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12.8 Drawing conclusions
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12.6.3 Comparisons withprevious research
Cochrane Review authors are advised to put their research in the context of what previous reviews and other research have shown. In many cases, a Cochrane Review of diagnostic test accuracy may not be the first review to address the review question. It may
also be possible that other systematic reviews have been published for the same test,
but for different yet related target conditions. If so, the review authors should discuss
any differences between their review and the previously published reviews. These could
be differences in the search dates, the number and designs of the studies included, or a
different statistical approach for the meta- analysis. Sometimes multiple (related)
reviews stem from one generic protocol. If that is the case, review authors should state
this and put their particular review in the context of the related reviews.
If a review is based on an update of an existing review, the review authors may want
to point out key differences in the results from those in the previous review, in particular
if test features or important technical aspects of an index test or reference standard
have changed over time or if, for example, the use of an index test is extended to a new
target population.
12.7 Applicability offindings tothe review question
Review authors should discuss the applicability of the results of the review: the degree
to which the studies in the review correspond to the review objectives. For intervention
reviews, this is described as ‘indirectness’: the extent to which a review is relevant for
the purpose to which it is being put (Higgins 2019). Indirectness is also the term that is
used in the GRADE approach for both systematic reviews of interventions and test
accuracy.
Assessment of applicability is particularly important for systematic reviews of test
accuracy because of the degree to which setting, patient spectrum, index test and definition of the target condition (as defined by the reference standard) can affect test accuracy estimates. Therefore, estimates and judgements of their applicability should be
discussed with respect to these characteristics.
Two scenarios can be distinguished with different implications for assessing the
applicability of review findings. A systematic review of test accuracy may be general,
with broad eligibility criteria, which complicates investigation of heterogeneity but
allows exploration of differences in accuracy across settings, patient groups or applications or versions of the index test (see Chapter5, Section5.4.6). Alternatively, having a
narrowly focused question, with restricted review eligibility criteria, may simplify the
interpretation of the applicability of findings and avoid investigation of heterogeneity,
but the review may end up with very few studies and imprecise summary estimates.
12.8 Drawing conclusions
At this point in the review, the results of the meta- analysis– or the narrative summary
of key findings if meta- analysis was not performed– and the strength of the evidence
have been considered. The next step is to explain to readers how these results can be
used to draw conclusions. The Authors’ conclusions section in systematic reviews
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should discuss both the implications of the findings for practice and the implications
forresearch.
12.8.1 Implications forpractice
Implications for practice should be as practical and unambiguous as possible. They
should not go beyond the evidence that was reviewed and should be justifiable by the
data presented in the review. However, the decision to use a medical test will often be
based on the accuracy of other tests not included in the review, and on evidence
about the effectiveness of downstream actions, such as starting or withholding therapy to patients with specific test results.
Because Cochrane Reviews have an international audience, the implications for
practice should, as far as
possible, assume a broad international perspective, rather
than addressing specific national or local circumstances. Review authors should be
aware that different people might make different decisions based on the same evidence. The primary purpose of the review should be to present information rather
than to offer advice. The implications for practice should help readers understand
the implications of the evidence in relation to practical decisions.
Therefore, recommendations that depend on assumptions about costs, resources
and values should be avoided. A common mistake is for review authors to confuse facts
and judgements. For example, if the summary sensitivity is 80%, this is a fact. To
describe this as ‘high sensitivity’ would be a judgement. Review authors need also to
bear in mind that the potential consequences of introducing test(s) in practice may vary
greatly between countries and that costs in their local area may not be applicable to
other localities (see for example Box12.8.a).
Box 12.8.a An example ofimplications forpractice ina comparative review ofchest
ultrasonography (CUS) versus supine chest radiography (CXR) fordiagnosis ofpneumothorax intrauma patients inthe emergency department
“The diagnostic accuracy of CUS performed by frontline non- radiologist physicians for
the diagnosis of pneumothorax in ED trauma patients is superior to supine CXR.
