how to conduct a scoping literature review

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Publications
Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

Advanced Search
Journal List
J Grad Med Educ
v.14(5); 2022 Oct

Steps for Conducting a Scoping Review

Susanne mak.

Both authors are with McGill University, Montreal, Quebec, Canada

Susanne Mak, MSc, is an Assistant Professor, School of Physical and Occupational Therapy, and an Associate Member, Institute of Health Sciences Education, Faculty of Medicine and Health Sciences

Aliki Thomas

Aliki Thomas, PhD, is an Associate Professor, School of Physical and Occupational Therapy, and an Associate Member, Institute of Health Sciences Education, Faculty of Medicine and Health Sciences

A scoping review is a type of knowledge synthesis that uses a systematic and iterative approach to identify and synthesize an existing or emerging body of literature on a given topic. 1 While there are several reasons for conducting a scoping review, the main reasons are to map the extent, range, and nature of the literature, as well as to determine possible gaps in the literature on a topic. 1 - 3 Scoping reviews are not limited to peer-reviewed literature. 3 , 4

Identifying a Team

Before conducting the review, it is important to consider the composition of the research team: scoping reviews are not conducted by a single individual. The team should include someone with content expertise and an individual with experience conducting scoping reviews. 1 , 3 , 5 Adding a librarian who can assist with building the search strategy is also extremely helpful. 1 , 3 Thoughtful planning of the team membership will result in the right knowledge, skills, and expertise to successfully complete the review and ensure that the findings make a notable contribution to the field.

An overview of the steps involved in conducting scoping reviews is provided below.

Step 1: Identifying the Research Question

Creating the research question is a vital first step. 1 , 3 - 5 A question that is too broad increases the number of papers for consideration, which may affect the feasibility of the review. 5 A question that is too narrow may compromise the breadth and depth of the review. Therefore, a preliminary search of the literature may be helpful in determining: (1) the breadth of your question; (2) whether a scoping review on the topic has already been conducted; and (3) if there is sufficient literature to warrant a scoping review. Consulting with a librarian can help in deciding if a scoping review is the appropriate review method. 1 , 3 In particular, a librarian may confirm that there is insufficient literature or that there is too much, which will necessitate a more targeted research question.

Step 2: Identifying Relevant Studies

Early consultation with a librarian should occur to build the search strategy—keywords, Medical Subject Headings, databases—and further refine the strategy based on the papers found. For example, you may find too many irrelevant papers. In this case you may need to review your search strategy to identify the terms which introduce too much “noise.”

You will also need to define the inclusion and exclusion criteria. 1 , 3 - 5 Discussions with your team are important to ensure diverse perspectives and that the inclusion criteria are aligned with the research question. 5 , 6

Step 3: Selecting Studies to Be Included in the Review

Tools such as Covidence and Rayyan can be helpful in organizing papers and making the screening process more efficient ( Box ). Once you have collected the citations from the search, you can import these from reference management software (eg, EndNote) into Rayyan. After selecting papers for inclusion, the citations of the included papers can be exported to reference management software for the next stage of the review. Other helpful features of management software can include the identification of duplicates, proportion of an abstract that resembles another, and documentation of reasons for inclusion or exclusion. Both Covidence and Rayyan allow for blinding the results of team members' reviews to each other.

▪ Covidence: www.covidence.org
▪ NVivo: https://www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home
▪ Rayyan: https://rayyan.qcri.org/welcome

Having additional reviewers will accelerate the pace of the review but will require calibration between reviewers. 1 , 3 , 5 A calibration exercise consists of selecting 5% to 10% of the papers for independent screening by each reviewer. 1 If a high level of agreement among reviewers is not achieved (eg, lower than 90%), 7 , 8 the reviewers should discuss their points of disagreement and review (and possibly revise) the inclusion criteria. 1 Another 10% of the papers are then selected for a second calibration exercise to test the modified inclusion criteria. If having 2 reviewers for each paper is not feasible, one reviewer can conduct an independent review, with a second reviewer verifying a portion of the papers, with the goal of 90% or better agreement.

The actual screening of papers should consist of reading not only the title of the paper, but the abstract as well. If an abstract is not available, a full-text review of the paper is required. Screening papers by title alone is insufficient, as the contents of a paper are not always well reflected in the title.

Step 4: Charting the Data

The team develops the data extraction form collaboratively. Although the extraction categories vary depending on the research question and review purpose, common categories are: author, year, geographical location, study population, main results, study limitations, and future directions. 4 , 5 More specific categories will be needed to capture the data for a given research question.

The extraction form will need to be pilot tested for further refinements and undergo a calibration exercise as well. 1 , 3 , 5 This entails a dyad of reviewers independently extracting data from a small number of papers (eg, 5-10), and meeting afterward to discuss any discrepancies, with further refinement of the form if a high level of agreement between reviewers is not obtained.

Step 5: Collating, Summarizing, and Reporting the Results

Once the data have been extracted from all papers, numerical and thematic analyses are conducted. 5 The findings from the numerical analysis can be presented in a table or chart to showcase the most salient aspects of the review. Readers should be able to see alignment of findings with objectives for conducting the review. 1 , 3 Thematic analysis 9 consists of examining excerpts of text and asking how this text relates to the research question, as well as creating a code (label) that best reflects that text. A list of tentative codes (a codebook) is created and modified iteratively as the team engages in data analysis. Once codes are developed, a review of the codes and how they relate to each other can help to identify patterns among them, which leads to the creation of categories (collections of similar data in one place) 10 and themes (patterns across the dataset). 9

Reflexivity is essential throughout the review process but especially during thematic analysis, with use of memos, to capture the thoughts that arise from examining and interpreting the data. Once the codes are generated, the research team will further refine them through discussion. 6 The team should discuss not only the clarity of the operational definitions of the codes, but also how the codes are named and how they may relate to each other. As the codes are grouped together, the team will develop themes. 5

Step 6: Consulting Stakeholders (Optional)

Reasons for stakeholder consultation may be to obtain input on the research question and sources of information, and to provide insights on a topic. Other purposes may include obtaining feedback to help shed light on the review findings and pinpoint gaps not explored in the literature. While a stakeholder consultation has been named as the final step of a review, it can be incorporated throughout the review stages and can occur through focus groups, individual interviews, or surveys. 1 , 5

A scoping review is useful to map the literature on evolving or emerging topics and to identify gaps. It may be a step before undertaking research or conducting another type of review, such as a systematic review. Before conducting a scoping review, it is important to consider how the research team will implement each step and who will be involved at each stage, while being mindful that the methodological approach provides teams with the opportunity to move back to earlier stages as the review evolves.

Jump to navigation

Cochrane Training

Scoping reviews: what they are and how you can do them.

In these videos from a Cochrane Learning Live webinar delivered in partnership with GESI: the Global Evidence Synthesis Initiative , Dr Andrea C. Tricco presents the definition of a scoping review, examples of scoping reviews, steps of the scoping review process, and methods used in 494 scoping reviews from the literature. In the second video, Kafayat Oboirien presents her experiences of conducting a scoping review on strengthening clinical governance in low and middle income countries.

how to conduct a scoping literature review

Scoping reviews: an overview with examples
Example: Strengthening clinical governance in low- and middle-income countries
Examples of non-health related scoping reviews
Doing scoping reviews
Polling questions and Q&A session

Presenters Bio

Dr. Andrea C. Tricco (PhD, MSc) holds a Tier 2 Canada Research Chair in Knowledge Synthesis. Her research interests are related to responding to knowledge users (including patients, healthcare providers, and policy-makers) through knowledge synthesis. Her research also focuses on advancing the science of knowledge synthesis and she is leading research projects related to rapid reviews, network meta-analysis, and scoping reviews.

Kafayat Oboirien has a MPH in Health Economics. She has been involved in the analysis of utilisation in South Africa and a cross-country project evaluating reforms towards universal health coverage. Her present research interest lies in knowledge synthesis, specifically in mapping and documenting health systems’ work practices in LMICs.

Part 1: Scoping reviews: an overview with examples

Part 2: Example: Strengthening clinical governance in low- and middle-income countries

Part 3: Examples of non-health related scoping reviews

Part 4: Doing scoping reviews

Part 5: Polling questions and Q&A session

Scoping Review Guide

Is a Scoping Review Right for Me?
Scoping Review vs Systematic Review
Standards & Guidelines for a Scoping Review
An Example Scoping Review
Step 1 - Define the Review Objectives and Question(s)
Step 2 - Create the Search Strategy
Step 3 - Conduct the Searches
Step 4 - Select Studies to be Included
Step 5 - Perform Data Extraction and Interpret Findings
Step 6 - Present Findings
Help with Conducting a Scoping Review

Before Starting on a Review

Before embarking on a scoping review,

1) Make sure that a recent scoping or systematic review on the same topic has not already been published, and

2) Check for protocols that would indicate similar work is in progress. Protocols can be registered and/or published.

To check for published reviews, search journal databases such as MEDLINE/PubMed, Embase, CINAHL, and even Google Scholar (to catch any journal content that is not covered in bibliographic databases). You can also check Epistemonikos (an open source database of health evidence), Campbell Collaboration (systematic reviews on effectiveness of social interventions), FigShare , OSF (research repositories) or MedRXiv (a preprint server). Journals that publish scoping review protocols include BMJ Open and Systematic Reviews , among others. Registries include the JBI Review Registry .

You should consider registering and/or publishing your own Scoping Review Protocol once you've established your Plan.

Steps of a Scoping Review

Define the Review Objective and Questions
Create the Search Strategy
Conduct the Literature Search
Select Studies based on Inclusion/Exclusion Criteria
Perform Data Extraction & Interpret Findings
Present Findings
JBI Reviewer's Manual: Methodology for JBI Scoping Reviews
Step-by-Step tip sheets from PRISMA for Scoping Reviews

<< Previous: An Example Scoping Review
Next: Step 1 - Define the Review Objectives and Question(s) >>
Last Updated: Apr 8, 2024 10:07 AM
URL: https://guides.library.stonybrook.edu/ScR
Request a Class
Hours & Locations
Ask a Librarian
Special Collections
Library Faculty & Staff

Library Administration: 631.632.7100

Stony Brook Home
Campus Maps
Web Accessibility Information
Accessibility Barrier Report Form

Comments or Suggestions? | Library Webmaster

Except where otherwise noted, this work by SBU Libraries is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License .

Systematic Reviews: Scoping Reviews

Systematic Review Defined
Guides, Standards and Resources
Data Extraction
Risk of Bias
WCM's Data Retention Policy & Systematic Reviews
Scoping Reviews
Narrative Reviews
Covidence This link opens in a new window
Collaborations 2022-present
Collaborations 2012-2021

What is a Scoping Review?

Our Systematic Review Service can also assist you and your team with Scoping Reviews.

A scoping review is a relatively new approach to evidence synthesis and differs from systematic reviews in its purpose and aims. The purpose of a scoping review is to provide an overview of the available research evidence without producing a summary answer to a guide clinical decision-making.

Scoping reviews are a form of knowledge synthesis, which incorporate a range of study designs to comprehensively summarize and synthesize evidence with the aim of informing practice, programs, and policy and providing direction to future research priorities.

The general purpose for conducting scoping reviews is to identify and map the available evidence.

Adapted from: Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005 Feb;8(1):19–32.

Sucharew H, Macaluso, M. Methods for Research Evidence Synthesis: The Scoping Review Approach. J. Hosp. Med 2019;7;416-418.

How is this different from a Systematic Review?

Scoping reviews share a number of the same processes as systematic reviews, as they both use rigorous and transparent methods to comprehensively identify and analyze all the relevant literature pertaining to a research question.
The key differences between the two review methods can be attributed to their differing purposes and aims. The purpose of a scoping review is to map the body of literature on a topic area . The purpose of a systematic review is to synthesize the best available research on a specific intervention .
Scoping reviews identify key characteristics or factors related to a concept. They do not produce statements to guide decision-making.
A scoping review seeks to present an overview of a potentially large and diverse body of literature pertaining to a broad topic . A systematic review attempts to collate empirical evidence from a relatively smaller number of studies pertaining to a focused research question.
Scoping reviews aim to provide a descriptive overview of the reviewed material without critically appraising individual studies or synthesizing evidence from different studies (no risk of bias or meta-analysis/statistical pooling is performed). In contrast, systematic reviews aim to provide a synthesis of evidence from studies assessed for risk of bias .

Adapted from: Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency. Res Synth Methods. 2014 Dec;5(4):371–85.

The PCC Question Development Framework

Because the aim of a scoping review differs from that of a systematic review, question development may not fit into the PICO (Patient/Intervention/Comparison/Outcome) framework . Therefore, PCC (Population/Concept/Context) may be a more useful framework.

Per JBI's Scoping Review Manual : "The 'PCC' mnemonic is recommended as a guide to construct a clear and meaningful title for a scoping review. The PCC mnemonic stands for the Population, Concept, and Context. There is no need for explicit outcomes, interventions or phenomena of interest to be stated for a scoping review; however elements of each of these may be implicit in the concept under examination."

When do I perform a Systematic Review? When do I perform a Scoping Review?

When you have a specific clinical question that fits into the PICO framework or a hypothesis you are looking to test, you'll want to perform a systematic review.
If you are looking for a broad overview on a topic, with no hypothesis or specific clinical question, you'll want to perform a scoping review.

Adapted from: Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018 Nov 19;18(1):143.

How are both Systematic and Scoping Reviews different from Traditional Literature Reviews?

Systematic and scoping reviews aim to be comprehensive, transparent, reproducible, and unbiased – this is not typically the case with a traditional literature review. With clear and explicit methodology, the reader knows exactly how the authors of a study came to their conclusions, rather than relying on expert opinion or subjective selection that is usually found in a literature review.

Additional Resources

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H. Updated methodological guidance for the conduct of scoping reviews . JBI Evid Synth. 2020 Oct;18(10):2119-2126.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation . Ann Intern Med. 2018 Oct 2;169(7):467–73.
Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version) . In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020.
Munn Z, Peters MDJ, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach . BMC Med Res Methodol. 2018 Nov 19;18(1):143.
Arksey H, O’Malley L. Scoping studies: towards a methodological framework . Int J Soc Res Methodol. 2005 Feb;8(1):19–32.
Pham MT, Rajić A, Greig JD, Sargeant JM, Papadopoulos A, McEwen SA. A scoping review of scoping reviews: advancing the approach and enhancing the consistency . Res Synth Methods. 2014 Dec;5(4):371–85.
Colquhoun HL, Levac D, O’Brien KK, Straus S, Tricco AC, Perrier L, et al. Scoping reviews: time for clarity in definition, methods, and reporting . J Clin Epidemiol. 2014 Dec;67(12):1291–4.
Peters MDJ, Godfrey CM, Khalil H, McInerney P, Parker D, Soares CB. Guidance for conducting systematic scoping reviews . Int J Evid Based Healthc. 2015 Sep;13(3):141–6.
<< Previous: WCM's Data Retention Policy & Systematic Reviews
Next: Narrative Reviews >>
Last Updated: May 2, 2024 10:36 AM
URL: https://med.cornell.libguides.com/systematicreviews

UNC Libraries
HSL Academic Process
Scoping Reviews
Step 3: Conduct Literature Searches

Scoping Reviews: Step 3: Conduct Literature Searches

Created by health science librarians.

Step 1: Complete Pre-Review Tasks
Step 2: Develop a Protocol

Partner with a librarian

Systematic searching process, choose a few databases, search with controlled vocabulary and keywords, acknowledge outdated or offensive terminology, helpful tip - building your search, use nesting, boolean operators, and field tags, build your search, translate to other databases and other searching methods, document the search.

Step 4: Manage Citations
Step 5: Screen Citations
Step 6: Assess Quality of Included Studies (Optional)
Step 7: Extract Data from Included Studies
Step 8: Write the Review

Check our FAQ's

Email us

Call (919) 962-0800

Make an appointment with a librarian

Request a systematic or scoping review consultation

Search the FAQs

About step 3: conduct literature searches.

Click an item below to see how it applies to Step 3: Conduct Literature Searches.

For PRISMA, there are specific items you will want to report from your search. For this step, review the PRISMA-S checklist.

PRISMA-S for Searching
Specify all databases, registers, websites, organizations, reference lists, and other sources searched or consulted to identify studies. Specify the date when each source was last searched or consulted. Present the full search strategies for all databases, registers and websites, including any filters and limits used.
For information on how to document database searches and other search methods on your PRISMA flow diagram, visit our FAQs "How do I document database searches on my PRISMA flow diagram?" and "How do I document a grey literature search for my PRISMA flow diagram?"

For this step of the review, in Covidence you can:

Document searches in Covidence review settings so all team members can view
Add keywords from your search to be highlighted in green or red while your team screens articles in your review settings

Librarian's Role

When designing and conducting literature searches, a librarian can advise you on :

How to create a search strategy with Boolean operators, database-specific syntax, subject headings, and appropriate keywords
How to apply previously published systematic review search strategies to your current search
How to test your search strategy's performance
How to translate a search strategy from one database's preferred structure and syntax to another

The goal of a scoping review search is to retrieve all results that are relevant to your topic in order to map (ie, report on the scope), and to identify themes and gaps in the literature. Because scoping review searches can be quite extensive and retrieve large numbers of results, an important aspect is limiting the number of irrelevant results that need to be screened. Librarians are experts trained in literature searching and scoping review methodology. Ask us a question or partner with a librarian to save time and improve the quality of your review. Our comparison chart detailing two tiers of partnership provides more information on how librarians can collaborate with and contribute to scoping review teams.

Decorative image: Magnifying glass looking at city lights

Search Process

Use controlled vocabulary, if applicable
Include synonyms/keyword terms
Choose databases, websites, and/or registries to search
Translate to other databases
Search using other methods (e.g. hand searching)
Validate and peer review the search

Databases can be multidisciplinary or subject specific. Choose the best databases for your research question. Databases index various journals, so in order to be comprehensive, it is important to search multiple databases when conducting a scoping review. Consider searching databases with more diverse or global coverage (i.e., Global Index Medicus) when appropriate. A list of frequently used databases is provided below. You can access UNC Libraries' full listing of databases on the HSL website (arranged alphabetically or by subject ).

Generally speaking, when literature searching, you are not searching the full-text article. Instead, you are searching certain citation data fields, like title, abstract, keyword, controlled vocabulary terms, and more. When developing a literature search, a good place to start is to identify searchable concepts of the research question, and then expand by adding other terms to describe those concepts. Read below for more information and examples on how to develop a literature search, as well as find tips and tricks for developing more comprehensive searches.

Identify search concepts and terms for each

Start by identifying the main concepts of your research question. If unsure, try using a question framework to help identify the main searchable concepts. PICO is one example of a question framework and is used specifically for clinical questions. If your research question doesn't fit into the PICO model well, view other examples of question frameworks and try another!

View our example in PICO format

Question: for patients 65 years and older, does an influenza vaccine reduce the future risk of pneumonia, controlled vocabulary.

Controlled vocabulary is a set of terminology assigned to citations to describe the content of each reference. Searching with controlled vocabulary can improve the relevancy of search results. Many databases assign controlled vocabulary terms to citations, but their naming schema is often specific to each database. For example, the controlled vocabulary system searchable via PubMed is MeSH, or Medical Subject Headings. More information on searching MeSH can be found on the HSL Pubmed Ten Tips Legacy Guide .

Note: Controlled vocabulary may be outdated, and some databases allow users to submit requests to update terminology.

View Controlled Vocabulary for our example PICO

As mentioned above, databases with controlled vocabulary often use their own unique system. A listing of controlled vocabulary systems by database is shown below.

Keyword Terms

Not all citations are indexed with controlled vocabulary terms, however, so it is important to combine controlled vocabulary searches with keyword, or text word, searches.

Authors often write about the same topic in varied ways and it is important to add these terms to your search in order to capture most of the literature. For example, consider these elements when developing a list of keyword terms for each concept:

American versus British spelling
hyphenated terms
quality of life
satisfaction
vaccination
influenza vaccination

There are several resources to consider when searching for synonyms. Scan the results of preliminary searches to identify additional terms. Look for synonyms, word variations, and other possibilities in Wikipedia, other encyclopedias or dictionaries, and databases. For example, PubChem lists additional drug names and chemical compounds.

