Commentary
Cultivating Our Practice: A Reflection on Library Synthesis Review Services in the Context of Patient-Oriented Research
Catherine Boden
Associate Librarian
Leslie and Irene Dube Library
University of Saskatchewan
Saskatoon, Saskatchewan, Canada
Email: catherine.boden@usask.ca
Angie Gerrard
Associate Librarian
Murray Library
University of Saskatchewan
Saskatoon, Saskatchewan, Canada
Email: angie.gerrard@usask.ca
Received: 12 July
2021 Accepted: 26 Oct.
2021
2021 Boden and Gerrard. This is an Open Access article distributed under the
terms of the Creative Commons‐Attribution‐Noncommercial‐Share Alike License 4.0
International (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits unrestricted use,
distribution, and reproduction in any medium, provided the original work is
properly attributed, not used for commercial purposes, and, if transformed, the
resulting work is redistributed under the same or similar license to this one.
DOI: 10.18438/eblip29997
Academic libraries offering synthesis
review (SR) services must address researchers’ needs amidst an ever-changing
environment. SRs refer to various methodological review types which adhere to
rigorous methods (e.g., systematic reviews, scoping reviews, realist reviews,
and rapid reviews). Since the early 2000s, researchers have noted increasing
numbers of systematic reviews being published (Bastian et al., 2010; Ioannidis,
2016; Page et al., 2016), and a proliferation of SR types (e.g., Kastner et
al., 2016; Sutton et al., 2019; Tricco et al.,
2016). For each review type, the methods for finding literature share
similarities but also nuanced differences (Sutton et al., 2019). Furthermore,
health sciences research trends impact review team composition, such as patient
engagement in the research endeavour.
Patient oriented research (POR)
places individuals with lived experience at the centre of the research pursuit
with the goal of improving the relevance and applicability of health care
research (Canadian Institutes of Health Research, 2019a). The Canadian
Institutes of Health Research (2019b) defines “patient” in this context as an
overarching term that includes individuals with personal experience of a health
issue, and includes patients and informal caregivers, such as family and
friends. Patient partners, and indeed other stakeholders (e.g., Slattery et
al., 2020), engage in SRs, as evident in collaborations like the Cochrane
Collaboration (2021).
Patient partners can be involved at
any or all stages of a review. Examples of patient partner contributions
include: research agenda setting (e.g., identifying a need for reviews in
particular research areas), defining the research question, identifying
patient-oriented outcomes, planning the methods, writing protocols, and so
forth. Patient partners can also be full collaborators on the review (Pollock
et al., 2018). As SR practices evolve, there may be downstream consequences to
library services. In this commentary, we explore implications for librarians who
may now be engaged in supporting patient-oriented reviews and potential
consequences to library SR service models based on our experience with a
patient-oriented rapid review.
To understand how libraries can
better support POR through their SR services, we took a two-pronged approach:
(1) we initially conducted a rapid review of the perspectives of patient
partners engaged in SRs, and (2) we then reflected on the experience of
engaging patient partners in the rapid review process. This meant that we took an
evidence-based approach to enhancing our SR supports in a meta manner. In other
words, the patient partners were in a sense researching (meaningful
engagement patent partners in a review) what they were experiencing
(collaborating on a review as patient partners). After completing the
review, we undertook a reflective process guided by Rolfe’s (2010) framework
for reflexive practice to examine our experience collaborating on this
patient-oriented rapid review. Rolfe and Jasper (2010) suggest “that critical
reflection can be regarded not only as a form of research, as a way for
practitioners to conduct a critical inquiry into their own practice, but also
as a reflexive integration of research and practice into a single act” (pp.
7-8). Thus, we employed reflection to enhance both our understanding of the
research methods and the implications to practice.
Rolfe’s (2010) framework was
developed for practitioners to improve professional practice. It provided
a straightforward framework for reflecting and reporting on our own experience.