Regardless of type of trauma, type of CUS operator, or type of CUS probe used, the overall sensitivity of CUS is superior to supine CXR and their specificities are similar. While
many frontline physicians already use US for FAST scans as ‘standard of care’ to identify
intra- abdominal injuries, this review provides evidence that CUS is an accurate diagnostic tool compared to CXR for ED patients with traumatic pneumothorax. Rapid detection
of traumatic pneumothorax with CUS may lead to more timely therapeutic intervention
with tube thoracostomy, reducing the incidence of pneumothorax- related complications, and thus improving outcomes in ED trauma patients. The findings of this review
provide evidence to suggest that CUS could be incorporated into trauma (e.g. advanced
trauma life support, ATLS) protocols and algorithms in future medical training programmes. In addition, CUS may beneficially change routine management of trauma.”
Source: Chan 2020
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12.8 Drawing conclusions
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However, if one test is found to have superior accuracy to another and known to have
no drawbacks (for example, by being less invasive, cheaper, quicker and easier to
deliver), the review may provide adequate evidence to support its use (Lord 2006). In
contrast, estimates of accuracy for some tests may be so low as to indicate that conclusions can be drawn that a test has no useful role in diagnosis.
In other situations, the implications for practice may not be so clear. For example, if
one test has higher sensitivity but lower specificity than another, which test produces
better patient outcomes will not be discernible from evidence about test accuracy
alone. The potential consequences of false positives and false negatives need to be
known, and their trade- off assessed.
Sometimes the difference is large enough to be clear as to which test is better; other
times identifying the
preferredtest will require decision modelling. In this case, it
should be made clear that while a Cochrane Review ofdiagnostic test accuracy can
provide important information to use in the model, it cannot answer the question by
itself.
Similarly, if there are other aspects of the test that differ (for example, its invasiveness, cost, speed, acceptability and ease of delivery), the relative importance of accuracy compared to these other features should be assessed. Again, this will require
research outside of the review, perhaps synthesized in a decision model, or even requiring a randomized controlled trial comparing testing strategies. In such circumstances,
the review authors should point out the key factors involved in assessing the value of
the test, and the further research that would be needed to provide an answer, under
future research recommendations (see Box12.8.b).
We suggest that review authors consider the following issues when addressing implications for practice.
Box 12.8.b An example ofimplications forpractice fora review about computed
tomography (CT) fordiagnosis ofacute appendicitis inadults
“Sensitivity and specificity of CT for diagnosing acute appendicitis in adults are high,
hence the use of CT is likely to assist clinicians in treating persons with possible appendicitis. Unenhanced standard- dose CT appears to have lower sensitivity than standarddose CT with IV, rectal, or oral and IV contrast enhancement. Use of different types of
contrast enhancement or no enhancement does not appear to affect specificity.
Differences in sensitivity and specificity between low- dose and standard- dose CT appear
to be negligible. In adult persons, it seems that low- dose CT should be preferred over
standard- dose CT as a first- line imaging test, with standard- dose CT reserved for persons
with inconclusive findings on low- dose CT. To minimise radiation exposure, clinicians
should critically assess whether additional information from CT imaging is needed for
decision- making about surgery, watchful waiting, or discharge. Results of this review
should be interpreted with caution for two reasons. First, the results are based on studies of low methodological quality. Second, the comparisons between types of contrast
enhancement and radiation dose may be unreliable because they are based on indirect
comparisons that may be confounded by other factors.”
Source: Rud 2019
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How is thetest positioned inthe clinical pathway?
The position of the index test in a clinical pathway will affect the absolute numbers of
true positives, false positives, true negatives and false negatives and their potential
consequences. Tests used early in a clinical pathway where the prevalence of the target
condition is often at its lowest (for example, screening asymptomatic individuals) are
likely to result in a relatively high absolute number of false positives at any given specificity, and a relatively low absolute number of false negatives at any given sensitivity. A
higher prevalence of the target condition is likely to decrease the absolute number of
false positives at any given specificity and increase the number of false negatives at any
given sensitivity.
How does theindex perform inrelation toits intended role (e.g. add- on, replacement,
triage)?
Chapter5 outlined the different roles that index tests might have in a clinical testing
pathway, such as: Can an index replace another test? Can an index test be added after
another test? Can an index test be used to triage individuals, to prevent some from
receiving another test? (Bossuyt 2006). Review authors should consider whether the
performance characteristics of the test(s) evaluated in the review are consistent with its
intended role in practice.