Display Controlled Vocabulary and Keywords for our example PICO

Combining controlled vocabulary and text words in PubMed would look like this:

"Influenza Vaccines"[Mesh] OR "influenza vaccine" OR "influenza vaccines" OR "flu vaccine" OR "flu vaccines" OR "flu shot" OR "flu shots" OR "influenza virus vaccine" OR "influenza virus vaccines"

Social and cultural norms have been rapidly changing around the world. This has led to changes in the vocabulary used, such as when describing people or populations. Library and research terminology changes more slowly, and therefore can be considered outdated, unacceptable, or overly clinical for use in conversation or writing.

For our example with people 65 years and older, APA Style Guidelines recommend that researchers use terms like “older adults” and “older persons” and forgo terms like “senior citizens” and “elderly” that connote stereotypes. While these are current recommendations, researchers will recognize that terms like “elderly” have previously been used in the literature. Therefore, removing these terms from the search strategy may result in missed relevant articles.

Research teams need to discuss current and outdated terminology and decide which terms to include in the search to be as comprehensive as possible. The research team or a librarian can search for currently preferred terms in glossaries, dictionaries, published guidelines, and governmental or organizational websites. The University of Michigan Library provides suggested wording to use in the methods section when antiquated, non-standard, exclusionary, or potentially offensive terms are included in the search.

Check the methods sections or supplementary materials of published scoping reviews for search strategies to see what terminology they used. This can help inform your search strategy by using MeSH terms or keywords you may not have thought of. However, be aware that search strategies will differ in their comprehensiveness.

You can also run a preliminary search for your topic, sort the results by Relevance or Best Match, and skim through titles and abstracts to identify terminology from relevant articles that you should include in your search strategy.

Nesting is a term that describes organizing search terms inside parentheses. This is important because, just like their function in math, commands inside a set of parentheses occur first. Parentheses let the database know in which order terms should be combined.

Always combine terms for a single concept inside a parentheses set. For example:

( "Influenza Vaccines"[Mesh] OR "influenza vaccine" OR "influenza vaccines" OR "flu vaccine" OR "flu vaccines" OR "flu shot" OR "flu shots" OR "influenza virus vaccine" OR "influenza virus vaccines" )

Additionally, you may nest a subset of terms for a concept inside a larger parentheses set, as seen below. Pay careful attention to the number of parenthesis sets and ensure they are matched, meaning for every open parentheses you also have a closed one.

Boolean operators

Boolean operators are used to combine terms in literature searches. Searches are typically organized using the Boolean operators OR or AND. OR is used to combine search terms for the same concept (i.e., influenza vaccine). AND is used to combine different concepts (i.e., influenza vaccine AND older adults AND pneumonia). An example of how Boolean operators can affect search retrieval is shown below. Using AND to combine the three concepts will only retrieve results where all are present. Using OR to combine the concepts will retrieve results that use all separately or together. It is important to note that, generally speaking, when you are performing a literature search you are only searching the title, abstract, keywords and other citation data. You are not searching the full-text of the articles.

The last major element to consider when building systematic literature searches are field tags. Field tags tell the database exactly where to search. For example, you can use a field tag to tell a database to search for a term in just the title, the title and abstract, and more. Just like with controlled vocabulary, field tag commands are different for every database.

If you do not manually apply field tags to your search, most databases will automatically search in a set of citation data points. Databases may also overwrite your search with algorithms if you do not apply field tags. For scoping review searching, best practice is to apply field tags to each term for reproducibility.

For example:

("Influenza Vaccines"[Mesh] OR "influenza vaccine"[tw] OR "influenza vaccines"[tw] OR "flu vaccine"[tw] OR "flu vaccines"[tw] OR "flu shot"[tw] OR "flu shots"[tw] OR "influenza virus vaccine"[tw] OR "influenza virus vaccines"[tw] OR ((flu[tw] OR influenza[tw]) AND (vaccine[tw] OR vaccines[tw] OR vaccination[tw] OR immunization[tw])))

View field tags for several health databases

For more information about how to use a variety of databases, check out our guides on searching.

Searching PubMed guide (HSL) Guide to searching Medline via the PubMed database
Searching Embase Guide
Searching Scopus guide Guide to searching Scopus via scopus.com
Searching EBSCO Databases guide Guide to searching CINAHL, PsycInfo, Global Health, & other databases via EBSCO

Combining search elements together

Organizational structure of literature searches is very important. Specifically, how terms are grouped (or nested) and combined with Boolean operators will drastically impact search results. These commands tell databases exactly how to combine terms together, and if done incorrectly or inefficiently, search results returned may be too broad or irrelevant.

For example, in PubMed:

(influenza OR flu) AND vaccine is a properly combined search and it produces around 50,000 results.

influenza OR flu AND vaccine is not properly combined. Databases may read it as everything about influenza OR everything about (flu AND vaccine), which would produce more results than needed.

We recommend one or more of the following:

put all your synonyms together inside a set of parentheses, then put AND between the closing parenthesis of one set and the opening parenthesis of the next set
use a separate search box for each set of synonyms
run each set of synonyms as a separate search, and then combine all your searches
ask a librarian if your search produces too many or too few results

View the proper way to combine MeSH terms and Keywords for our example PICO

Question: for patients 65 years and older, does an influenza vaccine reduce the future risk of pneumonia , translating search strategies to other databases.

Databases often use their own set of terminology and syntax. When searching multiple databases, you need to adjust the search slightly to retrieve comparable results. Our sections on Controlled Vocabulary and Field Tags have information on how to build searches in different databases. Resources to help with this process are listed below.

Polyglot search A tool to translate a PubMed or Ovid search to other databases
Search Translation Resources (Cornell) A listing of resources for search translation from Cornell University
Advanced Searching Techniques (King's College London) A collection of advanced searching techniques from King's College London

Other searching methods

Hand searching.

Literature searches can be supplemented by hand searching. One of the most popular ways this is done with scoping reviews is by searching the reference list and citing articles of studies included in the review. Another method is manually browsing key journals in your field to make sure no relevant articles were missed. Other sources that may be considered for hand searching include: clinical trial registries, white papers and other reports, pharmaceutical or other corporate reports, conference proceedings, theses and dissertations, or professional association guidelines.

Searching grey literature

Grey literature typically refers to literature not published in a traditional manner and often not retrievable through large databases and other popular resources. Grey literature should be searched for inclusion in scoping reviews in order to reduce bias and increase thoroughness. There are several databases specific to grey literature that can be searched.

Open Grey Grey literature for Europe
OAIster A union catalog of millions of records representing open access resources from collections worldwide
Grey Matters: a practical tool for searching health-related grey literature (CADTH) From CADTH, the Canadian Agency for Drugs and Technologies in Health, Grey Matters is a practical tool for searching health-related grey literature. The MS Word document covers a grey literature checklist, including national and international health technology assessment (HTA) web sites, drug and device regulatory agencies, clinical trial registries, health economics resources, Canadian health prevalence or incidence databases, and drug formulary web sites.
Duke Medical Center Library: Searching for Grey Literature A good online compilation of resources by the Duke Medical Center Library.

Scoping review quality is highly dependent on the literature search(es) used to identify studies. To follow best practices for reporting search strategies, as well as increase reproducibility and transparency, document various elements of the literature search for your review. To make this process more clear, a statement and checklist for reporting literature searches has been developed and and can be found below.

PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation Tricco AC, Lillie E, Zarin W, O'Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE. PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med. 2018 Oct 2;169(7):467-473. doi: 10.7326/M18-0850. Epub 2018 Sep 4. PMID: 30178033.
JBI Manual for Evidence Synthesis Chapter 11: Scoping Reviews Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global. https://doi.org/10.46658/JBIMES-20-12

At a minimum, document and report certain elements, such as databases searched, including name (i.e., Scopus) and platform (i.e. Elsevier), websites, registries, and grey literature searched. In addition, this also may include citation searching and reaching out to experts in the field. Search strategies used in each database or source should be documented, along with any filters or limits, and dates searched. If a search has been updated or was built upon previous work, that should be noted as well. It is also helpful to document which search terms have been tested and decisions made for term inclusion or exclusion by the team. Last, any peer review process should be stated as well as the total number of records identified from each source and how deduplication was handled.

If you have a librarian on your team who is creating and running the searches, they will handle the search documentation.

You can document search strategies in word processing software you are familiar with like Microsoft Word or Excel, or Google Docs or Sheets. A template, and separate example file, is provided below for convenience.

Search Strategy Documentation Template
Search Strategy Documentation Example

*Some databases like PubMed are being continually updated with new technology and algorithms. This means that searches may retrieve different results than when originally run, even with the same filters, date limits, etc.

<< Previous: Step 2: Develop a Protocol
Next: Step 4: Manage Citations >>
Last Updated: May 16, 2024 3:24 PM
URL: https://guides.lib.unc.edu/scoping-reviews

Library buildings are open for UniSA staff and students via UniSA ID swipe cards. Please contact us on Ask the Library for any assistance. Find out about other changes to Library services .

ScR overview
Other review types
Define objective & question/s
Top tools and techniques
How to search
Where to search
Subject headings
Search filters
Review your search
Run your search on other databases
Search the grey literature
Report search results
Updating a search
How to Screen
Data extraction
Report & write

Overview of scoping reviews

Why a scoping review? Peters MDJ et al., JBI Manual for Evidence Synthesis 11.1.1. Chapter 11: Scoping Reviews (2020 version). Details why scoping reviews may be conducted, including key characteristics and differences from systematic reviews
What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis Munn, Z., Pollock, D., Khalil, H., Alexander, L., McInerney, P., Godfrey, C. M., Peters, M., & Tricco, A. C. (2022). JBI Evidence Synthesis. doi:10.11124/jbies-21-00483
What are scoping reviews? (Video length: 5:58) In this 2022 video (YouTube), Assoc Prof Zachary Munn and Dr Danielle Pollock discuss the definition for scoping reviews formalised by the JBI Scoping Reviews Methodology Group

Guidelines and standards

Key historical papers

Using a standard or guideline will help you conduct your scoping review correctly.

Scoping review methodology has evolved over time. A number of key papers that were fundamental to this evolution are available on the Key historical papers tab of this box. These are not recommended to be used as current methodology, but can be useful to provide background and context.

Watch the video below, narrated by Dr Micah Peters, UniSA Clinical & Health Sciences, to learn how the scoping review methodology evolved (to 2017).

Video Length: 4:03

Current standards and guidelines:

The Joanna Briggs Institute's (JBI) approach is widely considered the standard. It aims to consolidate and build on earlier works describing scoping review methodologies. The Cochrane Collaboration follows a similar approach.

JBI Manual for Evidence Synthesis - Chapter 11: Scoping reviews (2020 version) Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil, H. Chapter 11: Scoping Reviews (2020 version). In: Aromataris E, Munn Z (Editors). JBI Manual for Evidence Synthesis, JBI, 2020. Available from https://synthesismanual.jbi.global. This chapter provides a comprehensive explanation, discussion and recommendations for conducting scoping reviews.
Updated methodological guidance for the conduct of scoping reviews (2020) '...describe the updated methodological guidance for conducting a JBI scoping review' - Peters, M. D. J., Marnie, C., Tricco, A. C., Pollock, D., Munn, Z., Alexander, L., McInerney, P., Godfrey, C. M., & Khalil, H. JBI Evidence Synthesis, 18(10), 2119-2126. doi:10.11124/jbies-20-00167
Practical guide to undertaking scoping reviews for pharmacy clinicians, researchers and policymakers (2022) Khalil, H., McInerney, P., Pollock, D., Alexander, L., Munn, Z., Tricco, A. C., Godfrey, C. M., & Peters, M. D. J. Journal of Clinical Pharmacy and Therapeutics, 47(2), 129-134. doi:10.1111/jcpt.13558
Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics (2021) Pollock, D., Davies, E. L., Peters, M. D. J., Tricco, A. C., Alexander, L., McInerney, P., Godfrey, C. M., Khalil, H., & Munn, Z. (2021). Journal of Advanced Nursing, 77(4), 2102-2113. doi:10.1111/jan.14743
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Includes links to key documents including the PRISMA 2020 Statement, Checklist, Flow Diagram, Explanation and Elaboration, and all PRISMA Extensions.
PRISMA for Scoping Reviews webpage Access the PRISMA Extension for Scoping Reviews checklist and explanation (2018), fillable version of the checklist, and tip sheets
Current best practices for the conduct of a scoping review (2016) A presentation by Heather Colquhoun, from the Equator Network and the University of Toronto.
Scoping reviews - what they are and how you can do them (2017) Cochrane Training suite of videos on scoping reviews, presented by Dr Andrea Tricco
Scoping studies: towards a methodological framework (Arksey & O'Malley 2005) International Journal of Social Research Methodology, 8(1), 19-32. doi:10.1080/1364557032000119616. The paper distinguishes different types of scoping reviews and framework.
Asking the right questions: scoping studies in the commissioning of research on the organisation and delivery of health services (Anderson et al. 2008) Health Research Policy and Systems, 6(7). doi:10.1186/1478-4505-6-7. This article highlights four objectives of scoping reviews in the context of the UK's Service Delivery and Organisation Research Programme (SDO).
What are scoping studies? A review of the nursing literature (Davis, Drey & Gould 2009) International Journal of Nursing Studies, 46(10), 1386-1400. doi:10.1016/j.ijnurstu.2009.02.010. The paper explores the nature and status of the scoping review within the nursing literature.
Scoping studies: advancing the methodology (Levac, Colquhoun & O'Brien 2010) Implementation Science, 5(69). doi:10.1186/1748-5908-5-69. Based on Arksey and O'Malley's framework (2005), this paper further clarifies and enhances each stage of the scoping review framework.
Scoping the scope of a Cochrane Review (Armstrong et al. 2011) Journal of Public Health, 33(1), 147-150. doi:10.1093/pubmed/fdr015. Comments on the scoping review framework from a public health perspective
A scoping review of scoping reviews: advancing the approach and enhancing the consistency (Pham et al. 2014) Research Synthesis Methods, 5(4), 371-385. doi:10.1002/jrsm.1123
A scoping review on the conduct and reporting of scoping reviews (Tricco et al. 2016) Based on 494 scoping reviews between 1999 and 2014, this scoping review summarises the conduct and reporting guidelines of scoping reviews.
An evidence-based approach to scoping reviews (Khalil et al. 2016) Worldviews on Evidence-Based Nursing, 13(2), 118-123. doi:10.1111/wvn.12144. This article explains the methodological development for scoping reviews based on the Arksey and O'Malley framework, the Levac, Colquhoun, and O'Brien, and the JBI methods of evidence synthesis

The scoping review process

The steps below are based on Chapter 11 of the JBI Manual for Evidence synthesis.

This is the plan for your review.

Eligibility criteria (inclusion/exclusion)
Screening process
Critical appraisal process (optional -not typical)
Charting process

Then, per your protocol:

Exemplar reviews

Engaging policy-makers, health system managers, and policy analysts in the knowledge synthesis process: a scoping review Tricco, AC, Zarin, W, Rios, P, Nincic, V, Khan, PA, Ghassemi, M & Langlois, EV 2018, Implementation Science : IS, vol. 13, no. 1, pp. 1–19.
Scoping review of pediatric tonsillectomy quality of life assessment instruments Kao, ST, Peters, MD, Dharmawardana, N, Stew, B & Ooi, EH 2017, Laryngoscope, vol. 127, no. 10, pp. 2399-2406.
Nursing minimum data sets for documenting nutritional care for adults in primary healthcare: a scoping review Håkonsen, SJ, Pedersen, PU, Bjerrum, M, Bygholm, A & Peters, DJ 2018, JBI Database of Systematic Reviews and Implementation Reports, vol. 16, no. 1, pp. 117.

Not sure if this is the review type for you?

Right Review - decision support tool Not sure of the most suitable review method? Answer a few questions and be guided to suitable knowledge synthesis methods. New 2022 and featured in the Journal of Clinical Epidemiology 10.1016/j.jclinepi.2022.03.004
Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach Munn, Z. et al. (2018). BMC Medical Research Methodology, 18(1), 143. doi:10.1186/s12874-018-0611-x. Explains the different purposes and processes of systematic reviews and scoping reviews
Should I undertake a scoping review or a systematic review? (Video length: 12:43) In this video (YouTube), Assoc Prof Zachary Munn discusses the purpose of a scoping review and the difference between scoping reviews and systematic reviews
Systematic Reviews Research Guide UniSA Library guide detailing the methodology and search requirements of a systematic review
Scoping Reviews Research Guide > Other review types Find out more about narrative and scoping reviews.

Navigate to report broken links and provide feedback page

Next topic →

<< Previous: Overview
Next: Other review types >>
Last Updated: May 14, 2024 12:59 PM
URL: https://guides.library.unisa.edu.au/ScopingReviews

University Libraries University of Nevada, Reno

Skill Guides
Subject Guides

Systematic, Scoping, and Other Literature Reviews: Overview

Project Planning

What Is a Systematic Review?

Regular literature reviews are simply summaries of the literature on a particular topic. A systematic review, however, is a comprehensive literature review conducted to answer a specific research question. Authors of a systematic review aim to find, code, appraise, and synthesize all of the previous research on their question in an unbiased and well-documented manner. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) outline the minimum amount of information that needs to be reported at the conclusion of a systematic review project.

Other types of what are known as "evidence syntheses," such as scoping, rapid, and integrative reviews, have varying methodologies. While systematic reviews originated with and continue to be a popular publication type in medicine and other health sciences fields, more and more researchers in other disciplines are choosing to conduct evidence syntheses.

This guide will walk you through the major steps of a systematic review and point you to key resources including Covidence, a systematic review project management tool. For help with systematic reviews and other major literature review projects, please send us an email at [email protected] .

Getting Help with Reviews

Organization such as the Institute of Medicine recommend that you consult a librarian when conducting a systematic review. Librarians at the University of Nevada, Reno can help you:

Understand best practices for conducting systematic reviews and other evidence syntheses in your discipline
Choose and formulate a research question
Decide which review type (e.g., systematic, scoping, rapid, etc.) is the best fit for your project
Determine what to include and where to register a systematic review protocol
Select search terms and develop a search strategy
Identify databases and platforms to search
Find the full text of articles and other sources
Become familiar with free citation management (e.g., EndNote, Zotero)
Get access to you and help using Covidence, a systematic review project management tool

Doing a Systematic Review

Plan - This is the project planning stage. You and your team will need to develop a good research question, determine the type of review you will conduct (systematic, scoping, rapid, etc.), and establish the inclusion and exclusion criteria (e.g., you're only going to look at studies that use a certain methodology). All of this information needs to be included in your protocol. You'll also need to ensure that the project is viable - has someone already done a systematic review on this topic? Do some searches and check the various protocol registries to find out.
Identify - Next, a comprehensive search of the literature is undertaken to ensure all studies that meet the predetermined criteria are identified. Each research question is different, so the number and types of databases you'll search - as well as other online publication venues - will vary. Some standards and guidelines specify that certain databases (e.g., MEDLINE, EMBASE) should be searched regardless. Your subject librarian can help you select appropriate databases to search and develop search strings for each of those databases.
Evaluate - In this step, retrieved articles are screened and sorted using the predetermined inclusion and exclusion criteria. The risk of bias for each included study is also assessed around this time. It's best if you import search results into a citation management tool (see below) to clean up the citations and remove any duplicates. You can then use a tool like Rayyan (see below) to screen the results. You should begin by screening titles and abstracts only, and then you'll examine the full text of any remaining articles. Each study should be reviewed by a minimum of two people on the project team.
Collect - Each included study is coded and the quantitative or qualitative data contained in these studies is then synthesized. You'll have to either find or develop a coding strategy or form that meets your needs.
Explain - The synthesized results are articulated and contextualized. What do the results mean? How have they answered your research question?
Summarize - The final report provides a complete description of the methods and results in a clear, transparent fashion.

Adapted from

Types of reviews, systematic review.

These types of studies employ a systematic method to analyze and synthesize the results of numerous studies. "Systematic" in this case means following a strict set of steps - as outlined by entities like PRISMA and the Institute of Medicine - so as to make the review more reproducible and less biased. Consistent, thorough documentation is also key. Reviews of this type are not meant to be conducted by an individual but rather a (small) team of researchers. Systematic reviews are widely used in the health sciences, often to find a generalized conclusion from multiple evidence-based studies.