This framework, an expansion of Borton’s earlier work
(1970), asks three main questions: What?, So
What?, and Now What?. The first stage in this framework, the What,
is the description level of reflection and includes reflection cues such as
“what is the problem or difficulty,” “what was I trying to achieve,” and “what
was good/bad about the experience” (p. 45). The next stage is the theory- and
knowledge-building level of reflection. In this stage, practitioners are
encouraged to reflect on So What prompts such as “so what does this tell
me or teach me,” “so what is my new understanding of the situation,” and “so
what broader issues arise from the situation” (p. 45). The third stage is the
action-oriented (reflexive) level of reflection focusing on the Now What
and includes cues such as “now what do I need to do in order to improve
things,” “now what broader issues need to be considered if this action is to be
successful,” and “now what might be the consequences of this action” (p. 45).
While this model is sequential, it is also cyclical where in this final stage
one returns to the initial level to form a reflexive cycle (pp. 45-46).
Background: Patient Oriented Research Rapid Review Project
A collaboration between one author (CB)
of this commentary from the University of Saskatchewan Library and colleagues
at the Saskatchewan Centre for Patient-Oriented Research (SCPOR) has focused on
research capacity development activities for SRs in the province of
Saskatchewan. Products of this collaboration include webinar series and
in-person workshops. A self-directed learning SR toolkit was also developed
(University of Saskatchewan, 2021). The addition of guidance on
patient-oriented reviews is the second phase of the toolkit development, which
was an impetus for the project upon which we are reflecting in this paper. We
decided to employ an evidence-based approach to enhancing the SR toolkit by
conducting the rapid review. This approach simultaneously enabled us to gain an
understanding of the literature on patient engagement in reviews, have hands-on
experience doing a patient-oriented review, and answer a specific research
question on patient-oriented review methods.
Given the topic, it was natural that
the review team should include patient partners. The review team was recruited
in the summer of 2019 and comprised two librarian faculty, two patient
partners, two research faculty, and two SCPOR staff. One librarian (CB) was the
principal investigator, and all team members contributed to all aspects of the
review. We collectively determined that the rapid review would examine
patient partner perceptions of meaningful engagement in SRs. The review
took place from August 2019 to September 2020, with timelines extended due to
the COVID-19 pandemic. Patient partners bring their lived experience,
rather than research expertise, to a review and therefore are not expected to
be well-versed in the research methods. For this reason, we were very
deliberate about adding training at all stages of the review. Most
meetings consisted of training to varying degrees, discussion, and task
allocation. Team members completed tasks between meetings and met in small
groups where necessary. Prior to March 2020, regular team meetings were held in
person, and after that date the team shifted to online meetings due to public
health guidelines related to the COVID-19 pandemic.
In most instances, librarians join a
review team to fulfill specific needs or roles on the team, such as expert
searcher (Dudden & Protzko,
2011; Gore & Jones, 2015; Spencer & Eldredge, 2018). Both authors of
this paper have engaged in SRs in various capacities as researchers and in our
professional practice providing SR services. In this review, we initiated
and led the review which included facilitating the formation of the research
question, leading the training, and not only participating in, but also
managing the conduct of the review. Researchers and stakeholders we had
previously provided SR services to now became part of our review team, leading
to a transition in our roles from service-provider to research partner. Both
authors enhanced their knowledge and skills in all aspects of an SR by engaging
fully in all steps of the research project, as well as learning the nuances of
POR, recognizing resource requirements, managing workload, providing ongoing
methodology training, and ensuring clear communication.
On a very practical level the
immediate and concrete outcomes of our engagement in this research will be the
POR additions to the toolkit. We have identified key articles (e.g., Black
et al., 2018; Hamilton et al., 2018) and methods for meaningfully engaging
patient partners (Boden et al., 2021), and points in the SR process at which
this information will be useful to researchers. In this paper, however, we
wish to focus at a deeper and more generalizable level, extending this learning
to the potential impacts of patient-oriented or stakeholder-engaged reviews to
librarians and library SR services. Below we discuss the implications first for
librarians and then for library SR services.
