgement in research.

Background: Extrapolation of immature survival data is integral to health technology assessment (HTA) but is often associated with large uncertainty. Incorporation of expert judgements can help to address this uncertainty, but often these judgements are perceived as being “best guesses” due to a lack of methodological transparency. This review assesses the current implementation and reporting of structured expert elicitation for long-term survival outcomes in the broader literature and recent submissions to the National Institute for Health and Care Excellence (NICE). Methods: Three literature databases were searched: MEDLINE via Ovid, Embase, and Web of Science. The search algorithm included terms to identify articles which obtained expert judgements for survival extrapolation. A pearl-growing approach was also employed using three seed papers to supplement the electronic searches. To identify recent NICE technology appraisals in oncology, the NICE guidance database was searched. Results: The search of the broader literature identified six studies which utilised structured expert elicitation for long-term survival outcomes. Four NICE technology appraisals were identified to have used structured expert elicitation between October 2023 and October 2024. The reporting and conduct of elicitation for survival quantities was variable in detail and rigour in both the broader literature and NICE submissions. Despite the requirement for significant resource investment within the process, elicited values are variably used within analyses and are predominantly used as qualitative external validation. At all points throughout the elicitation, including planning, conduct and reporting, there appears to be a considerable lack of technical detail, which in the context of NICE appraisals may hinder full consideration of the elicited values by reviewing committees. Conclusions: Currently, the methods and limited reporting structures being used to elicit long-term survival outcomes are not fit for purpose. This review highlights key areas for improvement and identifies examples of good practice when conducting structured expert elicitations for long-term survival outcomes.

Systematic reviews are the gold standard of evidence syntheses and underpin decision making which affects outcomes for patients globally. A research integrity project funded by the UK Research and Innovation Medical Research Council, entitled ‘Systematic Reviewlution’ aimed to understand and document problems with these highly cited and influential articles, which are often being published at a rate that outpaces primary clinical research. This living systematic review found 485 articles in the first iteration, documenting 67 discrete problems relating to the conduct and reporting of published systematic reviews. These problems potentially jeopardise the reliability or validity of systematic reviews. A variety of institutional factors are likely fuelling the publication of substandard systematic reviews and these factors are representative of issues affecting the entire evidence ecosystem. These factors are discussed in reference to themes identified through this meta-meta-meta-research initiative. The publish or perish perverse academic reward system is fuelling a lack of reproducible research. Paradoxically, the reputation of systematic reviews as a high-quality form of evidence is leading to an overproduction as they are likely seen as a certainty for publication. Wider issues of the influences of research culture generally, the fallibility of peer review and the importance of diversity and representation in research teams are emphasised.

Objective: The purpose of this scoping review is to synthesize and map available evidence on the design of “housing with care” (HWC) schemes to inform design decisions built on objective data from previous research, which is key to ensuring such schemes are fit for purpose for older people. Background: HWC is becoming increasingly recognized as a model for developing housing schemes for older people and balances independent living with elevated levels of care. However, as this scheme is still relatively novel, there are currently no established theoretical frameworks to inform design. Methods: Scoping review, thematic analysis, and mapping methods were used to comprehensively search for and synthesize evidence that links design with assessments of quality-of-life data for HWC schemes. Study findings for each included paper were subject to data extraction for inductive analysis, and the quality of each study was assessed using a modified critical appaisal skills programme (CASP) checklist. Results: Our searches yielded 821 unique references, of which 18 unique articles met the inclusion criteria. The outcomes of interest were the design considerations or features in HWC schemes and their impact on the residents. The main themes identified were related to design element, accessibility, maneuverability, views, design procedure, and quality of life (QOL). Further subthemes identified across papers were identified to create a comprehensive map of the key features to consider in designing HWC schemes. Conclusion: This review provides an initial framework for designers and architects to (1) understand the effect of each design element of HWC and (2) inform design to ultimately improve the QOL of aged people.

Background: It remains uncertain whether Kaposi sarcoma (KS) is a true neoplasm, in that it regresses after removal of the stimulus to growth (as HHV8) when immunosuppression is reduced. We aimed to summarize the available evidence on somatic mutations and clonality within KS to assess whether KS is a neoplasm or not. Methods: Medline and Web of Science were searched until September 2020 for articles on clonality or mutation in KS. Search strings were supervised by expert librarians, and two researchers independently performed study selection and data extraction. An adapted version of the QUADAS2 tool was used for methodological quality appraisal. Results: Of 3077 identified records, 20 publications reported on relevant outcomes and were eligible for qualitative synthesis. Five studies reported on clonality, 10 studies reported on various mutations, and 5 studies reported on chromosomal aberrations in KS. All studies were descriptive and were judged to have a high risk of bias. There was considerable heterogeneity of results with respect to clonality, mutation and cytogenetic abnormalities as well as in terms of types of lesions and patient characteristics. Conclusions: While KS certainly produces tumours, the knowledge is currently insufficient to determine whether KS is a clonal neoplasm (sarcoma), or simply an aggressive reactive virus-driven lesion.