Meta-Analysis

A systematic method that uses statistics to analyze the data from numerous studies. The researchers combine the data from studies with similar data types and analyze them as a single, expanded dataset. Meta-analyses are a type of systematic review.

Scoping Review

A scoping review employs the systematic review methodology to explore a broader topic or question rather than a specific and answerable one, as is generally the case with a systematic review. Authors of these types of reviews seek to collect and categorize the existing literature so as to identify any gaps.

Rapid Review

Rapid reviews are systematic reviews conducted under a time constraint. Researchers make use of workarounds to complete the review quickly (e.g., only looking at English-language publications), which can lead to a less thorough and more biased review.

Narrative Review

A traditional literature review that summarizes and synthesizes the findings of numerous original research articles. The purpose and scope of narrative literature reviews vary widely and do not follow a set protocol. Most literature reviews are narrative reviews.

Umbrella Review

Umbrella reviews are, essentially, systematic reviews of systematic reviews. These compile evidence from multiple review studies into one usable document.

Grant, Maria J., and Andrew Booth. “A Typology of Reviews: An Analysis of 14 Review Types and Associated Methodologies.” Health Information & Libraries Journal , vol. 26, no. 2, 2009, pp. 91-108. doi: 10.1111/j.1471-1842.2009.00848.x .

Next: Project Planning >>

Literature Review: Scoping Reviews

Traditional or narrative literature reviews
Scoping Reviews
Systematic literature reviews
Annotated bibliography
Keeping up to date with literature
Finding a thesis
Evaluating sources and critical appraisal of literature
Managing and analysing your literature
Further reading and resources

Scoping Reviews - What Are They?

A scoping review serves the purpose of identifying the existing literature on a specific research question .

They can also clarify concepts in the literature and define gaps in knowledge. Unlike systematic reviews, "...scoping reviews do not aim to produce a critically appraised and synthesised result/answer to a particular question, [they] rather aim to provide an overview or map of the evidence" ( Munn et al., 2018 ).
Scoping Reviews are nevertheless "systematic-like", and require a rigorous approach. They often include a protocol; the searching is systematic and fairly exhaustive; and methods are documented thoroughly. They can be the precursor to a full systematic review.

Guidelines and Management

In the health sciences, there are guidelines for Scoping Reviews which could be successfully adapted for other disciplines. See:

Chapter 11 (Scoping Reviews) of the JBI Manual for Evidence Synthesis .
PRISMA for Scoping Reviews , which includes a checklist.

You can use the PRISMA flow diagram to keep track of studies you've found, and record how many you have included and excluded (with reasons) during the screening process.

Steps in a Scoping Review

If you're undertaking a Scoping Review in any discipline, the steps in this guide (with a few adjustments) will be useful.

Step 1: Identify your answerable research question - for all types of reviews it's important to pin down your research question. Follow the tips in this guide for trying to decide your focus and then using search frameworks such as PICO or SPIDER to help define your question.

Step 2: Develop your protocol - this step is not always undertaken for a Scoping Review in every discipline, and the PROSPERO protocol database, for example, does not publish Scoping Reviews. However, the JBI Reviewer's Manual states: ... "an a priori protocol must be developed before undertaking the scoping review. A scoping review protocol is important as it pre-defines the objectives, methods and reporting of the review and allows for transparency of process. The protocol should detail the criteria that the reviewers intend to use to include and exclude studies and to identify what data is relevant, and how the data will be extracted and presented. The protocol provides the plan for the scoping review and is important in limiting the occurrence of reporting bias."

You can register your protocol in one of the following repositories:

Open Science Framework (recommended by PRISMA-ScR)

Step 3: Conduct systematic searches - all the parts of Step 3 will be useful for Scoping Reviews. Work out a search strategy (including keywords and limitations), decide where to run your searches and be sure to document everything you do carefully and methodically. The JBI Reviewer's Manual suggests you start with an initial search in relevant databases, then analyse the keywords and index terms used in the articles you find to inform a second search using all these terms. Finally check the reference lists of identified reports and studies. It is usual to also search the grey (unpublished) literature.

Step 4: Select studies for inclusion (screening) - you need to work out inclusion and exclusion criteria for all the studies you've found. This will have been outlined in the protocol, if you have one. Otherwise it is usually included in the Methods section of the review. Common exclusion criteria may be the date range, the geographic location of studies, the type of study or the language of publication.

Some guidelines for Scoping Reviews recommend that more than one reviewer goes through the two stages of screening (title/abstract, then full text screening) to reduce the risk of bias. As with all the steps, make sure you record carefully the decisions you make. This could be done on a spreadsheet or table such as in this article by Macvean et al (2017).

Step 5: Critically appraise articles - Munn and his colleagues (2018) state, "Critical appraisal is not mandatory however reviewers may decide to assess and report the risk of bias in scoping reviews".

Step 6: Extract and synthesise the data - as the goal in a Scoping Review is to determine the range of evidence available on a topic, the data is not synthesised in the same way it is for a Systematic Review. Instead, charts, tables and other graphics typically map the results. See again the Macvean et al (2017) as an example.

The Literature Review

Narrative Review
Systematic Review
Scoping Review

Scoping Review Resources

JBI Manual Chapter 11 JBI's Manual for Evidence Synthesis has a specific chapter on Scoping Reviews and how to conduct them.
PRISMA extension for Scoping Reviews PRISMA extended their Systematic Review Reporting Guidelines to provide for Scoping Reviews. Use this checklist in your process.
Cochrane Scoping Review Video Series This video series by Cochrane provides detailed instructions on the process of a scoping review
Open Science Framework Open Science Framework (OSF) is a tool that promotes open, centralized workflows by enabling capture of different aspects and products of the research lifecycle, including developing a research idea, designing a study, storing and analyzing collected data, and writing and publishing reports or papers. It is developed and maintained by the Center for Open Science (COS).

Examples of Scoping Reviews

Learning Analytics in Flipped Classrooms: A Scoping Review Algayres, M., & Triantafyllou, E. (2020). Learning Analytics in Flipped Classrooms: A Scoping Review. Electronic Journal of E-Learning, 18(5), 397–409.
A scoping review of design thinking in school-based teacher professional learning and development Blundell, C. N. (2022). A scoping review of design thinking in school-based teacher professional learning and development. Professional Development in Education, 1–16.

What is a Scoping Review?

Like a systematic review, a scoping review follows specific protocols for evaluating a body of literature. However, a scoping review is a much broader approach to a topic. The are also referred to as "mapping reviews or "scoping studies." Here are some reasons you may look to conduct a scoping review as opposed to a systematic review from the JBI Manual for Evidence Synthesis:

As a precursor to a systematic review.
To identify the types of available evidence in a given field.
To identify and analyse knowledge gaps.
To clarify key concepts/ definitions in the literature.
To examine how research is conducted on a certain topic or field.
To identify key characteristics or factors related to a concept.

Difference between Systematic and Scoping Reviews

Table adapted from the Ontario Tech University Library's Research Guide on Scoping Reviews.

Search Tips

Picking key words.

Use your research questions to pick out essential keywords: see the Venn Diagram on joining topics into a research focus.
Find related terms and synonyms for each concept in your research question. for example:

art museums

Cultural heritage

Constructing Searches

Most search engines, including Educat+ and CLIO, use standard search language and symbols to convey searches:

Boolean operators connect your terms: AND connects different topics together, OR connects related terms within each topic, NOT removes that search term from results. See the example below.

Quotations : using quotation marks allows you to search for an exact phrase i.e. "Teachers College" instead of 'Teachers' and 'College'.

Parentheses : help group sets of terms to delineate relationships within the search.

Question mark : a question mark in a search has a similar function to an asterisk, but for only one letter i.e. 'wom?n' will capture woman and women.

Asterisks : adding an asterisk at the end of a word will capture related words with the same root or base, i.e. 'philosoph*' will capture philosophy, philosophical, philosopher etc.

Example Search

(“art museum*” OR museu* OR galler*) AND (hiring OR recruit*) AND (divers* OR DEAI OR DEI) AND (manage* OR executiv* OR leader*)

Lincoln School Of Teachers College. Summer Demonstration. Recreation Program. (1939). Historical Photographs of Teachers College . Courtesy of Gottesman Libraries.

<< Previous: Systematic Review
Last Updated: Mar 20, 2024 12:38 PM
URL: https://tc-columbia.libguides.com/review

Literature Reviews

1. Define your research question
Getting started
Types of reviews

Define topic

Brainstorming, limit scope, how ai can help, helpful resources.

2. Plan your search
3. Search the literature
4. Organize your results
5. Synthesize your findings
6. Write the review
Artificial intelligence (AI) tools
Thompson Writing Studio This link opens in a new window
Need to write a systematic review? This link opens in a new window

Contact a Librarian

Ask a Librarian

Mission animated icons created by Freepik - Flaticon

For example, the following research question is too broad.

Does social media affect mental health in college students?

A more focused research question could be:

Does social media play a role in the number of eating disorder diagnoses in college-aged women?

Need some guidance? Contact your subject librarian for a research consultation or reach out to [email protected] .

Start the brainstorming process:

Begin by identifying a broad topic of research interest (the more you're personally interested in it, the better!). Write it down to clarify your focus.
Narrow down your scope by considering specific areas within this topic that you want to explore.
Identify key themes and elements related to these specific areas. These will be the building blocks of your investigation.
Finally, integrate these key areas and elements into a well-crafted research question.

One way to brainstorm is to use a flowchart.

The scope of a topic encompasses the boundaries and constraints you set for your research. The more precise your research question, the smoother the research process becomes.

Feeling stuck? Here are some ways you can narrow down your topic:

geographic location
time period
discipline/field of study
age group, etc.

You: I need to conduct a literature review about social media, mental health, and college students. What are some example research questions within this topic?

ChatGPT:

How does the frequency and nature of social media use impact the mental health of college students?
What role do specific social media platforms play in influencing the mental well-being of college students?
How do online social interactions on platforms like Facebook, Instagram, or Twitter relate to the mental health outcomes of college students?
Are there differences in the association between social media use and mental health outcomes based on demographic factors such as gender, age, or academic major among college students?
What strategies do college students employ to cope with negative mental health effects associated with social media use?
How does the perception of social support through online platforms affect the mental health of college students?
To what extent does the comparison of oneself to others on social media contribute to mental health challenges among college students?
What interventions or educational programs are effective in promoting positive mental health behaviors in the context of social media use for college students?
How do social media literacy and awareness programs impact the mental health attitudes and behaviors of college students?
What is the relationship between the use of social media for academic and social purposes and the mental health outcomes of college students?

Generative AI tools : ChatGPT , Google Gemini (formerly Bard) , Claude , Microsoft Copilot

For more information on how to incorporate AI tools into your research, check out the section on AI Tools .

Developing Your Research Question
Developing a Researchable Question
Brainstorming tips from UNC Writing Center
<< Previous: Types of reviews
Next: 2. Plan your search >>
Last Updated: May 17, 2024 8:42 AM
URL: https://guides.library.duke.edu/litreviews

Services for...

Faculty & Instructors
Graduate Students
Undergraduate Students
International Students
Patrons with Disabilities

Harmful Language Statement
Re-use & Attribution / Privacy
Support the Libraries

Open access
Published: 14 May 2024

Protocol for a scoping review study on learning plan use in undergraduate medical education

Anna Romanova ORCID: orcid.org/0000-0003-1118-1604 1 ,
Claire Touchie 1 ,
Sydney Ruller 2 ,
Victoria Cole 3 &
Susan Humphrey-Murto 4

Systematic Reviews volume 13 , Article number: 131 ( 2024 ) Cite this article

Metrics details

The current paradigm of competency-based medical education and learner-centredness requires learners to take an active role in their training. However, deliberate and planned continual assessment and performance improvement is hindered by the fragmented nature of many medical training programs. Attempts to bridge this continuity gap between supervision and feedback through learner handover have been controversial. Learning plans are an alternate educational tool that helps trainees identify their learning needs and facilitate longitudinal assessment by providing supervisors with a roadmap of their goals. Informed by self-regulated learning theory, learning plans may be the answer to track trainees’ progress along their learning trajectory. The purpose of this study is to summarise the literature regarding learning plan use specifically in undergraduate medical education and explore the student’s role in all stages of learning plan development and implementation.

Following Arksey and O’Malley’s framework, a scoping review will be conducted to explore the use of learning plans in undergraduate medical education. Literature searches will be conducted using multiple databases by a librarian with expertise in scoping reviews. Through an iterative process, inclusion and exclusion criteria will be developed and a data extraction form refined. Data will be analysed using quantitative and qualitative content analyses.

By summarising the literature on learning plan use in undergraduate medical education, this study aims to better understand how to support self-regulated learning in undergraduate medical education. The results from this project will inform future scholarly work in competency-based medical education at the undergraduate level and have implications for improving feedback and supporting learners at all levels of competence.

Scoping review registration:

Open Science Framework osf.io/wvzbx.

Peer Review reports

Competency-based medical education (CBME) has transformed the approach to medical education to focus on demonstration of acquired competencies rather than time-based completion of rotations [ 1 ]. As a result, undergraduate and graduate medical training programs worldwide have adopted outcomes-based assessments in the form of entrustable professional activities (EPAs) comprised of competencies to be met [ 2 ]. These assessments are completed longitudinally by multiple different evaluators to generate an overall impression of a learner’s competency.

In CBME, trainees will progress along their learning trajectory at individual speeds and some may excel while others struggle to achieve the required knowledge, skills or attitudes. Therefore, deliberate and planned continual assessment and performance improvement is required. However, due to the fragmented nature of many medical training programs where learners rotate through different rotations and work with many supervisors, longitudinal observation is similarly fragmented. This makes it difficult to determine where trainees are on their learning trajectories and can affect the quality of feedback provided to them, which is a known major influencer of academic achievement [ 3 ]. As a result, struggling learners may not be identified until late in their training and the growth of high-performing learners may be stifled [ 4 , 5 , 6 ].

Bridging this continuity gap between supervision and feedback through some form of learner handover or forward feeding has been debated since the 1970s and continues to this day [ 5 , 7 , 8 , 9 , 10 , 11 ]. The goal of learner handover is to improve trainee assessment and feedback by sharing their performance and learning needs between supervisors or across rotations. However, several concerns have been raised about this approach including that it could inappropriately bias subsequent assessments of the learner’s abilities [ 9 , 11 , 12 ]. A different approach to keeping track of trainees’ learning goals and progress along their learning trajectories is required. Learning plans (LPs) informed by self-regulated learning (SRL) theory may be the answer.

SRL has been defined as a cyclical process where learners actively control their thoughts, actions and motivation to achieve their goals [ 13 ]. Several models of SRL exist but all entail that the trainee is responsible for setting, planning, executing, monitoring and reflecting on their learning goals [ 13 ]. According to Zimmerman’s SRL model, this process occurs in three stages: forethought phase before an activity, performance phase during an activity and self-reflection phase after an activity [ 13 ]. Since each trainee leads their own learning process and has an individual trajectory towards competence, this theory relates well to the CBME paradigm which is grounded in learner-centredness [ 1 ]. However, we know that medical students and residents have difficulty identifying their own learning goals and therefore need guidance to effectively partake in SRL [ 14 , 15 , 16 , 17 ]. Motivation has also emerged as a key component of SRL, and numerous studies have explored factors that influence student engagement in learning [ 18 , 19 ]. In addition to meeting their basic psychological needs of autonomy, relatedness and competence, perceived learning relevance through meaningful learning activities has been shown to increase trainee engagement in their learning [ 19 ].

LPs are a well-known tool across many educational fields including CBME that can provide trainees with meaningful learning activities since they help them direct their own learning goals in a guided fashion [ 20 ]. Also known as personal learning plans, learning contracts, personal action plans, personal development plans, and learning goals, LPs are documents that outline the learner’s roadmap to achieve their learning goals. They require the learner to self-identify what they need to learn and why, how they are going to do it, how they will know when they are finished, define the timeframe for goal achievement and assess the impact of their learning [ 20 ]. In so doing, LPs give more autonomy to the learner and facilitate objective and targeted feedback from supervisors. This approach has been described as “most congruent with the assumptions we make about adults as learners” [ 21 ].

LP use has been explored across various clinical settings and at all levels of medical education; however, most of the experience lies in postgraduate medical education [ 22 ]. Medical students are a unique learner population with learning needs that appear to be very well suited for using LPs for two main reasons. First, their education is often divided between classroom and clinical settings. During clinical training, students need to be more independent in setting learning goals to meet desired competencies as their education is no longer outlined for them in a detailed fashion by the medical school curriculum [ 23 ]. SRL in the workplace is also different than in the classroom due to additional complexities of clinical care that can impact students’ ability to self-regulate their learning [ 24 ]. Second, although most medical trainees have difficulty with goal setting, medical students in particular need more guidance compared to residents due to their relative lack of experience upon which they can build within the SRL framework [ 25 ]. LPs can therefore provide much-needed structure to their learning but should be guided by an experienced tutor to be effective [ 15 , 24 ].

LPs fit well within the learner-centred educational framework of CBME by helping trainees identify their learning needs and facilitating longitudinal assessment by providing supervisors with a roadmap of their goals. In so doing, they can address current issues with learner handover and identification as well as remediation of struggling learners. Moreover, they have the potential to help trainees develop lifelong skills with respect to continuing professional development after graduation which is required by many medical licensing bodies.

An initial search of the JBI Database, Cochrane Database, MEDLINE (PubMed) and Google Scholar conducted in July–August 2022 revealed a paucity of research on LP use in undergraduate medical education (UGME). A related systematic review by van Houten–Schat et al. [ 24 ] on SRL in the clinical setting identified three interventions used by medical students and residents in SRL—coaching, LPs and supportive tools. However, only a couple of the included studies looked specifically at medical students’ use of LPs, so this remains an area in need of more exploration. A scoping review would provide an excellent starting point to map the body of literature on this topic.

The objective of this scoping review will therefore be to explore LP use in UGME. In doing so, it will address a gap in knowledge and help determine additional areas for research.

This study will follow Arksey and O’Malley’s [ 26 ] five-step framework for scoping review methodology. It will not include the optional sixth step which entails stakeholder consultation as relevant stakeholders will be intentionally included in the research team (a member of UGME leadership, a medical student and a first-year resident).

Step 1—Identifying the research question

The overarching purpose of this study is to “explore the use of LPs in UGME”. More specifically we seek to achieve the following:

Summarise the literature regarding the use of LPs in UGME (including context, students targeted, frameworks used)

Explore the role of the student in all stages of the LP development and implementation

Determine existing research gaps

Step 2—Identifying relevant studies

An experienced health sciences librarian (VC) will conduct all searches and develop the initial search strategy. The preliminary search strategy is shown in Appendix A (see Additional file 2). Articles will be included if they meet the following criteria [ 27 ]:

Participants

Medical students enrolled at a medical school at the undergraduate level.

Any use of LPs by medical students. LPs are defined as a document, usually presented in a table format, that outlines the learner’s roadmap to achieve their learning goals [ 20 ].

Any stage of UGME in any geographic setting.

Types of evidence sources

We will search existing published and unpublished (grey) literature. This may include research studies, reviews, or expert opinion pieces.

Search strategy

With the assistance of an experienced librarian (VC), a pilot search will be conducted to inform the final search strategy. A search will be conducted in the following electronic databases: MEDLINE, Embase, Education Source, APA PsycInfo and Web of Science. The search terms will be developed in consultation with the research team and librarian. The search strategy will proceed according to the JBI Manual for Evidence Synthesis three-step search strategy for reviews [ 27 ]. First, we will conduct a limited search in two appropriate online databases and analyse text words from the title, abstracts and index terms of relevant papers. Next, we will conduct a second search using all identified key words in all databases. Third, we will review reference lists of all included studies to identify further relevant studies to include in the review. We will also contact the authors of relevant papers for further information if required. This will be an iterative process as the research team becomes more familiar with the literature and will be guided by the librarian. Any modifications to the search strategy as it evolves will be described in the scoping review report. As a measure of rigour, the search strategy will be peer-reviewed by another librarian using the PRESS checklist [ 28 ]. No language or date limits will be applied.