Implications for Librarians Providing Synthesis Review Services
Our experience, existing literature
(Black et al., 2018; Hamilton et al., 2018) and the results of our rapid review
(Boden et al., 2021) emphasize the importance of strong communications skills,
understanding team dynamics, relationship building, and the ability to provide
training, such as on literature search methods. Emotional and interpersonal
skills are infrequently talked about as competencies for providing SR services
(Townsend et al., 2017). However, research team dynamics are affected by
relationships, power dynamics, trust, and demands on time (Thurow
et al., 1999; Whitehair & Berdanier,
2017). Key approaches for engaging patient partners and other stakeholders in
reviews include relationship building, clear communication, and clarity on
roles and time commitments (Black et al., 2018; Boden et al., 2021; Hamilton et
al., 2018; Pollock et al., 2021). Applying these approaches requires
inter-related knowledge and skills to be successful in working with review
teams. These include: navigating research team dynamics; communicating to
diverse audiences within a review team; and sensitivity to the ‘place’
(motivations, expertise, goals, perspectives, and others) from which team
members are contributing. Below we illustrate the role of these competencies
through our experience with this review.
The dynamics within each review team
are unique and librarians providing SR services often interact with teams
without the benefit of knowing those dynamics. For instance, the inclusion
of patient partners in our review added different dimensions to the team
dynamics as they brought unique perspectives, competencies, and experience. This
kind of dynamic may heighten the need for librarians to understand their
audience and tailor communications accordingly, especially when patients and
other stakeholders experience the review process through different lenses and
knowledge bases. This has also been noted for other kinds of multi-disciplinary
teams (Thurow et al., 1999).
Interpersonal and communication
skills are infrequently discussed and under-appreciated in regard to librarian
competencies for supporting SRs. An exception is Nicholson et al. (2017) who
identified interpersonal interactions as a challenge for librarians supporting
SRs. They recommended clear communication as a strategy to address this
challenge. Our experience highlighted the need for all team members, but
particularly the individual leading a discussion, to possess skills at
facilitating complex discussions and communicating clearly to a diverse
audience. There were many times throughout the process where we had to
recalibrate through some challenging conversations, particularly defining the
research question. As the expert searchers on a review team, librarians
may be in situations where there is a need to lead complex conversations
through multiple points of view, for instance emphasizing the centrality of a
well-formed research question and literature search to the overall SR quality (Schvaneveldt & Stellrecht,
2021). For these kinds of multi-disciplinary teams, it is all the more
important to be able to communicate clearly to diverse audiences.
In addition, librarians must be
cognizant of and sensitive to the personal needs and experiences of all team
members, including the patient partners involved in the review. Patient
partners often engage in research with specific motivations and share their
lived experience. Librarians need to be aware of these factors as these may
direct, influence, or impact the research process, such as formulating the
research question, and the team dynamics (e.g., when delegating tasks). The
choice of language and terms should be chosen carefully as language that may be
appropriate for some circumstances may be perceived as too blunt or insensitive
for individuals who have a personal stake or experience with the research
topic. To illustrate, Vale et al. (2012) describe the surprise of a patient
partner to the blunt and scientific communication about the disease used by a
clinician in a research setting as compared to the bedside (p. 5). This means
not only being aware of patient partners’ or stakeholders’ motivations for
being on the research team, but also being cognizant of their emotional
engagement, personal goals, and reactions to the experience of being involved
in the review.