For example, a new test intended to triage individuals for a more invasive test, referring only new test positives to the second test, can be expected to have high sensitivity,
to ensure that introduction of the new triage test will not result in cases being missed.
It is acceptable for the new triage test to have a relatively low specificity, as introducing
the test will still lead to a reduction in the number of individuals having to undergo the
more invasive test.
There may be issues in addition to accuracy that should be highlighted by review
authors when considering the consequences of introducing the test in its intended role
(Ferrante di Ruffano 2012). For example, for a test replacement question, consideration
of whether test A should replace test B may not rely solely on evidence of improved
accuracy of test A compared to test B. If test B is less costly or less invasive than test A,
then evidence of comparable accuracy of the two tests may be considered sufficient.
What are thepotential consequences ofintroducing theindex test(s), forthe intended use,
inthe intended role, forpatient outcomes?
This refers to the potential consequences of testing, using a hypothetical cohort of people, as explained in Chapter11 and Chapter13. Evaluating the potential consequences
of introducing the index test(s) into practice requires comparison with other tests –
prior tests or additional tests– that are available for the same target condition, and for
the same intended use. In addition to the implications of test errors associated with the
intended use and the role of the index test, review authors may want to highlight other
issues that may be relevant for readers in reaching a decision about the potential benefits and harms of adopting the index test(s). Costs, organizational outcomes, uninterpretable results, acceptability, uptake and direct harms and benefits of tests (physical
and psychological) are examples of such issues (Ferrante di Ruffano 2012, Schünemann
2016). Information on these issues may come from other (not systematically searched
and assessed) sources.
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12.8 Drawing conclusions
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Review authors should be cautious when providing additional information that has
not been gathered in a systematic way and that may therefore be dependent on interpretation, or even be prone to bias. However, information about test features can assist
decision- makers assessing the value and use of the test and should be provided where
available.
Explorations of heterogeneity may return in the implications for practice. It is possible
that the analyses of heterogeneity have pointed to significant and consistent differences in test performance associated with differences in patient selection criteria,
setting or prior testing in such a way that this has implications for practice: the test has
the desired diagnostic accuracy in some conditions, but not in others. The same could
apply to subtypes of the index tests: some assays, for example, may have superior
accuracy than others, possibly leading to recommendations for practice.
Finally, the strength of the evidence should also be mentioned in the Authors’ conclusions. It may be impossible to draw conclusions, because of all the shortcomings of the
included studies and the body of evidence as a whole. This should be made explicit in
such a case (see Box12.8.c).
12.8.2 Implications forresearch
Implications for research may cover two broad areas: further studies of test accuracy
that should be undertaken and additional research needed on aspects of tests beyond
their accuracy. Researchers, research funders and commissioners will read this section
of the review to help inform decisions about the design and funding of future studies.
Where the evidence on test accuracy is inconclusive, review authors may recommend future test accuracy studies. This may involve stating that similar but betterreported studies are needed, accuracy studies of better methodological quality, done
in the appropriate patient population, at the right point in the clinical pathway, or setting, or comparative head- to- head accuracy studies. Review authors should provide as
much detail about the design of future studies as possible. If better comparative accuracy studies are needed, it is important to describe the important comparisons that
should be made. If there are issues that should be resolved before future accuracy
studies are commissioned, such as obtaining consensus on the best reference standard or the delivery method for the new index test, suggestions of how to achieve this
could be stated.
Box 12.8.c An example of implications for practice in a situation where there was a
very low certainty of the evidence. The review authors used GRADE to assess the
certainty of the evidence
“Based on the very low certainty of the evidence and the low number of included studies
there is little evidence in this review to support the widespread introduction of electrical
conductance devices as an adjunct to clinical examination.”
Source: Macey 2021
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If the review revealed new questions or generated hypotheses, then this is the place
to discuss them. This may be particularly important where review authors have disclosed conclusions from investigations of between- study heterogeneity, or where heterogeneity exists but cannot be explained.
Evidence about other routes (such as increased access or benefits of point- of- care
testing) by which tests have an impact on patients should be taken into account to
assess the potential of tests to improve patient outcomes in clinical practice (Ferrante
di Ruffano 2012). Review authors should specify the characteristics of the tests to be
assessed and the method by which this should be done (i.e. from other systematic
reviews, routine data sources, new primary studies and qualitative research).