Step 3—Study selection

The screening process will consist of a two-step approach: screening titles/abstracts and, if they meet inclusion criteria, this will be followed by a full-text review. All screening will be done by two members of the research team and any disagreements will be resolved by an independent third member of the team. Based on preliminary inclusion criteria, the whole research team will first pilot the screening process by reviewing a random sample of 25 titles/abstracts. The search strategy, eligibility criteria and study objectives will be refined in an iterative process. We anticipate several meetings as the topic is not well described in the literature. A flowchart of the review process will be generated. Any modifications to the study selection process will be described in the scoping review report. The papers will be excluded if a full text is not available. The search results will be managed using Covidence software.

Step 4—Charting the data

A preliminary data extraction tool is shown in Appendix B (see Additional file 3 ). Data will be extracted into Excel and will include demographic information and specific details about the population, concept, context, study methods and outcomes as they relate to the scoping review objectives. The whole research team will pilot the data extraction tool on ten articles selected for full-text review. Through an iterative process, the final data extraction form will be refined. Subsequently, two members of the team will independently extract data from all articles included for full-text review using this tool. Charting disagreements will be resolved by the principal and senior investigators. Google Translate will be used for any included articles that are not in the English language.

Step 5—Collating, summarising and reporting the results

Quantitative and qualitative analyses will be used to summarise the results. Quantitative analysis will capture descriptive statistics with details about the population, concept, context, study methods and outcomes being examined in this scoping review. Qualitative content analysis will enable interpretation of text data through the systematic classification process of coding and identifying themes and patterns [ 29 ]. Several team meetings will be held to review potential themes to ensure an accurate representation of the data. The PRISMA Extension for Scoping Reviews (PRISMA-ScR) will be used to guide the reporting of review findings [ 30 ]. Data will be presented in tables and/or diagrams as applicable. A descriptive summary will explain the presented results and how they relate to the scoping review objectives.

By summarising the literature on LP use in UGME, this study will contribute to a better understanding of how to support SRL amongst medical students. The results from this project will also inform future scholarly work in CBME at the undergraduate level and have implications for improving feedback as well as supporting learners at all levels of competence. In doing so, this study may have practical applications by informing learning plan incorporation into CBME-based curricula.

We do not anticipate any practical or operational issues at this time. We assembled a team with the necessary expertise and tools to complete this project.

Availability of data and materials

All data generated or analysed during this study will be included in the published scoping review article.

Abbreviations

Competency-based medical education

Entrustable professional activity

Learning plan
Self-regulated learning
Undergraduate medical education

Frank JR, Snell LS, Cate OT, et al. Competency-based medical education: theory to practice. Med Teach. 2010;32(8):638–45.

Article PubMed Google Scholar

Shorey S, Lau TC, Lau ST, Ang E. Entrustable professional activities in health care education: a scoping review. Med Educ. 2019;53(8):766–77.

Hattie J, Timperley H. The power of feedback. Rev Educ Res. 2007;77(1):81–112.

Article Google Scholar

Dudek NL, Marks MB, Regehr G. Failure to fail: the perspectives of clinical supervisors. Acad Med. 2005;80(10 Suppl):S84–7.

Warm EJ, Englander R, Pereira A, Barach P. Improving learner handovers in medical education. Acad Med. 2017;92(7):927–31.

Spooner M, Duane C, Uygur J, et al. Self-regulatory learning theory as a lens on how undergraduate and postgraduate learners respond to feedback: a BEME scoping review : BEME Guide No. 66. Med Teach. 2022;44(1):3–18.

Frellsen SL, Baker EA, Papp KK, Durning SJ. Medical school policies regarding struggling medical students during the internal medicine clerkships: results of a National Survey. Acad Med. 2008;83(9):876–81.

Humphrey-Murto S, LeBlanc A, Touchie C, et al. The influence of prior performance information on ratings of current performance and implications for learner handover: a scoping review. Acad Med. 2019;94(7):1050–7.

Morgan HK, Mejicano GC, Skochelak S, et al. A responsible educational handover: improving communication to improve learning. Acad Med. 2020;95(2):194–9.

Dory V, Danoff D, Plotnick LH, et al. Does educational handover influence subsequent assessment? Acad Med. 2021;96(1):118–25.

Humphrey-Murto S, Lingard L, Varpio L, et al. Learner handover: who is it really for? Acad Med. 2021;96(4):592–8.

Shaw T, Wood TJ, Touchie T, Pugh D, Humphrey-Murto S. How biased are you? The effect of prior performance information on attending physician ratings and implications for learner handover. Adv Health Sci Educ Theory Pract. 2021;26(1):199–214.

Artino AR, Brydges R, Gruppen LD. Chapter 14: Self-regulated learning in health professional education: theoretical perspectives and research methods. In: Cleland J, Duning SJ, editors. Researching Medical Education. 1st ed. John Wiley & Sons; 2015. p. 155–66.

Chapter Google Scholar

Cleland J, Arnold R, Chesser A. Failing finals is often a surprise for the student but not the teacher: identifying difficulties and supporting students with academic difficulties. Med Teach. 2005;27(6):504–8.

Reed S, Lockspeiser TM, Burke A, et al. Practical suggestions for the creation and use of meaningful learning goals in graduate medical education. Acad Pediatr. 2016;16(1):20–4.

Wolff M, Stojan J, Cranford J, et al. The impact of informed self-assessment on the development of medical students’ learning goals. Med Teach. 2018;40(3):296–301.

Sawatsky AP, Halvorsen AJ, Daniels PR, et al. Characteristics and quality of rotation-specific resident learning goals: a prospective study. Med Educ Online. 2020;25(1):1714198.

Article PubMed PubMed Central Google Scholar

Pintrich PR. Chapter 14: The role of goal orientation in self-regulated learning. In: Boekaerts M, Pintrich PR, Zeidner M, editors. Handbook of self-regulation. 1st ed. Academic Press; 2000. p. 451–502.

Kassab SE, El-Sayed W, Hamdy H. Student engagement in undergraduate medical education: a scoping review. Med Educ. 2022;56(7):703–15.

Challis M. AMEE medical education guide No. 19: Personal learning plans. Med Teach. 2000;22(3):225–36.

Knowles MS. Using learning contracts. 1 st ed. San Francisco: Jossey Bass; 1986.

Parsell G, Bligh J. Contract learning, clinical learning and clinicians. Postgrad Med J. 1996;72(847):284–9.

Article CAS PubMed PubMed Central Google Scholar

Teunissen PW, Scheele F, Scherpbier AJJA, et al. How residents learn: qualitative evidence for the pivotal role of clinical activities. Med Educ. 2007;41(8):763–70.

Article CAS PubMed Google Scholar

van Houten-Schat MA, Berkhout JJ, van Dijk N, Endedijk MD, Jaarsma ADC, Diemers AD. Self-regulated learning in the clinical context: a systematic review. Med Educ. 2018;52(10):1008–15.

Taylor DCM, Hamdy H. Adult learning theories: Implications for learning and teaching in medical education: AMEE Guide No. 83. Med Teach. 2013;35(11):e1561–72.

Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19–32.

Peters MDJ, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalol H. Chapter 11: Scoping reviews. In: Aromataris E, Munn Z, eds. JBI Manual for Evidence Synthesis. JBI; 2020. https://synthesismanual.jbi.global. . Accessed 30 Aug 2022.

McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS Peer Review of Electronic Search Strategies: 2015 Guideline Statement. J Clin Epidemiol. 2016;75:40–6.

Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.

Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.

Venables M, Larocque A, Sikora L, Archibald D, Grudniewicz A. Understanding indigenous health education and exploring indigenous anti-racism approaches in undergraduate medical education: a scoping review protocol. OSF; 2022. https://osf.io/umwgr/ . Accessed 26 Oct 2022.

Download references

Acknowledgements

Not applicable.

This study will be supported through grants from the Department of Medicine at the Ottawa Hospital and the University of Ottawa. The funding bodies had no role in the study design and will not have any role in the collection, analysis and interpretation of data or writing of the manuscript.

Author information

Authors and affiliations.

The Ottawa Hospital – General Campus, 501 Smyth Rd, PO Box 209, Ottawa, ON, K1H 8L6, Canada

Anna Romanova & Claire Touchie

The Ottawa Hospital Research Institute, Ottawa, Canada

Sydney Ruller

The University of Ottawa, Ottawa, Canada

Victoria Cole

The Ottawa Hospital – Riverside Campus, Ottawa, Canada

Susan Humphrey-Murto

You can also search for this author in PubMed Google Scholar

Contributions

AR designed and drafted the protocol. CT and SH contributed to the refinement of the research question, study methods and editing of the manuscript. VC designed the initial search strategy. All authors reviewed the manuscript for final approval. The review guarantors are CT and SH. The corresponding author is AR.

Authors’ information

AR is a clinician teacher and Assistant Professor with the Division of General Internal Medicine at the University of Ottawa. She is also the Associate Director for the internal medicine clerkship rotation at the General campus of the Ottawa Hospital.

CT is a Professor of Medicine with the Divisions of General Internal Medicine and Infectious Diseases at the University of Ottawa. She is also a member of the UGME Competence Committee at the University of Ottawa and an advisor for the development of a new school of medicine at Toronto Metropolitan University.

SH is an Associate Professor with the Department of Medicine at the University of Ottawa and holds a Tier 2 Research Chair in Medical Education. She is also the Interim Director for the Research Support Unit within the Department of Innovation in Medical Education at the University of Ottawa.

CT and SH have extensive experience with medical education research and have numerous publications in this field.

SR is a Research Assistant with the Division of General Internal Medicine at the Ottawa Hospital Research Institute.

VC is a Health Sciences Research Librarian at the University of Ottawa.

SR and VC have extensive experience in systematic and scoping reviews.

Corresponding author

Correspondence to Anna Romanova .

Ethics declarations

Ethics approval and consent to participate, consent for publication, competing interests.

The authors declare that they have no competing interests.

Additional information

Publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1. prisma-p 2015 checklist., 13643_2024_2553_moesm2_esm.docx.

Additional file 2: Appendix A. Preliminary search strategy [ 31 ].

Additional file 3: Appendix B. Preliminary data extraction tool.

Rights and permissions.

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Cite this article.

Romanova, A., Touchie, C., Ruller, S. et al. Protocol for a scoping review study on learning plan use in undergraduate medical education. Syst Rev 13 , 131 (2024). https://doi.org/10.1186/s13643-024-02553-w

Download citation

Received : 29 November 2022

Accepted : 03 May 2024

Published : 14 May 2024

DOI : https://doi.org/10.1186/s13643-024-02553-w

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Systematic Reviews

ISSN: 2046-4053

Submission enquiries: Access here and click Contact Us
General enquiries: [email protected]

Mapping scoping reviews in neurosurgery: a scoping review protocol

Affiliations.

1 Department of Neurosurgery, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan.
2 Chang Gung University College of Medicine, Taoyuan, Taiwan.
3 Department of Radiation Oncology, Proton and Radiation Therapy Center, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan [email protected].
PMID: 38719324
PMCID: PMC11086454
DOI: 10.1136/bmjopen-2023-080878

Introduction: The realm of neurosurgery is currently witnessing a surge in primary research, underscoring the importance of adopting evidence-based approaches. Scoping reviews, as a type of evidence synthesis, offer a broad perspective and have become increasingly vital for managing the ever-expanding body of research in swiftly evolving fields. Recent research has indicated a rising prevalence of scoping reviews in healthcare literature. In this context, the concept of a 'review of scoping reviews' has emerged as a means to offer a higher level synthesis of insights. However, the field of neurosurgery appears to lack a comprehensive integration of scoping reviews. Therefore, the objective of this scoping review is to identify and evaluate the extent of scoping reviews within neurosurgery, pinpointing research gaps and methodological issues to enhance evidence-based practices in this dynamic discipline.

Methods: The method framework of Arksey and O'Malley will be used to conduct the scoping review. A thorough literature search will be performed on Medline, Scopus and Web of Science to find eligible studies using the keywords related to neurosurgery , scoping review and its variants . Two reviewers will independently revise all of the full-text articles, extract data and evaluate the study extent. A narrative overview of the findings from included studies will be given.

Ethics and dissemination: This review will involve secondary analysis of published literature, and therefore ethics approval is not required. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist will be used to guide translation of findings. Results will be disseminated through peer-reviewed journals and presented in conferences via abstract and presentation.

Keywords: neurosurgery; qualitative research.

Publication types

Research Support, Non-U.S. Gov't
Neurosurgery*
Neurosurgical Procedures / methods
Research Design
Review Literature as Topic*
Systematic Reviews as Topic / methods

Click through the PLOS taxonomy to find articles in your field.

For more information about PLOS Subject Areas, click here .

Loading metrics

Open Access

Peer-reviewed

Research Article

Ethical guidance for conducting health research with online communities: A scoping review of existing guidance

Roles Conceptualization, Data curation, Formal analysis, Methodology, Project administration, Validation, Visualization, Writing – original draft, Writing – review & editing

Affiliation Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom

Roles Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

* E-mail: [email protected]

Roles Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing

Jane Harris,
Jennifer Germain,
Ellie McCoy,
Rosemary Schofield

Published: May 17, 2024
https://doi.org/10.1371/journal.pone.0302924
Reader Comments

Online research methods have grown in popularity due in part to the globalised and far-reaching nature of the internet but also linked to the Covid-19 pandemic whereby restrictions to travel and face to face contact necessitated a shift in methods of research recruitment and data collection. Ethical guidance exists to support researchers in conducting online research, however this is lacking within health fields. This scoping review aims to synthesise formal ethical guidance for applying online methods within health research as well as provide examples of where guidance has been used. A systematic search of literature was conducted, restricted to English language records between 2013 and 2022. Eligibility focused on whether the records were providing ethical guidance or recommendations, were situated or relevant to health disciplines, and involved the use or discussion of online research methods. Following exclusion of ineligible records and duplicate removal, three organisational ethical guidance and 24 research papers were charted and thematically analysed. Four key themes were identified within the guidance documents, 1) consent, 2) confidentiality and privacy, 3) protecting participants from harm and 4) protecting researchers from harm with the research papers describing additional context and understanding around these issues. The review identified that there are currently no specific guidelines aimed at health researchers, with the most cited guidance coming from broader methodological perspectives and disciplines or auxiliary fields. All guidance discussed each of the four key themes within the wider context of sensitive topics and vulnerable populations, areas and issues which are often prominent within health research thus highlighting the need for unifying guidance specific for health researchers. Further research should aim to understand better how online health studies apply ethical principles, to support in informing gaps across both research and guidance.

Citation: Harris J, Germain J, McCoy E, Schofield R (2024) Ethical guidance for conducting health research with online communities: A scoping review of existing guidance. PLoS ONE 19(5): e0302924. https://doi.org/10.1371/journal.pone.0302924

Editor: Ayush Anand, BP Koirala Institute of Health Sciences, NEPAL

Received: September 5, 2023; Accepted: April 15, 2024; Published: May 17, 2024

Copyright: © 2024 Harris et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All relevant data are within the manuscript and its Supporting Information files.

Funding: The author(s) received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Introduction

Globally, there are 5.3 billion and 4.95 billion users of the internet and social media respectively [ 1 ], with these online spaces creating unprecedented research opportunities, particularly within health research and leading the internet to be coined ‘the laboratory for the social sciences’ [ 2 , 3 ]. Online methods are frequently used in health research to engage with populations who are hard to reach or seldom heard outside of online spaces, as well as those who are engaging in illicit or risky behaviours [ 4 ]. More recently, the Covid-19 pandemic restrictions necessitated a shift in methods of data collection and heightened interest in online methods [ 5 , 6 ]. Online research methods can range from recruiting participants online, e.g., advertising surveys online, through to online communities and social media becoming sources of data through data capture or scraping. It is this latter category where data is ‘taken’ from existing online spaces which often poses the most ethical questions, challenges and blurring of boundaries for researchers [ 7 ] who are working in spaces which are changing and adapting all the time as technology advances.

Ethical guidance exists to support researchers conducting online research and comes from both discipline specific fields such as psychology [ 8 ] and sociology [ 9 , 10 ], as well as more general guidance from cross disciplinary organisations [ 11 ]. This guidance applies offline ethical considerations to online methods, considering issues regarding consent, confidentiality and anonymity as well as protecting both participants and researchers from harm. Whilst these are standard ethical principles, their application can differ in online spaces and guidelines can often be interpreted differently or overlooked entirely within research and by researchers [ 12 ]. Furthermore, the study of online communities can present new ethical considerations such as whether these spaces can be considered public or private, a distinction which is difficult to navigate within the context of online platforms and where views are inconsistent even by those who inhabit such spaces [ 13 ]. Whilst online research has been used extensively within social sciences and particularly within health research, no guidance exists which is aimed specifically at health researchers. This coupled with complex ethical issues within an ever-changing online landscape can make conducting this research challenging. Therefore, this scoping review aims to synthesise current best ethical practice and guidance for online research and specifically for health researchers, consider the application of these sets of guidance within health research.

Due to a paucity in guidance specifically aimed at health researchers, this scoping review aimed to synthesise existing formal online ethical guidance within health research. Arksey and O’Malley’s [ 14 ] five-stage iterative process for scoping reviews was followed throughout, comprising the following 5 stages: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting the data and (5) collating, summarizing and reporting the results.

Research question

The review aimed to understand what ethical guidance is available for researchers conducting online research. The underpinning research question was ‘what guidance exists on the ethical considerations that should be taken by health researchers conducting research with or about online health communities’ which guided the systematic search strategy. The overarching review question allowed the reviewers to search a wide range of available literature to capture what guidance is already available in the public domain and collate and review recommendations developed from other studies.

Aims and objectives

Specifically, this study aimed to:

Map the available guidance on online ethics that is of relevance to health researchers
Thematically describe the key ethical considerations covered by this guidance (e.g., consent, protection from harm, preventing identification, verbatim quotes)
Highlight any areas of disagreement across the guidance
Identify any gaps or ethical grey areas in current guidance.

Identifying relevant studies

The search strategy was developed using search terms based on the PCC framework [ 15 , 16 ]; population of interest (health researchers), the concept (ethical guidance and considerations) and context (research with online health communities). JH and JG led the development of the search strategy and search terms focused on 1) online 2) research 3) ethics and 4) policy and guidance. Searches were conducted across Scopus, Web of Science, Medline and Psycinfo to locate publications over a 10-year timeframe between 2013 and 2022. A ten year timeframe was chosen due to rapidly evolving trends across social media and technology, with this time frame best reflecting the current online platform landscape. Manual searching of reference lists was undertaken and grey literature searched using Google Scholar, Google and websites of key health related research bodies and regulators (e.g., NIHR, BPS, Royal College of Physicians).

Searches identified 3,294 records which were imported into Rayan online reference manager and duplicates removed (n = 1,177). Study selection utilised a two-step process to screen titles and abstracts (n = 2,117) and then full paper screening (n = 189). All screening was undertaken by JH, JG, EMC and RS and following inclusion and exclusion criteria set out in Table 1 . Two reviewers each blind screened papers at both screening stages with conflicts resolved by group discussion and a third review where necessary. Research papers were selected for the review if they were conducting one of the forms of online research outlined in Table 1 in a health-related field and if their article made recommendations or guidance of their own for ethical practice as a result of their research experiences. Grey literature followed the same two-step process for screening. Twenty-seven articles and guidance were selected for data charting. All searches were conducted between February and June 2022, and were repeated in August 2023 however no new guidance was identified in these latter searches.