In light of the reflections above, we
considered the competencies and associated upskilling of librarians supporting
patient-oriented SRs. Librarians who are new to POR or stakeholder engagement
would benefit from an introduction to the nuances of engaging in this form of
research. We believe there is a need for librarians supporting patient-oriented
or stakeholder-engaged reviews to have additional training in various areas
related to interpersonal skills and communication. These areas include:
understanding why and how patients (or indeed other stakeholders) may engage in
the review; the ability to adapt to the unique needs of a particular team,
particularly that of the patient partners who may come to the project with a
diverse and unique skill set; knowledge and skills at facilitating discussions;
and understanding of research team dynamics. Libraries providing SR services
can support librarians by providing formal support, such as mentoring or
training in these skills beyond the technical or methodological kinds.
Recognizing that these skills are important and there is increasing interest in
patient-oriented and stakeholder-engaged SRs, these skills should be explicitly
included in librarian competencies for supporting SRs.
Implications for Synthesis Review Service Models
In addition to reflecting on the
relevance of our experience to individual librarians conducting POR SRs, we
also reflected on the provision of library SR services. A common factor with
most SRs is that the process takes time (Bullers et
al., 2018). Patient and stakeholder approaches to reviews may increase
the unpredictability of review timelines, increase the time demands, or
lengthen the timelines. In our review, timelines were affected by a variety of
factors, including the need to provide training to all team members as an
integrated element of the review process.
While it was not our own experience,
the literature (e.g., Oliver et al., 2019) suggests potential challenges for
researchers involved in stakeholder-engaged research, some of which may also
impact librarians supporting POR. Co-producing research can introduce tensions for researchers
and stakeholders between the individual consequences and the potential positive
impacts on health research (Oliver
et al., 2019). A recent
qualitative study suggests some researchers and patient partners report a
degree of ambivalence in their experiences and perceptions of engaging in POR;
they see value and reward, but also the need for additional support and
infrastructure to manage some of the complexities (Boylan et al., 2019). While a patient-oriented approach offers the promise
of enhanced health research, it also comes with complexities that researchers
and patient partners must consider. In describing realist reviews, Abrams and
colleagues noted a need for researchers and patient partners to clarify how and
why they would be involved (Abrams
et al., 2020). They
provide reflection prompts to engage researchers and patient partners in
examining their own expectations, expertise, scope of commitment, communication
needs, and so forth prior to committing to the project. Although their focus was
on realist reviews, we believe this can be applied to other kinds of SRs. In
our view, these questions shed light on some of the complexities of engaging in
patient-oriented reviews and may also be appropriate for librarians providing
SR support or entering into these types of collaborations.
To address some of the additional
complexity of engaging patient partners in SRs, libraries should consider
developing guidelines to manage boundaries and expectations of the SR services
(e.g., time, ethical, legal), particularly if their librarians are supporting
patient-oriented or stakeholder-engaged SRs. Especially in light of time
demands, this could improve the sustainability of the SR services. These
guidelines could include agreements on the average allowable time per project
(e.g., based in hours or months, depending on the level of involvement) and
articulate the extent and nature of the role of the librarian on the research
team. These guidelines or policies at the library level, formalize, or at least
recognize, ways of partnering with stakeholders or stakeholder organizations to
manage expectations, outcomes, ethical issues, and legal issues.
Conclusion
By engaging in an evidence-based
approach, we not only contributed to the research on patient-oriented reviews
(Boden et al., 2021), but also enhanced our understanding as it applied in our
practice (e.g., will provide guidance on patient-oriented reviews to our
synthesis toolkit). Employing a reflective approach (Rolfe, 2010) allowed
us to consider the broader implication of these kinds of reviews to library SR
services and models. We believe competencies in navigating research team
dynamics, clear communication to diverse audiences within a review team, and
sensitivity to the “place” from which team members are contributing
(motivations, expertise, goals, perspectives, and others) should be recognized.
Awareness of the unique attributes of patient- or stakeholder-oriented reviews
can prepare libraries and librarians to offer services that accommodate the
requirements of this methodology. We argue in this commentary that while
technical competencies for librarians providing SR services are well described
in the literature, additional knowledge and skills deserve consideration, and
that SR services should include policies, guidelines, and training to support
librarians who engage in this ever-evolving area of researcher support.
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