Additionally, they should indicate whether decision modelling or randomized trials
comparing different diagnostic pathways should be undertaken, and comment on the
key design features of the studies required.
12.9 Chapter information
Authors: Mariska M. Leeflang (Department of Epidemiology and Data Science, University
of Amsterdam, The Netherlands), Karen R. Steingart (Department of Clinical Sciences,
Liverpool School of Tropical Medicine, UK), Rob J. Scholten (Cochrane Netherlands,
Utrecht University, The Netherlands), Clare Davenport (Institute of Applied Health
Research, University of Birmingham, UK).
Sources of support: The authors declare no sources of support for writing this
chapter.
Declarations of interest: Mariska Leeflang, Karen R. Steingart and Clare Davenport are
members of Cochrane’s Diagnostic Test Accuracy Editorial Team. Mariska Leeflang is
co- convenor of the Cochrane Screening and Diagnostic Tests Methods Group. Rob J.
Scholten is a past member of Cochrane’s Diagnostic Test Accuracy Editorial Team and
the GRADE Working Group. The authors declare no other potential conflicts of interest
relevant to the topic of this chapter.
Acknowledgements: The authors would like to thank Mia Schmidt- Hansen, Miranda
Langendam and Jérémie Cohen for helpful peer review comments.
12.10 References
Agarwal R, Choi L, Johnson S, Takwoingi Y. Rapid diagnostic tests for Plasmodium vivax
malaria in endemic countries. Cochrane Database of Systematic Reviews 2020;
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Bossuyt PM, Irwig L, Craig J, Glasziou P. Comparative accuracy: assessing new tests against
existing diagnostic pathways. BMJ 2006; 332: 1089–1092.
Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A. Chest
ultrasonography versus supine chest radiography for diagnosis of pneumothorax in
trauma patients in the emergency department. Cochrane Database of Systematic
Reviews 2020; 7: CD013031.
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of diagnostic tests: a framework for designing and evaluating trials. BMJ 2012; 344: e686.
GRADEpro. GRADEpro Guideline Development Tool [Software]. Available from gradepro.
org. McMaster University (developed by Evidence Prime, Inc.); 2020. www.gradepro.org.
Hanchard NC, Lenza M, Handoll HH, Takwoingi Y. Physical tests for shoulder impingements
and local lesions of bursa, tendon or labrum that may accompany impingement.
Cochrane Database of Systematic Reviews 2013; 4: CD007427.
Harbord RM, Deeks JJ, Egger M, Whiting PF, Sterne JA. A unification of models for meta-
analysis of diagnostic accuracy studies. Biostatistics 2007; 8: 239–251.
Higgins J, Thomas J, Chandler J, Cumpston M, Li T, Page M, Welch V. Cochrane Handbook for
Systematic Reviews of Interventions. 2nd ed. Chichester (UK): John Wiley & Sons; 2019.
Hultcrantz M, Mustafa RA, Leeflang MMG, Lavergne V, Estrada-
Orozco K, Ansari MT, Izcovich
A, Singh J, Chong LY, Rutjes A, Steingart K, Stein A, Sekercioglu N, Arevalo- Rodriguez I,
Morgan RL, Guyatt G, Bossuyt P, Langendam MW, Schünemann HJ. Defining ranges for
certainty ratings of diagnostic accuracy: a GRADE concept paper. Journal of Clinical
Epidemiology 2020; 117: 138–148.
Jullien S, Dissanayake HA, Chaplin M. Rapid diagnostic tests for plague. Cochrane Database
of Systematic Reviews 2020; 6: CD013459.
Kohli M, Schiller I, Dendukuri N, Yao M, Dheda K, Denkinger CM, Schumacher SG, Steingart
KR. Xpert MTB/RIF Ultra and Xpert MTB/RIF assays for extrapulmonary tuberculosis and
rifampicin resistance in adults. Cochrane Database of Systematic Reviews 2021;
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Korevaar DA, Cohen JF, Spijker R, Saldanha IJ, Dickersin K, Virgili G, Hooft L, Bossuyt PM.