PPT PowerPoint slide
PNG larger image
TIFF original image

https://doi.org/10.1371/journal.pone.0302924.t001

Risk of bias

Whilst quality assessment is not a requirement of scoping reviews, assessing the methodological and other qualities of studies can support in contextualising findings and enable interpretation [ 15 ]. Therefore, the selected articles were assessed for quality and bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Text and Opinion [ 17 ]. The Text and Opinion checklist was considered most suitable as the scoping review had identified a range of different publications which made recommendations on ethical practice in online health research including organisational guidance documents, commentary and opinion pieces and methodological papers. As presented in Table 2 , the checklist criteria focused on whether the ethical recommendations made were clearly identified and logical, had standing in their field of expertise, were relevant to health researchers and had congruence with existing research. The quality of the papers and guidance was independently assessed by one of the four reviewers (JH, JG, EMC, RS) using the predetermined questions. The quality assessment of the papers can be viewed in Table 2 . The review papers largely met the criteria and after discussion, the decision was made to include all 27 papers in the final review.

https://doi.org/10.1371/journal.pone.0302924.t002

Data collection, summarisation and presentation of results

A data extraction form was developed in a Microsoft Excel Spreadsheet charting all relevant data including authors, year of publication, key ethical topics covered and, for research papers, which if any ethical organisational guidance had been followed. The data form was piloted independently by two authors (JH/JG) on 10% (n = 3) of papers, and the remainder of included studies split between the two reviewers. Data was charted across four key areas 1) consent , 2) confidentiality and privacy , 3) protecting participants from harm and 4) protecting researchers from harm . The areas where initially informed by the key subheading across all included ethical guidance and refined through discussions involving all members of the team. All data was systematically extracted and charting was conducted by two researchers (JH and JG) and checked for consistency. The researchers then made comparisons across the selected papers to identify common themes and gaps across the existing guidance. Once data extraction was complete, JH and JG discussed the findings to identify the key points of ethical consideration within each theme which were then synthesised to create a narrative account of the guidance.

Guidance from three organisations met the inclusion criteria for the review (See Fig 1 for PRISMA flow diagram): the British Psychological Society (BPS) [ 8 ], the Association of Internet Research (AoIR) [ 11 ] and the British Sociological Association (BSA) [ 9 , 10 ].

https://doi.org/10.1371/journal.pone.0302924.g001

Summaries of the guidance are included in Table 3 and our narrative is presented around four key themes: consent, confidentiality and privacy, protecting participants from harm and protecting researchers from harm ( Fig 2 ). Alongside these guidance documents, 24 research papers ( Table 4 ) were included to give a clearer understanding of which (if any) ethical guidance health researchers were following. The AoIR [ 11 ] was the most commonly cited guidance (n = 18), followed by the BPS [ 8 ] (n = 7), with the BSA [ 9 ] least cited (n = 1). Six papers did not cite any of the guidance documents, however, most papers were following the key guidance principles.

https://doi.org/10.1371/journal.pone.0302924.g002

https://doi.org/10.1371/journal.pone.0302924.t003

https://doi.org/10.1371/journal.pone.0302924.t004

All guidance discussed the complexities of obtaining informed participant consent in online research with BSA [ 9 ] and AOIR [ 11 ] noting particular difficulties for big data studies due to the sheer number of participants involved. According to the BSA, whilst informed consent is not legally required to obtain data from public online spaces, it cannot be overlooked from an ethical perspective [ 9 , 10 ], particularly when topics are sensitive in nature [ 10 ]. The BPS [ 8 ] assert that if data is not considered in the public domain and there is no scientific justification for undisclosed use, consent should always be gained. The AOIR [ 11 ] state that consent should consider environmental factors and expectations of the online communities and users under investigation. A number of practical difficulties were noted in obtaining consent including users having left online spaces and the potential disruption to online communities [ 10 ]. The BPS [ 8 ] outline the need to verify participant characteristics including vulnerability to coercion and ensure consent processes are not overly complicated and lengthy. BSA [ 9 ] advocate for a participatory approach of ongoing communication and recommend researchers consult forum moderators for permission (although they acknowledge moderators may not speak for all users) [ 10 ].

The majority of papers (n = 13) concurred that consent was more ambiguous in public online spaces [ 8 , 11 ] and was an ongoing process requiring continual reflection and communication with participants [ 4 , 18 , 19 , 23 , 25 , 27 , 30 , 32 , 33 , 35 , 36 , 38 – 40 ]. Eight papers repeated the BPS assertion that not seeking consent for public domain online data could be justified when the scientific and social value outweighed the associated risk [ 18 , 19 , 23 , 30 , 33 , 36 , 38 , 40 ]. Examples included data on non-sensitive health topics taken from large publicly accessible forums (for example Mumsnet) and blog or vlog data produced for a public audience [ 25 , 27 , 33 ]. Two studies [ 21 , 22 ] took a more extreme view that all online spaces are private, and consent should always be sought. However, in these instances both were discussing recruiting participants from online spaces to take part in conventional research.

In line with AoIR, seven papers gave attention to the expectations of online communities in relation to research [ 19 , 25 , 30 , 33 , 36 , 39 , 40 ]. For example, Burles et al [ 25 ] suggested that disrupting online illness support communities could cause members to change or reduce the support they provide to others. Three papers agreed with the BSA that consent should be sought from community moderators [ 40 ] using the examples of a private fathering forum [ 33 ], an online youth counselling platform [ 36 ] and closed Facebook groups [ 33 , 39 ]. However, seven papers acknowledged challenges of verifying age characteristics online [ 26 , 28 , 29 , 32 , 34 – 36 ] and the ability to give or capture informed consent online [ 36 ], and recommended consent processes relative to topic sensitivity [ 35 ] developed in consultation with clinical and subject experts [ 36 ]. Five papers acknowledged the challenges of ensuring participant information was read by participants [ 27 – 29 , 32 , 36 ] with solutions including FAQs [ 28 ], online quizzes [ 28 , 29 ] and multi-stage consent forms [ 32 ]. The scale of online datasets was also viewed as a barrier to seeking individual level consent [ 8 , 9 , 11 ]. Solutions proposed included seeking consent for quotes used in publications [ 11 , 27 ], as well as the posting of debriefing messages on the online communities or a dedicated study site [ 27 , 36 , 40 ]. Finally, three papers discussed the challenges of withdrawing consent in online research, for example when data included in a study is deleted by the user [ 4 , 36 ] or in prospective studies when the sensitive data has not yet been produced, with Clark et al [ 27 ] giving the example of using Twitter posts to predict post-natal depression.

Confidentiality/Privacy/Anonymity

As the guidance on consent indicates, all three guidance documents acknowledge that privacy is challenging to define in online spaces [ 8 , 9 , 11 ]. The BPS generally defines a public space as one where participants could reasonably be expected to be observed by strangers [ 8 ]. However, their internet mediated research guidance acknowledges this distinction is not so clear cut for online research because online interaction can simultaneously take place publicly (for example a public online forum) and privately (from the home) [ 8 ]. Where this ambiguity exists the BPS [ 8 ] and BSA [ 9 ] propose several practical steps to ensure participants are sufficiently protected from harm which are discussed in the section below. As the only international guidance included, the AoIR [ 11 ] gives a wider contextual outlook at differing perspectives between disciplines and across countries. They highlight the difference between deontological approaches to privacy (protecting the rights of autonomous individuals) in Europe versus the more utilitarian approaches (achieving a greater good for society) taken in the UK and US and advocate for “ ethical pluralism” which acknowledges these legitimate differences but develops shared norms and practices. The AoIR highlights several contextual factors which must be considered alongside the practical steps outlined by the BPS [ 8 ] and BSA [ 9 ]. This includes legal frameworks (e.g., GDPR), platform terms and conditions, management of data, adequate anonymisation of large data sets and reliance on companies giving access to their API which can favour certain countries, universities and researchers.

Twelve papers reflected on the blurred lines between public and private spaces online and users varying expectations of privacy in relation to research [ 4 , 21 , 23 – 27 , 29 – 33 , 36 ]. For example DeCamp [ 29 ] made recommendations which aligned well with the guidance, stating: 1) researchers should understand site Terms and Conditions regarding privacy and research participation, 2) if a site requires registration and moderator approval, there is some expectation of privacy, and 3) sites with express purpose of sharing individual health stories might have some expectation of privacy and researchers should engage with moderators and users before beginning the research. Two papers recommend the publication of a privacy statement via study or research group specific websites [ 18 , 32 , 35 ]. The issues highlighted by the AoIR in relation to different legal and cultural understandings of privacy internationally were rarely discussed, with only three papers providing any reflection on this [ 26 – 28 ].

Participant harm

The BSA [ 9 ] and BPS [ 8 ] both argue that online research should maximise benefits and minimise harm through values of protection, respect, dignity, and privacy [ 9 ] and gaining informed consent and anonymisation are vital to this. The BPS highlight social responsibility to respect the social structures of existing online groups and the consequences of undertaking research upon group cohesion and trust. Several practical steps are recommended to address this. These include: familiarisation with the online space of study to ascertain if participants perceive it to be public [ 9 ], discussions with group moderators on the best way to research their online groups [ 8 , 9 ], anonymisation of data through removal of personal information [ 8 , 9 ] including online pseudonyms [ 8 ], not including potentially embarrassing or sensitive information [ 9 ], paraphrasing or combining quotes [ 8 , 9 ], age verification and not naming online communities [ 8 ]. The guidance also note that these actions should be proportional to the risk of harm, for example sensitive topics and more vulnerable groups including children and young people, women, certain emotional states such as grieving and/or trauma, illnesses; and minorities such LGBTQ+ communities [ 8 , 11 ]. Research on sensitive topics where risks are high and the ability to control is low should be avoided and consideration must be given to researchers’ responsibility in reporting online users discussing negative well-being and criminal activity [ 8 ].

Sixteen of the studies recommended the anonymisation of data [ 4 , 19 , 23 – 28 , 30 – 33 , 35 – 37 , 40 ], achieved through removing online pseudonyms, sensitive health information, geolocation data and the names of sites from which data was collected. Benton et al [ 23 ] advise caution when linking data across multiple platforms as individual online personas could “out” sensitive health information. Ten studies recommended paraphrasing verbatim quotes [ 4 , 18 , 23 – 26 , 30 , 33 , 35 ], and this varied from changing minor words to prevent retrieval form a search engine, through to the fabrication of synthetic quotes based on participants’ words [ 23 , 25 ]. Eighteen papers felt potential harm was dependent on the sensitivity and anonymity of each online group and that vulnerability should be sensitively negotiated as the research progresses [ 4 , 18 , 19 , 21 – 24 , 26 – 32 , 34 – 36 ]. Three papers suggest this is addressed through familiarisation with site netiquette and potential impacts on cohesion and trust [ 29 , 31 , 33 ].

Researcher harm

Two of the three guidance discussed protecting researchers from harm [ 9 , 11 ]. This was considered particularly important for research relating to politically sensitive topics or where researchers hold identities (e.g., ethnicity, minority identity, sexual identity, political activism, etc.) that could trigger strong ideological reactions [ 11 ], placing them in publicly visible, vulnerable positions and at risk of abuse [ 9 ]. Both guidelines called for the support from individual institutions, stating that researchers should receive ethical approval prior to commencing research and continue to discuss challenges with the committee throughout [ 9 ]. Furthermore, institutions should develop policy detailing support procedures for researchers experiencing online threats or harassment related to their work [ 11 ]. The BPS [ 8 ] also highlight the challenges of ensuring integrity and scientific value when researchers have less control over who can participate, environmental conditions and responses during the research and variations in the research procedures caused by different hardware and software.

Seven papers considered the potential researcher harms from online research. Two papers noted that researchers should be cautious of putting themselves at risk of online abuse particularly if they were from groups vulnerable to harm [ 18 , 24 ]. Hunter et al [ 4 ], in line with AoIR [ 11 ], discuss the emotional impacts of exposure to sensitive or politically extreme information online, recommending clearly defined researcher roles and regular debriefs when exposed to content. Five papers reflect on the impacts upon research integrity raised by the BPS [ 8 , 26 , 30 , 33 , 36 ] with three papers suggesting that seeking approval from institutional research ethics committees is the best way to ensure methodologically and ethically sound research [ 30 , 33 , 36 ].

Our scoping review identified three online ethical guidance documents published within the last ten years which were relevant to researchers working across health-related disciplines: the Association of Internet Researchers (AoIR) [ 11 ], the British Psychological Society (BPS) [ 8 ], and the British Sociological Association (BSA) [ 9 ]. Whilst our review identified common thematic components across this guidance, it is also important to acknowledge that these guidance documents differ in scope and intention. The AoIR guidance promotes ethical pluralism, by highlighting key principles which are relevant to multidisciplinary researchers globally. In contrast, the BPS and BSA are country and discipline specific, presenting structured guidance on research practices. Our review identified a notable gap in formal guidance produced by international and national health organisations. As a result, a number of papers were identified which aimed to give advice to health researchers on conducting ethical online research and these papers drew on a combination of the existing guidance from other disciplines and research experience. Seventeen of the selected papers cited at least one of the three guidance documents, highlighting a clear will among health researchers to make use of guidance when designing their research. However, this also highlights a lack of standardisation of ethical approaches in health research with papers citing different or multiple ethical guidelines including those published prior to the last decade or from wider, less relevant disciplines such as marketing or education. This lack of uniform guidance for health research makes it challenging for researchers seeking to design online studies and for ethical review committees seeking to make consistent decisions about how such research should be conducted [ 41 – 44 ]. Previous reviews have also noted the variation in practices across social media research specifically and called for concrete guidelines on research ethics for social media research to be made available [ 45 ]. However, it should be noted that there has been an argument against a “one size fits all” approach to online research due to the diversity in online cultures, values, and platforms [ 46 ]. Whilst these complexities should not deter researchers from conducting online research they often instead require an individual assessment of the potential ethical issues [ 47 ]. However, the reflexive approach taken to online ethics by the BPS [ 8 ], BSA [ 9 ] and AoIR [ 11 ] (termed “ethical pluralism” by the AoIR [ 11 ]) and commonality in key themes, suggests that it is possible to develop research guidance which covers varying health research aims and approaches.

Broadly, the guidance documents covered four common thematic areas and recommended 1) decisions about seeking consent to use publicly available online data should balance the scientific value to the research with environmental factors relating to the online community including sensitivity of the research topic, vulnerability of populations and the potential for community disruption 2) there is ambiguity around which online spaces are public and private which can vary according to individual, online community, cultural and legal perceptions 3) researchers must therefore take active steps to protect participants from harm relative to the perceived risk, for example through anonymisation of data, and 4) researchers must also protect themselves from individual and reputational harm by seeking the correct ethical approvals for their research. Overall, there was good coverage of these principles within the selected papers with the principles of anonymity (n = 16) and perceptions of privacy (n = 12) most frequently included. Issues of consent (n = 7) and potential researcher harm (n = 7) were considered less often.

Notably across these themes, the guidance documents recommended decisions were made relative to the sensitivity of the research topic and vulnerability of the population under study. Examples of sensitive research areas included mental health [ 8 ], experiences of personal illness [ 9 ] and grief and trauma [ 11 ]. Vulnerable populations included women, children and young people, people in certain emotional states and LGBTQ+ people [ 8 , 11 ]. From our reading of this guidance, it was clear to us that a significant proportion of research undertaken in health-related disciplines could be considered sensitive by this definition as they involve the sharing of personal health experiences [ 48 ] or data, cover sensitive topics (such as mental health, chronic conditions, or substance use) and aim to include or target vulnerable populations [ 49 ]. This suggest that health researchers will be required to consider many of the more complex issues within the guidance as well as ethical safeguards around such issues as potential confidentiality breaches, the collection of sensitive data, or the unauthorised reuse of it [ 50 ]. Health research has a long- and well-established tradition of ethical guidance. In many countries, research taking place on healthcare premises or with patients is reviewed by separate institutional boards within healthcare organisations and there are many standardised expectations and procedures which govern how health related research can take place. For example, in the UK approval for research with National Health Service (NHS) patients must be granted by an NHS ethical committee and then individual approval provided by each hospital or healthcare trust where research will take place. Given the rigorous ethical requirements for health-related research in many countries, it is therefore quite surprising that guidance for online health research has not been produced by any official health organisations. This guidance would be valuable in assisting health researchers to reflexively design their studies to meet the ethical requirements in both health-related disciplines and the wider online research community.

Limitations

This scoping review only included studies which were of relevance to health-related researchers. Given the lack of guidance from health organisations, this may have excluded some broader ethics documents which are being used by health researchers to inform their studies. We limited our scoping review to guidance and papers published in the past 10 years to reflect the fast-changing nature of online communities and online research methodologies. It is possible this may have excluded some earlier guidance in health-related fields, although if these documents have not been updated then their relevance to current health related researchers may be limited. Our review also identified some emerging issues which were beyond the scope of this paper including the ethics of digital images [ 11 ] and the ethical impacts of big data in health, particularly prospective studies which predict sensitive health issues such as mental health or chronic conditions [ 27 , 51 ] which warrant further research. Similarly, we only included papers which presented some form of recommendation or guidance to other researchers on ethical online research practices. Further research could consider online health studies more generally to understand which key ethical principles are being applied, although the early stage of our review suggests that reporting of ethical practices in online research studies is inconsistent.

This scoping review aimed to synthesise current best ethical practice for online research in health -related fields. The review identified that there are currently no specific guidelines aimed at health researchers, with the most cited guidance coming from broader methodological perspectives (Franzke et al, 2020) or auxiliary fields [ 8 , 9 ]. As a consequence, many researchers had attempted to synthesise the recommendations from this guidance, their own research and previous studies to produce their own recommendations on ethical practice. Our review identified four key principles of ethical practice which were well cited in the online health research literature 1) a reflexive approach to seeking informed consent 2) protecting the privacy and anonymity of online participants 3) protecting participants from any harm associated with analysing their online data 4) preventing researchers from harm whilst undertaking online research. Across all the existing guidance, ethical decision making was framed in relation to the sensitivity of the research topic and vulnerability of the population. Given that much health research focuses on sensitive topics and populations, our review recommends unifying guidance specific for health researchers to help them design reflexive and ethical online research. Next steps should be focused on developing tailored health research guideline which draws on the experiences of health researchers working in this domain, as well as providing particular consideration to research across sensitive topics and with vulnerable groups.

Supporting information

S1 checklist. prisma 2020 checklist..

https://doi.org/10.1371/journal.pone.0302924.s001

https://doi.org/10.1371/journal.pone.0302924.s002

1. Statista. Number of internet and social media users worldwide as of April 2023 2023. Available from: https://www.statista.com/statistics/617136/digital-population-worldwide/ .
View Article
Google Scholar
PubMed/NCBI
8. British Psychological Society. Ethics guidelines for internetmediated research. Leceister: BPS; 2020 2020.
9. BSA (British Sociological Association). Ethics Guidelines and Collated Resources for Digital Research: British Sociological Association; 2017 2017.

Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review

REVIEW ARTICLE
Open access
Published: 11 May 2024

Cite this article

You have full access to this open access article

Louise Murphy ORCID: orcid.org/0000-0003-2349-1087 1 , 2 ,
Mohamad M. Saab ORCID: orcid.org/0000-0002-7277-6268 1 ,
Nicola Cornally ORCID: orcid.org/0000-0003-0644-0026 1 ,
Sheena McHugh ORCID: orcid.org/0000-0002-6595-0491 3 &
Patrick Cotter ORCID: orcid.org/0000-0002-6881-9421 1

182 Accesses

Explore all metrics

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care.

Strategies for implementation of guideline recommended cardiovascular risk management for patients with rheumatoid arthritis: results from a questionnaire survey of expert rheumatology centers

Awareness and perceived risk of cardiovascular disease among individuals living with rheumatoid arthritis is low: results of a systematic literature review

Managing cardiovascular disease risk in rheumatoid arthritis: clinical updates and three strategic approaches.

Avoid common mistakes on your manuscript.

Introduction

Rheumatoid Arthritis (RA) is a chronic, destructive, musculoskeletal disorder of unknown aetiology, characterised by symmetric polyarthritis and erosive synovitis [ 1 ]. RA age-standardised prevalence rates are rising globally [ 2 ], with current rates ranging from 0.24 to 1% of the general population [ 3 ]. Despite significant advancements in treatments over the past 20 years, RA still causes substantial mortality due to comorbidities such as cardiovascular disease (CVD) [ 4 ]. Studies have demonstrated 45 to 60% increased mortality in RA patient groups due to CVD compared to the general adult population [ 5 , 6 , 7 ]. This can be attributed to a high prevalence of traditional risk factors which, when combined with chronic inflammation, result in accelerated atherosclerosis [ 8 , 9 ]. CVD as an umbrella term represents four separate disease entities: ischemic heart disease, cerebrovascular disease, peripheral arterial disease, and aortic atherosclerosis [ 10 ]. Ischemic heart disease and cerebrovascular disease are the top two causes of death globally, with eight out of 10 events being preventable [ 11 ].

