10.1.1 Why a scoping review?
- Carolyn Phillips
There are a number of reasons why a scoping review might be conducted. Unlike other reviews that tend to address relatively precise questions (such as a systematic review of the effectiveness of an intervention assessed using a predefined set of outcomes), scoping reviews can be used to map the key concepts that underpin a field of research, as well as to clarify working definitions, and/or the conceptual boundaries of a topic (Arksey & O’Malley 2005). A scoping review may address one of these aims or all of them. A scoping review of scoping reviews found that the three most common reasons for conducting a scoping review were to explore the breadth or extent of the literature, map and summarize the evidence, and inform future research (Tricco et al. 2016b). The indications for scoping reviews are listed below: (Munn et al. 2018a)
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.
Scoping reviews undertaken with the objective of providing a 'map' of the available evidence can be undertaken as a preliminary exercise prior to the conduct of a systematic review (Anderson et al. 2008). Scoping reviews are useful for examining emerging evidence when it is still unclear what other, more specific questions can be posed for evidence syntheses and valuably addressed. For example, while there are few studies on the sustainability of knowledge translation interventions in the area of chronic disease management, a scoping review has provided the foundation for a future systematic review to investigate the impact of sustainable knowledge translation interventions on health outcomes (Tricco et al. 2016a).
Authors deciding between the systematic review or scoping review approach should carefully consider the indications discussed above and determine exactly what question they are asking and what purpose they are trying to achieve with their review (Munn et al. 2018a). It is important for authors to clearly articulate why they are undertaking a scoping review; i.e. why is it necessary to identify and map the evidence in a given field? What will mapping the evidence achieve in terms of the objective of the review? Perhaps the most important consideration is whether or not the authors wish to use the results of their review as the basis for a trustworthy clinical guideline, to answer a clinically meaningful question, or provide evidence to inform practice or policy (Munn et al. 2018a). If so, then a systematic review approach is best. If the authors have a question addressing the feasibility, appropriateness, meaningfulness or effectiveness of a certain treatment or practice, then a systematic review is likely the most valid approach (Pearson 2004, 2005). A diverse suite of approaches to conducting systematic reviews to answer different types of clinical questions (i.e. effectiveness, prognosis, risk, etc) exist (Munn et al. 2018b). However, authors do not always wish to ask single or precise clinical questions and may be more interested in the identification of certain characteristics/concepts in sources of evidence, and in the mapping, reporting or discussion of these characteristics/concepts. In these cases, a scoping review is the better choice.
Unlike a systematic review, scoping reviews do not tend to produce and report results that have been synthesized from multiple evidence sources following a formal process of methodological appraisal to determine the quality of the evidence. Rather, scoping reviews aim to provide an overview or map of the evidence. Due to this, an assessment of methodological limitations or risk of bias of the evidence included within a scoping review is generally not performed (unless there is a specific requirement due to the nature of the scoping review aim) (Khalil et al. 2016; Peters et al. 2015). Given this assessment of bias is not conducted, the implications/recommendations for practice (from a clinical or policy making point of view) that arise from a scoping review are quite different compared to those of a systematic review. In some cases, there may be no need to articulate implications for practice and if there is a need to do so, these implications may be limited in terms of providing guidance from a clinical or policy making point of view. Conversely, when we compare this to systematic reviews, the provision of implications for practice is a key feature of systematic reviews and is recommended in reporting guidelines for systematic reviews (Liberati et al. 2009). To put it simply, systematic reviews normally inform the development of trustworthy clinical guidelines and recommendations. Scoping reviews are not conducted for this reason but rather to provide an overview of the evidence or to answer questions regarding the nature and diversity of the evidence/knowledge available
Davis and colleagues (2009) explain how, as useful tools for evidence reconnaissance, scoping reviews can be used to provide a broad overview of a topic. For instance, a scoping review that seeks to develop a “concept map” may aim to explore how, by whom and for what purpose a particular term is used in a given field (Anderson et al. 2008). Another example includes where scoping reviews have been performed to establish a comprehensive understanding of how scoping reviews have been conducted and reported (Pham et al 2014; Tricco et al. 2016b). Scoping review methodology was used to identify papers and guidelines that had either utilized or described scoping review methods and/or assessed the quality of reporting for scoping reviews (Tricco et al. 2016b). The review by Tricco et al (2016b) illustrates how the number of scoping reviews has steadily increased since 2012, that there was variation in terms of how they were conducted and reported, and that standardized reporting guidelines were absent.
Scoping reviews may also be used to develop “policy maps” by identifying and mapping evidence from policy documents and reports that guide practice in a particular field (Anderson et al. 2008). For example, a scoping review might include the objective of mapping research papers and policy documents that concern models of transition for young people to adult health services to provide evidence for best practice transitional care for children with complex health needs (Watson et al. 2011).The value of scoping reviews to evidence-based healthcare and practice lies in the examination of a broader area to identify gaps in the research knowledge base (Crilly et al. 2009, clarify key concepts (de Chavez et al. 2005), and report on the types of evidence that address and inform practice in the field (Decaria et al. 2012).
Due to the range of reasons why a scoping review may be conducted, it is important that reviewers clearly describe the rationale behind their particular scoping review within both the protocol and the review. This gives readers a clearer understanding of the importance of the topic and why a particular type of scoping review is being conducted.