Due to the increased global prevalence of RA and associated costs to healthcare, particularly in the presence of concomitant CVD, preventative care is vital [ 12 , 13 ]. In patients with RA, CVD risk screening can be undertaken by any healthcare professional (HCP) involved in patient care including physicians, nurses, and allied health professionals working in a variety of disciplines including but not limited to rheumatology, cardiology, vascular medicine, neurology, and general medicine. CVD risk screening is undertaken to detect the presence or absence of traditional CVD risk factors such as smoking, hyperlipidaemia, or hypertension. CVD risk assessment, however, is the next step in identifying those patients who are deemed ‘at-risk’ of developing a cardiovascular event and stratifies that risk into low, medium, high, or very high, so interventions can be tailored accordingly [ 14 ]. CVD risk assessment, therefore, involves the application of an instrument as a composite measure of risk factor variables, and the recording of a score to assess risk beyond the initial screening for traditional risk factors [ 15 ]. European guidelines recommend that in patients with RA, a CVD risk assessment using a composite measure of risk factor variables should be performed at least once every five years and following a major change in anti-rheumatic medication [ 16 ].

The use of a validated composite measure as part of a standardised approach to CVD risk assessment in patients with RA enables an accurate risk prediction for individual patients [ 16 ]. This allows HCPs to inform patients about their prognosis and permits personalised treatment decisions for CVD prevention [ 17 ]. Numerous CVD risk assessment measures exist, from general population measures with and without adaptation for RA, to RA disease specific tools, examples of which can be seen in Online Resource 1 . EULAR (European Alliance of Associations for Rheumatology, formally the European League Against Rheumatism) published recommendations on CVD risk management in patients with RA [ 16 ]. These recommendations suggest all patients with RA should be CVD risk assessed using a CVD risk assessment measure, recommended by either national or international guidelines. Furthermore, EULAR recommends all risk prediction algorithms not including RA as an independent variable should be adjusted by a 1.5 multiplication factor to enable more accurate risk prediction estimates in this patient cohort [ 16 ].

The delivery of CVD risk assessments, beyond the use of a composite measure has not been well defined. Supportive strategies may be in use to assist HCPs in delivering CVD risk assessments in practice. Therefore, the aim of this review was to identify the scope of literature available regarding CVD risk assessments undertaken by HCPs as part of routine care in patients with RA.

The objectives of this review were to:

Map the strategies HCPs use to deliver CVD risk assessment in patients with RA.

Determine how and who conducts a CVD risk assessment in patients with RA.

Identify what composite measures are used in practice when assessing patients with RA for CVD risk.

This scoping review applied the Joanna Briggs Institute Methodological Guidelines [ 18 ]. A protocol for this review was registered with the Open Science Framework ( https://osf.io/f68vu ). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist [ 19 ] was used to guide the reporting of this review and is available in Online Resource 2 .

Eligibility criteria

The population, concept, and context (PCC) framework was used to determine the review eligibility criteria [ 18 ]. These were as follows: Population: Any HCP involved in the care of patients with RA; Concept: CVD risk assessment, including risk assessment using a risk prediction instrument as a composite measure of risk factors, as part of a risk management strategy, or risk prediction study; Context: Patients aged 18 years and older with RA cared for in any setting. We sought to include experimental and epidemiological studies including randomised and non-randomised controlled trials, quasi-experimental studies, prospective and retrospective cohort studies, case reports, cross-sectional studies, qualitative research, and grey literature such as policy statements, and government reports that yield data relating to CVD risk assessment in patients with RA as part of routine care. In this review, routine care was defined as an established way of working at the time a study or report was undertaken [ 20 ], as opposed to experimental systems introduced as part of an intervention for the study period only. Routine care encompasses patient centred centre, and is focused on individual patients, conducted by HCPs, in real-world settings, rather than investigative studies that tend to be focused on populations, involving researchers and research subjects, conducted under experimental conditions [ 21 ]. We included interventional studies where the intervention delivered CVD risk assessments in a routine care setting or where CVD risk assessment was part of routine care and the intervention aimed to enhance risk assessment rates or improve patient outcomes.

Studies involving patients with other forms of inflammatory joint disease where RA data couldn’t be isolated were excluded. Studies that focused on single risk factor prediction models or individual risk factor correlation/ incidence/ prevalence studies were also excluded. Studies where CVD risk assessment scoring was researcher led and conducted as part of the study intervention, rather than clinician led as part of routine care were excluded. Data relating to participants younger than 18 years of age were also excluded.

Information sources

Searches for peer-reviewed publications were conducted in six electronic databases (MEDLINE and CINAHL via EBSCO, the Cochrane Database of Systematic Reviews, Scopus, Web of Science and Academic Search Complete). Three trial registries (ClinicalTrials.gov, EU Clinical Trial Register, and the International Clinical Trials Registry Platform) were also searched to capture any relevant information.

Three grey literature databases (Base, OAIster, and Trip Pro) were searched for information relating to standard methods of CVD risk assessment in patients with RA internationally. Databases of relevant major medical clearing houses (Lenus, the National Guidelines Clearing House, and the Guidelines International Network) were also searched for information relating to policy documents or recommendations. Of note, grey literature searching was conducted with a focus on countries that score high on the human development index (HDI) and that possess similar healthcare development rankings such as life expectancy, education, and gross income per capita [ 22 ]. These countries include Ireland, the United Kingdom (UK), Denmark, Sweden, the Netherlands, the United States of America (USA), Canada, Australia, and New Zealand [ 23 ].

Considering the target population (i.e., patients with RA), further grey literature specific to the discipline of rheumatology was sought from the International League of Associations for Rheumatology website. This helped identify relevant information from regional partner organisations including EULAR, the American College of Rheumatology, the African League of Associations for Rheumatology, the Asia Pacific League of Associations for Rheumatology, and the Pan American League of Associations for Rheumatology.

Search strategy

Relevant keywords and subject headings were identified for CVD, risk assessment, and RA (Online Resource 3 ). Searches were last conducted in December 2023. The search strategy for each database is available in Online Resource 4 . Searches were customised to all peer-reviewed electronic databases and limited to the English language. No date or setting limitations were applied to maximise retrieval. The reference lists of all sources deemed eligible and included in the review were searched for additional relevant studies.

Selection of sources of evidence

The web-based software tool Covidence was used to screen and select relevant studies from all information sources [ 24 ]. Duplicates were deleted automatically in Covidence. Title, abstract, and full text screenings were conducted independently by two authors (LM and either PC, MMS, or NC) and conflicts were resolved by a third.

Charting the data

A data extraction tool adapted from the Joanna Briggs Institute [ 18 ] was utilised to extract key information about the sources of evidence regarding the author(s), year of publication, country, aims, design, sample size and target population, CVD assessment delivery including any strategy used, who the assessment was conducted by and in what location, composite measure(s) used (including modifications), frequency of assessment, and study findings. Data extraction was completed by LM and checked for accuracy by PC, MMS, and NC.

Synthesis of results

A narrative synthesis was conducted from the extracted data using a priori determined headings guided by the objectives of this review and included: strategies used to CVD risk assess patients with RA, HCPs who conduct CVD risk assessments in patients with RA, the setting where CVD risk assessments took place, the composite measure used, if adjusted for RA, and frequency of measure application.

The initial search following deduplication yielded 3,243 results. After title and abstract screening, 207 records were included for full text review. Of those, 12 records were deemed eligible for inclusion in the review. All records were identified from electronic database searching. No records were included from trial registries or the grey literature search. Further details on study selection can be found in the PRISMA flowchart (Fig. 1 ).

PRISMA flow chart

Results of individual sources of evidence

Findings from the included studies, including study characteristics are available in the data extraction table (Table 1 ).

Characteristics of sources of evidence

Of the 12 studies included, three originated from Norway [ 30 , 31 , 35 ], two from the UK [ 27 , 28 ], two from the Netherlands [ 34 , 36 ] and one from: Ireland [ 26 ], France [ 29 ], Malta [ 33 ], Canada [ 32 ], and the USA [ 25 ]. Studies were published between 2009 [ 26 ] and 2023 [ 34 ]. The designs of included studies were quasi-experimental [ 25 ], pre-post intervention audit [ 26 ], survey [ 27 ], prospective observational [ 28 , 29 ], service audits [ 30 , 33 ], observational implementational [ 31 ], retrospective cohort and survey [ 32 ], cross-sectional observational [ 34 , 35 ], and prospective cross-sectional [ 36 ]. Sample sizes ranged from 22 [ 29 ] to 4,483 [ 31 ] participants. The combined target populations of included studies were patients with RA ( n = 8,420), rheumatology consultants ( n = 119), and General Practitioners (GPs)/Family Physicians ( n = 207).

Strategies to support the delivery of CVD risk assessments in patients with RA in routine care were reported in eight studies [ 25 , 26 , 29 , 30 , 31 , 34 , 35 , 36 ], three of which reported 100% CVD risk assessment rates in routine care ( n = 125) [ 34 ], ( n = 201) [ 35 ], ( n = 720) [ 36 ]. Each strategy adopted various system-based interventions with two approaches to support delivery: (a) multidisciplinary team (MDT) collaboration [ 25 , 30 , 31 , 35 , 36 ] and (b) education [ 25 , 26 , 31 ].

System-based interventions involved the use of an electronic medical record reminder with a decision support tool [ 25 ], a shared care booklet [ 26 ], a standardised CVD risk assessment form [ 29 ], a purposively designed CVD risk assessment clinic [ 30 ], an electronic data collection and display system [ 31 ], structured scheduling of CVD risk assessment [ 34 ], a purposively designed CVD prevention clinic [ 35 ], and a guideline implementation project [ 36 ]. Electronic systems were used by two studies as strategies to support delivery of CVD risk assessments in practice. Akenroye et al.’s [ 25 ] electronic medical record reminder was deemed unsuccessful by the authors as CVD risk assessments were not performed in 93% ( n = 104) of patients. Ikdahl et al. [ 31 ] also reported the use of an electronic support system to support delivery of CVD risk assessments and cite an assessment rate of 44.7% ( n = 2,004) in practice which, in their opinion, was deemed successful. Ambrose et al. [ 26 ] used a shared care booklet to improve rates of CVD risk factor screening and assessment in practice and found, after re-auditing their service, improved rates of risk factor screening (necessary to conduct CVD risk assessments) from 60–85% for blood pressure, 58–75% for lipid profiles, and from 55–80% for weight assessment. Ikdahl et al. [ 30 ] reported the use of a purposively designed clinic for CVD risk factor measurement and assessment yielding a 52.1% ( n = 276) assessment rate. Raadsen et al. [ 34 ] also reported the use of a similar system-based approach with scheduling of CVD risk assessment clinic visits and reported a 100% ( n = 125) CVD risk assessment rate. Semb et al. [ 35 ] used additional vascular imaging as part of their CVD risk assessment strategy. In their observational study 42% ( n = 85) were found to have improved CVD risk stratification as a direct result of identifying carotid plaque on ultrasound compared to using a composite measure alone. Van den Oever et al. [ 36 ] designed the I-CaRe project to implement Dutch cardiovascular risk management recommendations [ 37 ]. As a result, van den Oever et al. [ 36 ] report a 100% ( n = 720) CVD risk assessment rate in practice.

Of the studies that reported successful system-based interventions [ 30 , 31 , 34 , 35 , 36 ], four adopted an MTD approach to support delivery [ 30 , 31 , 35 , 36 ]. Ikdahl et al. [ 30 ] developed a structured MDT clinic with defined roles for rheumatology doctors, nurses, and secretaries to implement European recommendations at that time [ 38 ]. They reported an increase of CVD risk assessment rates from 5.1% ( n = 31) to 52.1% ( n = 276) when patients were seen in the structured MDT clinic [OR = 20.97 (95% CI = 14.0; 31.3)]. Ikdahl et al. [ 31 ] presented results after implementation of a nation-wide quality assurance project involving a purposively designed CVD risk assessment programme. They also assigned duties to members of the rheumatology MDT and attribute its success primarily to this MDT approach. Semb et al. [ 35 ] reported the improvement of CVD risk stratification in their RA patient cohort because of specialised vascular imaging made possible by their cross disciplinary cardiology- rheumatology clinic. Van den Oever et al. [ 36 ] reported research nurses and rheumatology doctors undertake CVD risk assessments on all patients with RA as part of their Cardiovascular Risk Management in Rheumatoid Arthritis (I-Ca-Re) strategy, citing a 100% ( n = 720) CVD risk assessment rate in routine care. Akenroye et al. [ 25 ] reported rheumatology consultants and GPs conducted CVD risk assessments collaboratively in their patients with RA, however despite implementing their electronic reminder, their intervention was deemed unsuccessful as assessment rates were only 7% ( n = 8) in practice.

Education as a component of system-based interventions to support CVD risk assessment delivery was seen in three studies. Akenroye et al. [ 25 ] described the need for information sessions for participating rheumatologists. HCP and patient education was used in Ambrose et al.’s [ 26 ] shared care intervention to support CVD risk assessment delivery. The type, structure or content of this education was not described by the authors; however, a service audit eight months later demonstrated an improvement in measurement rates of CVD risk factors. Ikdahl et al. [ 31 ] reported the use of a CVD module and brief intervention training on smoking cessation and dietary advice for HCPs as part of their nationwide CVD risk assessment project.

Type of HCP conducting CVD risk assessments in patients with RA and the setting in which CVD risk assessments are carried out

Rheumatology doctors undertook CVD risk assessments on their own in four studies [ 26 , 29 , 32 , 36 ], GPs undertook assessments in primary care in two studies [ 27 , 28 ], and one study reported nurse led CVD risk assessment in routine care [ 34 ]. Another study reported that rheumatology consultants and GPs conducted CVD risk assessments on shared patients independently [ 25 ], and two studies reported involving a combination of rheumatology consultants, nurses, and secretaries in CVD risk assessment delivery [ 30 , 31 ]. Information on who conducted CVD risk assessment was not reported in two papers [ 33 , 35 ]. CVD risk assessments took place in the hospital setting [ 25 , 26 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], in primary care [ 25 , 27 , 28 ], in private practice [ 29 ], and in a rehabilitation centre [ 36 ].

CVD risk assessment (instrumentation)

Composite cvd risk assessment measures in use and frequency of application.

A variety of general population CVD risk assessment measures were used: the Systemic Coronary Risk Evaluation (SCORE) calculator [ 30 , 31 , 33 , 34 , 35 , 36 ]; the Framingham Risk Score (FRS) [ 25 , 26 , 28 , 29 , 32 ]; the Q Research Cardiovascular Risk (Q Risk) calculator [ 27 , 28 ]; the Joint British Societies (JBS) score [ 28 ]; and the American College of Cardiology/American Heart Association (ACC/AHA) calculator [ 35 ]. Two studies stated the use of more than one composite measure of CVD risk in routine care [ 28 , 35 ]. Only four studies reported on the frequency of CVD risk reassessment, which was conducted on a yearly basis [ 30 , 31 , 33 , 36 ].

Of the 12 studies, four acknowledged the increased risk of CVD due to systemic inflammation related to RA [ 30 , 31 , 33 , 36 ] and three acknowledged the impact of both, RA disease-specific and RA treatment-specific factors that result in increased CVD risk [ 27 , 29 , 32 ]. Interpretation of CVD risk assessment in terms of the impact of RA was discussed in three studies [ 29 , 34 , 36 ], where it was acknowledged that higher RA disease activity results in an increased CVD risk and therefore timing of the CVD assessment, for patients with RA, should be completed when disease is quiescent.

Adjustment of CVD risk assessment measure for RA

Of the six studies that reported using the SCORE tool [ 30 , 31 , 33 , 34 , 35 , 36 ], five stated the results were adjusted for RA [ 30 , 31 , 33 , 34 , 35 ] with varying methods including application of the 1.5 coefficient [ 33 , 34 , 35 ], using the high-risk country chart [ 31 ], or adding 15 years to the patients age [ 36 ]. Four of the five studies that reported using the FRS did not state if it was adjusted for RA [ 25 , 26 , 28 , 32 ]. Gossec et al. [ 29 ] who also reported using the FRS reminded rheumatology consultants to apply the 1.5 multiplication factor to the FRS score as part of their study requirements; however, they acknowledged they were unable to ascertain if the consultants complied. Authors that cited the JBS and the Q RISK 2 as being in use in routine care [ 27 , 28 ] did not need to adjust results to account for RA as both calculators include RA as an independent variable. The Q RISK 2 was used by the GP samples in both Bell and Rowe’s [ 27 ] survey and Emanuel et al.’s [ 28 ] observational study. The JBS calculator cited by Emanual et al. [ 28 ] also includes RA as an independent variable. The ACC/AHA calculator reported in Semb et al.’s [ 35 ] study does not have RA as a variable in its algorithm nor does the study indicate the results were adjusted to account for RA related CVD risk.

Results from this review demonstrated that although there is evidence that some strategies are used to support CVD risk assessment in patients with RA, extensive evidence establishing how HCPs conduct CVD risk assessments in practice is lacking. It was anticipated that a scoping review of the literature would yield the breadth of evidence necessary to map the strategies used in routine care. Many of the included studies focused on interventions to enhance current practices or reported CVD risk assessment as a by-product of an intervention to implement guidelines. Evidence such as retrospective chart reviews and standard operating protocols or procedures from professional rheumatology organisations might have allowed for more of a robust review of the current practice landscape.

From the studies included in this review, there is evidence to suggest that some strategies are used to support the delivery of CVD risk assessments in patients with RA [ 25 , 26 , 29 , 30 , 31 , 34 , 35 , 36 ] with associated improved [ 29 , 30 , 31 ] or optimum [ 34 , 35 , 36 ] rates of assessment. Other evidence has been published that supports system-based programmes in the identification and measurement of CVD risk factors in patients with RA [ 39 , 40 ], and system-based clinical decision supports for CVD risk assessment in the general population [ 41 , 42 , 43 ]. Tong et al. [ 44 ] suggests tools to assist HCPs in engaging in the CVD risk assessment conversation should also be developed with follow-up systems to facilitate CVD risk assessment and management. Of the 12 studies included in this review, four did not reference using any supportive strategy to deliver risk assessments in practice [ 27 , 28 , 32 , 33 ]. Each of these four studies reported either low assessment rate levels [ 27 , 28 ], inadequate management of CVD risk in general by the HCP [ 32 ], or low levels of CVD risk factor measurement [ 33 ]. Low CVD risk assessment rates in patients with RA results in missed opportunities for identification of CVD risk factors [ 45 ] and inhibits communication of individualised risk to the patient [ 46 , 47 , 48 ].

According to Gosh-Swaby et al. [ 49 ] patients who have the highest risk of developing CVD report the lowest awareness. Therefore, maximising assessment rates in practice is vital to ensure patients are aware of their individual risk, so treatments can be tailored accordingly. The supportive strategies identified in this review, albeit limited in numbers, reported improved or maximised rates of CVD assessment in routine care. By maximising rates of CVD risk assessment through supportive strategies and appropriate communication of CVD risk, more patients can become aware of their individual risk factors and can work with HCPs in initiating preventative therapy [ 49 , 50 ].

Four of the five studies that used a system-based approach with MDT collaboration to support delivery of CVD risk assessments reported rates of between 44.7% -100% in practice [ 30 , 31 , 35 , 36 ]. Despite adopting a cross disciplinary collaboration between rheumatologists and GPs to deliver CVD risk assessments in patients with RA, Akenroye et al. [ 25 ] reported assessment rates remained suboptimal at only 7% ( n = 8). They suggest a possible reason for this was due to rheumatologists’ low awareness of RA related CVD risk. In contrast the broader literature has demonstrated that rheumatology consultants are aware of this risk but feel it’s the responsibility of the GPs to undertake CVD risk assessment in primary care [ 39 , 46 ], demonstrating a lack of physician ownership in practice [ 51 , 52 , 53 ]. Three of these four studies involved nursing in their MDT collaboration [ 30 , 31 , 36 ]. One study cited independent nurse-led CVD risk assessment as part of routine care [ 34 ], without MTD collaboration but reported 100% CVD risk assessment rates. Studies exploring the impact of nurse-led care in patients with other chronic conditions have demonstrated improved outcomes compared to usual care [ 54 , 55 , 56 , 57 ]. Evidence has also been published to suggest nurses adopt a holistic and tailored approach to CVD risk assessment across a number of chronic conditions [ 58 ] with nurse-led CVD risk assessment programmes proving successful in the general population [ 59 ] primary care [ 60 ] and are well established in other chronic disease models of care [ 61 , 62 , 63 ]. Effective nurse-led CVD risk factor management programmes for patients with inflammatory disease have also been reported in the literature [ 64 , 65 ]. According to European recommendations for the role of the nurse in inflammatory arthritis [ 66 ] rheumatology nurses should participate in comprehensive disease management and undertake extended roles to improve patient outcomes. Therefore, implementing nurse-led CVD risk assessment for patients with RA may prove effective in increasing rates and standardising delivery.

Strategies that used system-based interventions with an educational approach to support delivery of CVD risk assessments involved information sessions on CVD risk factor definitions and treatment goals [ 25 ], dual doctor and patient education interventions which were identified but not described in the text [ 26 ] and educating HCPs on health promotion advice [ 31 ]. Only one of these studies reported having satisfactory CVD risk assessment rates in practice of 44.7% ( n = 2,004) [ 31 ]. Education highlighting the awareness of RA as an independent CVD risk factor was not seen in any of the included studies. Perhaps because the included studies were undertaken largely in hospital settings with rheumatology consultants who, according to Nguyen-Oghalai et al. [ 46 ], are aware of RA related CVD risk, therefore education of HCPs as a component of a CVD risk assessment framework might not be deemed necessary. Bell and Rowe’s [ 27 ] survey highlighted the importance of GP education where it was noted that GPs who had received education about RA, or who identified RA as a risk factor were significantly more likely to undertake a CVD risk assessment on patients with RA ( p < 0.0001). Patient education was only seen in combination with HCP education in one study [ 26 ]. Protocols defining integrated roles for both rheumatology teams and GPs when CVD risk assessing patients with RA is essential but should also include patient education to compliment clinical discussions [ 67 ]. Only two studies reported incorporating both MDT collaboration and HCP education [ 25 , 31 ] with varying results.

A number of CVD risk assessment measures were reported in use. Six of the European studies [ 30 , 31 , 33 , 34 , 35 , 36 ] reported using the SCORE calculator which was initially validated for use across 12 European cohorts [ 68 ]. Both the USA and Canadian studies [ 25 , 32 ] cited the use of the FRS, mirroring the American validation cohort [ 69 ]. Both UK based studies [ 27 , 28 ] reported using the Q RISK measure, aligning with the initial British derivation and validation cohort [ 70 ]. It appears, from this review, HCPs favour CVD risk assessment measures developed in cohorts similar to their patient populations. Measurements developed for and validated in specific countries may not be suitable for use in other countries unless adequate testing and validation has occurred, as differences in the prevalence of traditional risk factors across countries can affect risk scores, resulting in inaccurate risk predictions [ 71 ].

The most frequently cited assessment measure was the SCORE calculator [ 30 , 31 , 33 , 34 , 35 , 36 ] with five studies reporting score adjustment to account for RA [ 31 , 33 , 34 , 35 , 36 ]. The FRS was also cited in use [ 25 , 26 , 28 , 29 , 32 ] but without reference to adjustment for RA. The FRS algorithm significantly underestimates CVD risk in RA patients, particularly older patients with positive serology and patients with persistently elevated inflammatory markers [ 72 , 73 ]. Therefore, it is essential when using a general population calculator such as the FRS to adjust scores to account for RA related CVD risk [ 16 ].

This review found no RA disease specific CVD risk assessment measures in use in routine care. Disease specific calculators have been developed that include traditional CVD risk factors in their algorithm with the addition of disease specific variables such as clinical activity, corticosteroid use, and elements of functional ability (see in Online Resource 1 ) which have notable effects on CVD risk [ 74 ]. However, despite this, RA specific CVD risk calculators are not superior to general population CVD risk calculators in estimating future CVD risk in patients with RA [ 75 , 76 ] and as a result are not recommended for use in patients with RA over modified general population risk calculators [ 16 ].

Of the five composite measures mentioned in the included studies, two include RA disease as an independent variable (Q RISK and JBS), [ 27 , 28 ], recognizing the impact of inflammatory disease on CVD risk. None of the measures incorporated C-Reactive Protein, an inflammatory mediator, which rises in states of inflammation including flaring RA disease [ 77 , 78 ]. Only one measure (Q RISK) captured corticosteroid use, recognizing the impact of medication on CVD risk. Of note, composite measures included in our review did not make a distinction between the role of inflammation from RA disease and the role of RA treatment (e.g., corticosteroids) in increased CVD risk.

Strengths and limitations

The search strategy for this review was not limited to a specific period to help retrieval and avoid reporting bias. The search field was broadened by using a number of platforms to search for sources of evidence including electronic databases, trial registries, and the grey literature. The double screening process helped ensure that relevant studies were not missed. As for limitations it is possible that studies reporting CVD risk screening practices might have also conducted CVD risk assessments as part of routine care but did not report it as a separate/discrete element.

Conclusions

Findings of this scoping review identified a variety of system-based interventions to support the delivery of CVD risk assessments in patients with RA, operationalised in different ways using one, or a combination of, two approaches: (a) MDT collaboration, and (b) education. Various HCPs deliver CVD risk assessments in different settings including the hospital, private practice, rehabilitation units and primary care. A number of general population CVD risk assessment measurements were cited in use by studies in this review, with and without adjustment for RA. This review demonstrates that although several strategies to support the delivery of CVD risk assessments in patients with RA are cited in use in the literature, there is limited evidence to suggest a standardised model has been applied in practice. This review has identified a gap in the literature of robust evidence detailing the CVD risk assessment practices of HCPs in the routine care of patients with RA. Research needs to be undertaken to establish the extent to which HCPs are CVD risk assessing their patients with RA as part of routine care.

Data Availability

The author confirms that all data generated or analysed during this study are available in supplementary information files 1–4.

References:

Cush JJ (2022) Rheumatoid arthritis: early diagnosis and treatment. Rheum Dis Clin North Am 48(2):537–547. https://doi.org/10.1016/j.rdc.2022.02.010

Article PubMed Google Scholar

Safiri S, Kolahi AA, Hoy D, Smith E, Bettampadi D, Mansournia MA, Almasi-Hashiani A, Ashrafi-Asgarabad A, Moradi-Lakeh M, Qorbani M, Collins G, Woolf AD, March L, Cross M (2019) Global, regional and national burden of rheumatoid arthritis 1990–2017: a systematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis 78(11):1463–1471. https://doi.org/10.1136/annrheumdis-2019-215920

Almoallim H, Al Saleh J, Badsha H, Ahmed HM, Habjoka S, Menassa JA, El-Garf A (2020) A Review of the Prevalence and Unmet Needs in the Management of Rheumatoid Arthritis in Africa and the Middle East. Rheumatol Ther 8(1):1–16. https://doi.org/10.1007/s40744-020-00252-1

Article PubMed PubMed Central Google Scholar

Rezuș E, Macovei LA, Burlui AM, Cardoneanu A, Rezuș C (2021) Ischemic heart disease and rheumatoid arthritis-two conditions, the same background. Life (Basel) 11(10):1042. https://doi.org/10.3390/life11101042

Article CAS PubMed Google Scholar

Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D (2008) Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 59(12):1690–7. https://doi.org/10.1002/art.24092

Meune C, Touzé E, Trinquart L, Allanore Y (2009) Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: a systematic review and meta-analysis of cohort studies. Rheumatology (Oxford) 48(10):1309–13. https://doi.org/10.1093/rheumatology/kep252

Sparks JA, Chang SC, Liao KP, Lu B, Fine AR, Solomon DH, Costenbader KH, Karlson EW (2016) Rheumatoid Arthritis and Mortality Among Women During 36 Years of Prospective Follow-Up: Results From the Nurses’ Health Study. Arthritis Care Res (Hoboken) 68(6):753–62. https://doi.org/10.1002/acr.22752

Michaud K, Wolfe F (2007) Comorbidities in rheumatoid arthritis. Best Pract Res Clin Rheumatol 21(5):885–906. https://doi.org/10.1016/j.berh.2007.06.002

Jagpal A, Navarro-Millán I (2018) Cardiovascular co-morbidity in patients with rheumatoid arthritis: a narrative review of risk factors, cardiovascular risk assessment and treatment. BMC Rheumatol 2:10. https://doi.org/10.1186/s41927-018-0014-y

Olvera Lopez E, Ballard BD, Jan A (2023) Cardiovascular Disease. In: StatPearls [Internet]. StatPearls Publishing, Treasure Island

World Health Organisation (2022) The Top 10 causes of death—WHO | World Health Organization. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death . Accessed 8th Dec 2022

Joyce AT, Smith P, Khandker R, Melin JM, Singh A (2009) Hidden cost of rheumatoid arthritis (RA): estimating cost of comorbid cardiovascular disease and depression among patients with RA. J Rheumatol 36(4):743–52. https://doi.org/10.3899/jrheum.080670

Hollan I, Dessein PH, Ronda N, Wasko MC, Svenungsson E, Agewall S, Cohen-Tervaert JW, Maki-Petaja K, Grundtvig M, Karpouzas GA, Meroni PL (2015) Prevention of cardiovascular disease in rheumatoid arthritis. Autoimmun Rev 14(10):952–69. https://doi.org/10.1016/j.autrev.2015.06.004

Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC, Sperling LS, Virani SS, Blumenthal RS (2019) Use of risk assessment tools to guide decision-making in the primary prevention of atherosclerotic cardiovascular disease: a special report from the american heart association and American college of cardiology. Circle 139:e1162–e1177. https://doi.org/10.1161/CIR.0000000000000638

Article Google Scholar

Cooney MT, Dudina AL, Graham IM (2009) Value and limitations of existing scores for the assessment of cardiovascular risk: a review for clinicians. J Am Coll Cardiol 54(14):1209–27. https://doi.org/10.1016/j.jacc.2009.07.020

Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DP, Nurmohamed MT (2017) EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 76(1):17–28. https://doi.org/10.1136/annrheumdis-2016-209775

de Vries TI, Visseren FLJ (2020) Cardiovascular risk prediction tools made relevant for GPs and patients. Heart heartjnl-2019-316377. https://doi.org/10.1136/heartjnl-2019-316377

Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, McInerney P, Godfrey CM, Khalil H (2021) Updated methodological guidance for the conduct of scoping reviews. JBI Evid Implement 19(1):3–10. https://doi.org/10.1097/XEB.0000000000000277

Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, Moher D, Peters MDJ, Horsley T, Weeks L, Hempel S, Akl EA, Chang C, McGowan J, Stewart L, Hartling L, Aldcroft A, Wilson MG, Garritty C, Lewin S, Godfrey CM, Macdonald MT, Langlois EV, Soares-Weiser K, Moriarty J, Clifford T, Tunçalp Ö, Straus SE (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169(7):467–473. https://doi.org/10.7326/M18-0850

Etzelmueller A, Vis C, Karyotaki E, Baumeister H, Titov N, Berking M, Cuijpers P, Riper H, Ebert DD (2020) Effects of internet-based cognitive behavioral therapy in routine care for adults in treatment for depression and anxiety: systematic review and meta-analysis. J Med Internet Res 22(8):e18100. https://doi.org/10.2196/18100

Sacristán JA (2015) Clinical research and medical care: towards effective and complete integration. BMC Med Res Methodol 15:4. https://doi.org/10.1186/1471-2288-15-4

United Nations Development Programme (2021) https://hdr.undp.org/data-center/human-development-index#/indicies/HDI Accessed 19th Dec 2022

Hegarty J, Flaherty SJ, Saab MM, Goodwin J, Walshe N, Wills T, McCarthy VJC, Murphy S, Cutliffe A, Meehan E, Landers C, Lehane E, Lane A, Landers M, Kilty C, Madden D, Tumelty M, Naughton C (2021) An international perspective on definitions and terminology used to describe serious reportable patient safety incidents: a systematic review. J Patient Saf 17(8):e1247–e1254. https://doi.org/10.1097/PTS.0000000000000700

Covidence systematic review software (2023) Veritas health innovation, Melbourne, Australia. Available at www.covidence.org . Accessed 11 Dec 2023

Akenroye AT, Kumthekar AA, Alevizos MK, Mowrey WB, Broder A (2017) Implementing an electronic medical record-based reminder for cardiovascular risk screening in rheumatoid arthritis. Arthritis Care Res (Hoboken) 69(5):625–632. https://doi.org/10.1002/acr.22966

Ambrose NL, O’Connell P, Kearns G (2009) Limiting cardiovascular risk in Irish rheumatoid arthritis patients. Ir J Med Sci 178(1):53–5. https://doi.org/10.1007/s11845-008-0252-x

Bell C, Rowe IF (2011) The recognition and assessment of cardiovascular risk in people with rheumatoid arthritis in primary care: a questionnaire-based study of general practitioners. Musculoskeletal Care 9(2):69–74. https://doi.org/10.1002/msc.196

Emanuel G, Charlton J, Ashworth M, Gulliford MC, Dregan A (2016) Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care. Heart 102(24):1957–1962. https://doi.org/10.1136/heartjnl-2016-310111

Gossec L, Salejan F, Nataf H, Nguyen M, Gaud-Listrat V, Hudry C, Breuillard P, Dernis E, Boumier P, Durandin-Truffinet M, Fannius J, Fechtenbaum J, Izou-Fouillot MA, Labatide-Alanore S, Lebrun A, LeDevic P, LeGoux P, Sacchi A, Salliot C, Sparsa L, d’André FL, Dougados M, Rheumatology Network RHEVER (2013) Challenges of cardiovascular risk assessment in the routine rheumatology outpatient setting: an observational study of 110 rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 65(5):712–7. https://doi.org/10.1002/acr.21935

Ikdahl E, Rollefstad S, Olsen IC, Kvien TK, Hansen IJ, Soldal DM, Haugeberg G, Semb AG (2015) EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic. Biomed Res Int 2015:515280. https://doi.org/10.1155/2015/515280

Ikdahl E, Rollefstad S, Wibetoe G, Salberg A, Krøll F, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Gjesdal CG, Gulseth C, Haugeberg G, Semb AG (2018) Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: experiences from the nationwide NOCAR project. RMD Open 4(2):e000737. https://doi.org/10.1136/rmdopen-2018-000737

Ladak K, Hashim J, Clifford-Rashotte M, Tandon V, Matsos M, Patel A (2018) Cardiovascular risk management in rheumatoid arthritis: A large gap to close. Musculoskeletal Care 16(1):152–157. https://doi.org/10.1002/msc.1196

Magro R, Buhagiar M, Taliana N, Borg AA (2014) Cardiovascular risk assessment and management in rheumatoid arthritis: are guidelines being followed? Malta Med J 26(1):49–54. https://www.um.edu.mt/library/oar/bitstream/123456789/1625/1/2014.Vol26.Issue1.A9.pdf . Accessed 11 Dec 2023

Raadsen R, Hansildaar R, van Kuijk AWR, Nurmohamed MT (2023) Male rheumatoid arthritis patients at substantially higher risk for cardiovascular mortality in comparison to women. Semin Arthritis Rheum 62:152233. https://doi.org/10.1016/j.semarthrit.2023.152233

Semb AG, Ikdahl E, Hisdal J, Olsen IC, Rollefstad S (2016) Exploring cardiovascular disease risk evaluation in patients with inflammatory joint diseases. Int J Cardiol 223:331–336. https://doi.org/10.1016/j.ijcard.2016.08.129

van den Oever IAM, Heslinga M, Griep EN, Griep-Wentink HRM, Schotsman R, Cambach W, Dijkmans BAC, Smulders YM, Lems WF, Boers M, Voskuyl AE, Peters MJL, van Schaardenburg D, Nurmohamed MT (2017) Cardiovascular risk management in rheumatoid arthritis patients still suboptimal: the implementation of cardiovascular risk management in rheumatoid arthritis project. Rheumatology (Oxford) 56(9):1472–1478. https://doi.org/10.1093/rheumatology/kew497

Wiersma T, Smulders YM, Stehouwer CD, Konings KT, Lanphen J (2012) Samenvatting van de multidisciplinaire richtlijn 'Cardiovasculair risicomanagement' (herziening 2011) [Summary of the multidisciplinary guideline on cardiovascular risk management (revision 2011)] (in Dutch). Ned Tijdschr Geneeskd 156(36):A5104. Dutch

Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, McInnes IB, Haentzschel H, Gonzalez-Gay MA, Provan S, Semb A, Sidiropoulos P, Kitas G, Smulders YM, Soubrier M, Szekanecz Z, Sattar N, Nurmohamed MT (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69(2):325–31. https://doi.org/10.1136/ard.2009.113696

Bartels CM, Roberts TJ, Hansen KE, Jacobs EA, Gilmore A, Maxcy C, Bowers BJ (2016) Rheumatologist and primary care management of cardiovascular disease risk in rheumatoid arthritis: patient and provider perspectives. Arthritis Care Res (Hoboken) 68(4):415–23. https://doi.org/10.1002/acr.22689

Primdahl J, Clausen J, Hørslev-Petersen K (2013) Results from systematic screening for cardiovascular risk in outpatients with rheumatoid arthritis in accordance with the EULAR recommendations. Ann Rheum Dis 72(11)

Njie GJ, Proia KK, Thota AB, Finnie RKC, Hopkins DP, Banks SM, Callahan DB, Pronk NP, Rask KJ, Lackland DT, Kottke TE; Community Preventive Services Task Force (2015) Clinical decision support systems and prevention: a community guide cardiovascular disease systematic review. Am J Prev Med 49(5):784–795. https://doi.org/10.1016/j.amepre.2015.04.006

Holt TA, Thorogood M, Griffiths F, Munday S, Friede T, Stables D (2010) Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial. Br J Gen Pract 60(573):e137-43. https://doi.org/10.3399/bjgp10X483904

Yunda J, Pacheco D, Millan J (2015) A web-based fuzzy inference system based tool for cardiovascular disease risk assessment. NOVA 13(24):7–16. https://doi.org/10.22490/24629448.1712

Tong M, Gilmore-Bykovskyi A, Block L, Ramly E, White DW, Messina ML, Bartels CM (2022) Rheumatology clinic staff needs: barriers and strategies to addressing high blood pressure and smoking risk. J Clin Rheumatol 28(7):354–361. https://doi.org/10.1097/RHU.0000000000001868

Barber CE, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, Lopatina E, Marshall DA (2016) Gaps in addressing cardiovascular risk in rheumatoid arthritis: assessing performance using cardiovascular quality indicators. J Rheumatol 43(11):1965–1973. https://doi.org/10.3899/jrheum.160241

Nguyen-Oghalai TU, Hunnicutt SE, Smith ST, Maganti R, McNearney TA (2007) Factors that impact decision making among rheumatologists in the initiation of treatment for hypertension in rheumatoid arthritis. J Clin Rheumatol 13(6):307–12. https://doi.org/10.1097/RHU.0b013e318156bcc2

Barber CE, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GB, Lacaille D, Keeling S, Aviña-Zubieta JA, Marshall D (2015) Best practices for cardiovascular disease prevention in rheumatoid arthritis: a systematic review of guideline recommendations and quality indicators. Arthritis Care Res (Hoboken) 67(2):169–79. https://doi.org/10.1002/acr.22419

Schmidt TJ, Aviña-Zubieta JA, Sayre EC, Abrahamowicz M, Esdaile JM, Lacaille D (2018) Quality of care for cardiovascular disease prevention in rheumatoid arthritis: compliance with hyperlipidemia screening guidelines. Rheumatology (Oxford) 57(10):1789–1794. https://doi.org/10.1093/rheumatology/key164

Ghosh-Swaby OR, Kuriya B (2019) Awareness and perceived risk of cardiovascular disease among individuals living with rheumatoid arthritis is low: results of a systematic literature review. Arthritis Res Ther 21(1):33. https://doi.org/10.1186/s13075-019-1817-y

Teoh BC, Syed Sulaiman SA, Tan BE (2020) Knowledge of cardiovascular disease risk in rheumatoid arthritis patients before and after educational intervention from a Southeast Asia country: Malaysia. Arch Rheumatol 36(1):63–71. https://doi.org/10.46497/ArchRheumatol.2021.7726

Navarro-Millán I, Cornelius-Schecter A, O’Beirne RJ, Morris MS, Lui GE, Goodman SM, Cherrington AL, Fraenkel L, Curtis JR, Safford MM (2020) Views of primary care physicians and rheumatologists regarding screening and treatment of hyperlipidemia among patients with rheumatoid arthritis. BMC Rheumatol 4:14. https://doi.org/10.1186/s41927-020-0112-5

Navarro-Millán I, Young SR, Shurbaji S, McDavid C, Cornelius-Schecter A, Johnson B, Cherrington AL, Fraenkel L, Goodman SM, Curtis JR, Venkatachalam S, Safford MM (2020) Barriers and facilitators for screening and treatment of hyperlipidemia among patients with inflammatory arthritis. BMC Rheumatol 4:26. https://doi.org/10.1186/s41927-020-00123-w

Semb AG, Ikdahl E, Wibetoe G, Crowson C, Rollefstad S (2020) Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 16(7):361–379. https://doi.org/10.1038/s41584-020-0428-y

Chan RJ, Marx W, Bradford N, Gordon L, Bonner A, Douglas C, Schmalkuche D, Yates P (2018) Clinical and economic outcomes of nurse-led services in the ambulatory care setting: A systematic review. Int J Nurs Stud 81:61–80. https://doi.org/10.1016/j.ijnurstu.2018.02.002

Murfet GO, Allen P, Hingston TJ (2014) Maternal and neonatal health outcomes following the implementation of an innovative model of nurse practitioner-led care for diabetes in pregnancy. J Adv Nurs 70(5):1150–1163. https://doi.org/10.1111/jan.12277

Xu H, Mou L, Cai Z (2017) A nurse-coordinated model of care versus usual care for chronic kidney disease: meta-analysis. J Clin Nurs 26(11–12):1639–1649. https://doi.org/10.1111/jocn.13533

Hendriks JM, de Wit R, Crijns HJ, Vrijhoef HJ, Prins MH, Pisters R, Pison LA, Blaauw Y, Tieleman RG (2012) Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation. Eur Heart J 33(21):2692–9. https://doi.org/10.1093/eurheartj/ehs071 . Erratum in: Eur Heart J. 2013 Feb;34(6):408

Primdahl J, Ferreira RJ, Garcia-Diaz S, Ndosi M, Palmer D, van Eijk-Hustings Y (2016) Nurses’ role in cardiovascular risk assessment and management in people with inflammatory arthritis: a European perspective. Musculoskelet Care 14(3):133–51. https://doi.org/10.1002/msc.1121

Kavita, Thakur JS, Vijayvergiya R, Ghai S (2020) Task shifting of cardiovascular risk assessment and communication by nurses for primary and secondary prevention of cardiovascular diseases in a tertiary health care setting of Northern India. BMC Health Serv Res 20(1):10. https://doi.org/10.1186/s12913-019-4864-9

Tiessen AH, Smit AJ, Broer J, Groenier KH, Meer KVD (2012) Randomized controlled trial on cardiovascular risk management by practice nurses supported by self monitoring in primary care. BMC Fam Pract 3:90. https://doi.org/10.1186/1471-2296-13-90

Woodward A, Wallymahmed M, Wilding J, Gill G (2006) Successful cardiovascular risk reduction in type 2 diabetes by nurse-led care using an open clinical algorithm. Diabet Med 23(7):780–7. https://doi.org/10.1111/j.1464-5491.2006.01889.x

McLoughney CR, Khan ASA, Ahmed AB (2007) Effectiveness of a specialist nurse-led intervention clinic in the management of cardiovascular risk factors in diabetes. Eur Diab Nursing 4:100–105. https://doi.org/10.1002/edn.89

Zhang J, Zheng X, Ma D, Liu C, Ding Y (2022) Nurse-led care versus usual care on cardiovascular risk factors for patients with type 2 diabetes: a systematic review and meta-analysis. BMJ Open 12(3):e058533. https://doi.org/10.1136/bmjopen-2021-058533

Bartels CM, Ramly E, Johnson HM, Lauver DR, Panyard DJ, Li Z, Sampene E, Lewicki K, McBride PE (2019) Connecting rheumatology patients to primary care for high blood pressure: specialty clinic protocol improves follow-up and population blood pressures. Arthritis Care Res (Hoboken) 71(4):461–470. https://doi.org/10.1002/acr.23612

Bartels CM, Johnson L, Ramly E, Panyard DJ, Gilmore-Bykovskyi A, Johnson HM, McBride P, Li Z, Sampene E, Lauver DR, Lewicki K, Piper ME (2022) Impact of a rheumatology clinic protocol on tobacco cessation quit line referrals. Arthritis Care Res (Hoboken) 74(9):1421–1429. https://doi.org/10.1002/acr.24589

Bech B, Primdahl J, van Tubergen A, Voshaar M, Zangi HA, Barbosa L, Boström C, Boteva B, Carubbi F, Fayet F, Ferreira RJO, Hoeper K, Kocher A, Kukkurainen ML, Lion V, Minnock P, Moretti A, Ndosi M, Pavic Nikolic M, Schirmer M, Smucrova H, de la Torre-Aboki J, Waite-Jones J, van Eijk-Hustings Y (2020) 2018 update of the EULAR recommendations for the role of the nurse in the management of chronic inflammatory arthritis. Ann Rheum Dis 79(1):61–68. https://doi.org/10.1136/annrheumdis-2019-215458

John H, Hale ED, Treharne GJ, Korontzis K, Obrenovic K, Carroll D, Kitas GD (2011) Patient evaluation of a novel patient education leaflet about heart disease risk among people with rheumatoid arthritis. Musculoskeletal Care 9(4):194–9. https://doi.org/10.1002/msc.207

Conroy RM, Pyörälä K, Fitzgerald AP, Sans S, Menotti A, De Backer G, De Bacquer D, Ducimetière P, Jousilahti P, Keil U, Njølstad I, Oganov RG, Thomsen T, Tunstall-Pedoe H, Tverdal A, Wedel H, Whincup P, Wilhelmsen L, Graham IM, SCORE project group (2003) Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 24(11):987–1003. https://doi.org/10.1016/s0195-668x(03)00114-3

Wilson PW, D’Agostino RB, Levy D, Belanger AM, Silbershatz H, Kannel WB (1998) Prediction of coronary heart disease using risk factor categories. Circ 97(18):1837–47. https://doi.org/10.1161/01.cir.97.18.1837

Article CAS Google Scholar

Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, May M, Brindle P (2007) Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. BMJ 335(7611):136. https://doi.org/10.1136/bmj.39261.471806.55

Hermansson J, Kahan T (2018) Systematic review of validity assessments of Framingham risk score results in health economic modelling of lipid-modifying therapies in Europe. Pharmacoeconomics 36(2):205–213. https://doi.org/10.1007/s40273-017-0578-1

Crowson CS, Matteson EL, Roger VL, Therneau TM, Gabriel SE (2012) Usefulness of risk scores to estimate the risk of cardiovascular disease in patients with rheumatoid arthritis. Am J Cardiol 110(3):420–4. https://doi.org/10.1016/j.amjcard.2012.03.044

Arts EE, Popa C, Den Broeder AA, Semb AG, Toms T, Kitas GD, van Riel PL, Fransen J (2015) Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis 74(4):668–74. https://doi.org/10.1136/annrheumdis-2013-204024

Bonek K, Głuszko P (2016) Cardiovascular risk assessment in rheumatoid arthritis - controversies and the new approach. Reumatologia 54(3):128–35. https://doi.org/10.5114/reum.2016.61214

Crowson CS, Gabriel SE, Semb AG, van Riel PLCM, Karpouzas G, Dessein PH, Hitchon C, Pascual-Ramos V, Kitas GD: Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis (2017) Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries. Rheumatol (Oxford) 56(7):1102–1110. https://doi.org/10.1093/rheumatology/kex038

Solomon DH, Greenberg J, Curtis JR, Liu M, Farkouh ME, Tsao P, Kremer JM, Etzel CJ (2015) Derivation and internal validation of an expanded cardiovascular risk prediction score for rheumatoid arthritis: a consortium of rheumatology researchers of North America registry study. Arthritis Rheumatol 67(8):1995–2003. https://doi.org/10.1002/art.39195Erratum.In:ArthritisRheumatol.2016Feb;68(2):515

Bechman K, Tweehuysen L, Garrood T, Scott DL, Cope AP, Galloway JB, Ma MHY (2018) Flares in rheumatoid arthritis patients with low disease activity: predictability and association with worse clinical outcomes. J Rheumatol 45(11):1515–1521. https://doi.org/10.3899/jrheum.171375

Article CAS PubMed PubMed Central Google Scholar

Sproston NR, Ashworth JJ (2018) Role of C-reactive protein at sites of inflammation and infection. Front Immunol 13(9):754. https://doi.org/10.3389/fimmu.2018.00754

Download references

Open Access funding provided by the IReL Consortium. This research was undertaken as part of a PhD programme of study supported by an employment-based scholarship funded by the College of Medicine and Health, University College Cork.

Author information

Authors and affiliations.

Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland

Louise Murphy, Mohamad M. Saab, Nicola Cornally & Patrick Cotter

Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland

Louise Murphy

School of Public Health, University College Cork, Cork, Ireland

Sheena McHugh

You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Louise Murphy .

Ethics declarations

Disclosures, additional information, publisher's note.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 23 KB)

Supplementary file2 (docx 26 kb), supplementary file3 (docx 15 kb), supplementary file4 (docx 21 kb), rights and permissions.

Reprints and permissions

About this article

Murphy, L., Saab, M.M., Cornally, N. et al. Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review. Clin Rheumatol (2024). https://doi.org/10.1007/s10067-024-06996-3

Download citation

Received : 01 February 2024

Revised : 19 April 2024

Accepted : 03 May 2024

Published : 11 May 2024

DOI : https://doi.org/10.1007/s10067-024-06996-3

Share this article

Anyone you share the following link with will be able to read this content:

Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative

Cardiovascular disease
Rheumatoid arthritis
Scoping review
Cardiovascular risk assessment
Patient assessment
Routine care
Find a journal
Publish with us
Track your research

IMAGES

Steps of Literature Review stock image. Image of search
Scoping Reviews: What they are and how you can do them
how to conduct the literature review
A basic guide to writing a literature review
Guidance on Conducting a Systematic Literature Review
Scoping literature review example

VIDEO

I-Falls LPOE SEIS Scoping Meeting 2022
How to conduct quick literature review using litmaps
Scientometric Literature Review [Extended version 1]
How to use generative artificial intelligence in your literature review: Perplexity AI and Elicit AI
How to Do a Good Literature Review for Research Paper and Thesis
Synthesizing Research with a Scoping Review: CMU Libraries

COMMENTS

Steps for Conducting a Scoping Review
A scoping review is a type of knowledge synthesis that uses a systematic and iterative approach to identify and synthesize an existing or emerging body of literature on a given topic. 1 While there are several reasons for conducting a scoping review, the main reasons are to map the extent, range, and nature of the literature, as well as to determine possible gaps in the literature on a topic ...
PDF Scoping reviews: What they are & How you can do them
Most common reasons for conducting a scoping review*, N = 494 Count (%) Explore breadth/extent of evidence 336 (68%) Map and summarize evidence 177 (36%) ... Search grey literature Scoping review steps by the Joanna Briggs Institute 7. Screen titles & abstracts (by ≥2 reviewers) 8. Screen full-texts (by ≥2
Undertaking a scoping review: A practical guide for nursing and
Davis et al. undertook a review that explored the nature and status of scoping review studies in nursing literature. Their ... When conducting a scoping review, the information that is located can highlight new avenues of inquiry. It can be tempting to discuss these tangential subjects in the discussion section, without re-focussing on the ...
Scoping reviews: reinforcing and advancing the methodology and
Scoping reviews are an increasingly common approach to evidence synthesis with a growing suite of methodological guidance and resources to assist review authors with their planning, conduct and reporting. The latest guidance for scoping reviews includes the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses—Extension for Scoping Reviews.
Scoping reviews: what they are and how you can do them
In these videos from a Cochrane Learning Live webinar delivered in partnership with GESI: the Global Evidence Synthesis Initiative, Dr Andrea C. Tricco presents the definition of a scoping review, examples of scoping reviews, steps of the scoping review process, and methods used in 494 scoping reviews from the literature.
Updated methodological guidance for the conduct of scoping... : JBI
e PRISMA-ScR). Introduction: Scoping reviews are an increasingly common approach to informing decision-making and research based on the identification and examination of the literature on a given topic or issue. Scoping reviews draw on evidence from any research methodology and may also include evidence from non-research sources, such as policy. In this manner, scoping reviews provide a ...
Steps of a Scoping Review
Before embarking on a scoping review, 1) Make sure that a recent scoping or systematic review on the same topic has not already been published, and. ... Conduct the Literature Search; Select Studies based on Inclusion/Exclusion Criteria; Perform Data Extraction & Interpret Findings; Present Findings;
Scoping Reviews
The purpose of a scoping review is to map the body of literature on a topic area. The purpose of a systematic review is to synthesize the best available research on a specific intervention . Scoping reviews identify key characteristics or factors related to a concept. They do not produce statements to guide decision-making.
Scoping
The PRISMA extension for scoping reviews was published in 2018. The checklist contains 20 essential reporting items and 2 optional items to include when completing a scoping review. Scoping reviews serve to synthesize evidence and assess the scope of literature on a topic. Among other objectives, scoping reviews help determine whether a ...
Scoping Reviews: Step 3: Conduct Literature Searches
The goal of a scoping review search is to retrieve all results that are relevant to your topic in order to map (ie, report on the scope), and to identify themes and gaps in the literature. Because scoping review searches can be quite extensive and retrieve large numbers of results, an important aspect is limiting the number of irrelevant ...
Overview of scoping reviews
Overview of scoping reviews. "In general, scoping reviews are commonly used for 'reconnaissance' - to clarify working definitions and conceptual boundaries of a topic or field. Scoping reviews are therefore particularly useful when a body of literature has not yet been comprehensively reviewed, or exhibits a complex or heterogeneous nature not ...
(PDF) How to Write a Scoping Review?
A scoping review is a method of review in which a systematic. approach is used to identify and synthesize existing or. emerging literature on a given topic. [3] The primary purpose. of a scoping ...
PDF CURRENT BEST PRACTICES FOR THE CONDUCT OF SCOPING REVIEWS
Exercises in and of themselves. to summarize and disseminate research findings. to identify research gaps or general gaps in an area. make recommendations for the future research. map a body of literature with relevance to time, location (e.g. country or context), source (e.g. peer-reviewed or grey literature), and origin (e.g. healthcare ...
Systematic, Scoping, and Other Literature Reviews: Overview
Scoping Review. A scoping review employs the systematic review methodology to explore a broader topic or question rather than a specific and answerable one, as is generally the case with a systematic review. Authors of these types of reviews seek to collect and categorize the existing literature so as to identify any gaps. Rapid Review
Literature Review: Scoping Reviews
A scoping review serves the purpose of identifying the existing literature on a specific research question.. They can also clarify concepts in the literature and define gaps in knowledge. Unlike systematic reviews, "...scoping reviews do not aim to produce a critically appraised and synthesised result/answer to a particular question, [they] rather aim to provide an overview or map of the ...
Scoping Review
The are also referred to as "mapping reviews or "scoping studies." Here are some reasons you may look to conduct a scoping review as opposed to a systematic review from the JBI Manual for Evidence Synthesis: As a precursor to a systematic review. To identify the types of available evidence in a given field. To identify and analyse knowledge gaps.
Getting started
Definition: A literature review is a systematic examination and synthesis of existing scholarly research on a specific topic or subject. Purpose: It serves to provide a comprehensive overview of the current state of knowledge within a particular field. Analysis: Involves critically evaluating and summarizing key findings, methodologies, and ...
Types of reviews
Types of reviews and examples. Definition: "A term used to describe a conventional overview of the literature, particularly when contrasted with a systematic review (Booth et al., 2012, p. 265). Characteristics: Example: Mitchell, L. E., & Zajchowski, C. A. (2022). The history of air quality in Utah: A narrative review.
LibGuides: Literature Reviews: 1. Define your research question
Identifying a well-defined research question is the first step in the literature review process. For undergraduates, professors will often assign a broad topic for a literature review assignment. You will need to more narrowly define your question before you can begin the research process. Do a preliminary search on your topic in either Google ...
Protocol for a scoping review study on learning plan use in
The search strategy, eligibility criteria and study objectives will be refined in an iterative process. We anticipate several meetings as the topic is not well described in the literature. A flowchart of the review process will be generated. Any modifications to the study selection process will be described in the scoping review report.
Mapping scoping reviews in neurosurgery: a scoping review protocol
Methods: The method framework of Arksey and O'Malley will be used to conduct the scoping review. A thorough literature search will be performed on Medline, Scopus and Web of Science to find eligible studies using the keywords related to neurosurgery, scoping review and its variants. Two reviewers will independently revise all of the full-text ...
Ethical guidance for conducting health research with online communities
This scoping review aims to synthesise formal ethical guidance for applying online methods within health research as well as provide examples of where guidance has been used. A systematic search of literature was conducted, restricted to English language records between 2013 and 2022.
Cardiovascular disease risk assessment in patients with ...
The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. ... It was anticipated that a scoping review of the literature would yield the breadth of evidence necessary to map the ...
Adaptation to life after sport for retired athletes: A scoping review
Retirement from sport is a life transition that has significant implications for athletes' physical and mental health, as well as their social and professional development. Although extensive work has been done to review the retirement experiences of athletes, relatively less work has been done to examine and reflect on this expansive body of literature with a pragmatic aim of deciding what ...

Steps for Conducting a Scoping Review

Aliki Thomas

Identifying a Team

Step 1: Identifying the Research Question

Step 2: Identifying Relevant Studies

Step 3: Selecting Studies to Be Included in the Review

Step 4: Charting the Data

Step 5: Collating, Summarizing, and Reporting the Results

Step 6: Consulting Stakeholders (Optional)

Cochrane Training

Presenters Bio

Part 1: Scoping reviews: an overview with examples

Part 2: Example: Strengthening clinical governance in low- and middle-income countries

Part 3: Examples of non-health related scoping reviews

Part 4: Doing scoping reviews

Part 5: Polling questions and Q&A session

Scoping Review Guide

Before Starting on a Review

Steps of a Scoping Review

Systematic Reviews: Scoping Reviews

What is a Scoping Review?

How is this different from a Systematic Review?

The PCC Question Development Framework

When do I perform a Systematic Review? When do I perform a Scoping Review?

How are both Systematic and Scoping Reviews different from Traditional Literature Reviews?

Additional Resources

Scoping Reviews: Step 3: Conduct Literature Searches

Partner with a librarian

Search the FAQs

Librarian's Role

Search Process

Identify search concepts and terms for each

View our example in PICO format

View Controlled Vocabulary for our example PICO

Keyword Terms

Display Controlled Vocabulary and Keywords for our example PICO

Boolean operators

View field tags for several health databases

Combining search elements together

View the proper way to combine MeSH terms and Keywords for our example PICO

Other searching methods

Searching grey literature

Overview of scoping reviews

Guidelines and standards

The scoping review process

Exemplar reviews

Not sure if this is the review type for you?

Systematic, Scoping, and Other Literature Reviews: Overview

What Is a Systematic Review?

Getting Help with Reviews

Doing a Systematic Review

Adapted from

Meta-Analysis

Scoping Review

Rapid Review

Narrative Review

Umbrella Review

Literature Review: Scoping Reviews

Scoping Reviews - What Are They?

Guidelines and Management

Steps in a Scoping Review

Further reading

The Literature Review

Scoping Review Resources

Examples of Scoping Reviews

What is a Scoping Review?

Difference between Systematic and Scoping Reviews

Search Tips

Constructing Searches

Example Search

Literature Reviews

Define topic

Ask a Librarian

Services for...

Protocol for a scoping review study on learning plan use in undergraduate medical education

Scoping review registration:

Step 1—Identifying the research question

Step 2—Identifying relevant studies

Types of evidence sources

Search strategy