Reported estimates of diagnostic accuracy in ophthalmology conference abstracts were
not associated with full- text publication. Journal of Clinical Epidemiology 2016; 79:
96–103.
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Ossenkopp YJ, Wang J, Visser CE, Scholten RJ, Hooft L, Bijlmer HA,
Reitsma JB, Zhang M, Bossuyt PM, Vandenbroucke- Grauls CM. Galactomannan detection
for invasive aspergillosis in immunocompromised patients. Cochrane Database of
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Lord SJ, Irwig L, Simes RJ. When is measuring sensitivity and specificity sufficient to
evaluate a diagnostic test, and when do we need randomized trials? Annals of Internal
Medicine 2006; 144: 850–855.
Macey R, Walsh T, Riley P, Glenny AM, Worthington HV, Clarkson JE, Ricketts D. Electrical
conductance for the detection of dental caries. Cochrane Database of Systematic Reviews
2021; 3: CD014547.
Nielsen LH, Ortner N, Nørgaard BL, Achenbach S, Leipsic J, Abdulla J. The diagnostic
accuracy and outcomes after coronary computed tomography angiography vs.
conventional functional testing in patients with stable angina pectoris: asystematic
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analysis. European Heart Journal Cardiovascular Imaging 2014;
15:961–971.
Rud B, Vejborg TS, Rappeport ED, Reitsma JB, Wille- Jørgensen P. Computed tomography
for diagnosis of acute appendicitis in adults. Cochrane Database of Systematic Reviews
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Schünemann HJ, Oxman AD, Brozek J, Glasziou P, Jaeschke R, Vist GE, Williams JW, Jr.,
Kunz R, Craig J, Montori VM, Bossuyt P, Guyatt GH. Grading quality of evidence and
strength of recommendations for diagnostic tests and strategies. BMJ 2008;
336:1106–1110.
Schünemann HJ, Mustafa R, Brozek J, Santesso N, Alonso-
Coello P, Guyatt G, Scholten R,
Langendam M, Leeflang MM, Akl EA, Singh JA, Meerpohl J, Hultcrantz M, Bossuyt P,
Oxman AD. GRADE Guidelines: 16. GRADE evidence to decision frameworks for tests in
clinical practice and public health. Journal of Clinical Epidemiology 2016; 76: 89–98.
Schünemann HJ, Mustafa RA, Brozek J, Steingart KR, Leeflang M, Murad MH, Bossuyt P,
Glasziou P, Jaeschke R, Lange S, Meerpohl J, Langendam M, Hultcrantz M, Vist GE, Akl EA,
Helfand M, Santesso N, Hooft L, Scholten R, Rosen M, Rutjes A, Crowther M, Muti P, Raatz
H, Ansari MT, Williams J, Kunz R, Harris J, Rodriguez IA, Kohli M, Guyatt GH. GRADE
guidelines: 21 part 1. Study design, risk of bias, and indirectness in rating the certainty
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Schünemann HJ, Mustafa RA, Brozek J, Steingart KR, Leeflang M, Murad MH, Bossuyt P,
Glasziou P, Jaeschke R, Lange S, Meerpohl J, Langendam M, Hultcrantz M, Vist GE, Akl EA,
Helfand M, Santesso N, Hooft L, Scholten R, Rosen M, Rutjes A, Crowther M, Muti P, Raatz
H, Ansari MT, Williams J, Kunz R, Harris J, Rodriguez IA, Kohli M, Guyatt GH. GRADE
guidelines: 21 part 2. Test accuracy: inconsistency, imprecision, publication bias, and
other domains for rating the certainty of evidence and presenting it in evidence profiles
and summary of findings tables. Journal of Clinical Epidemiology 2020b; 122: 142–152.
Simes RJ. Publication bias: the case for an international registry of clinical trials. Journal of
Clinical Oncology 1986; 4: 1529–1541.
Takwoingi Y, Leeflang MM, Deeks JJ. Empirical evidence of the importance of comparative
studies of diagnostic test accuracy. Annals of Internal Medicine 2013; 158: 544–554.
Whiting PF, Harbord R, Kleijnen J. No role for quality scores in systematic reviews of
diagnostic accuracy studies. BMC Medical Research Methodology 2005; 5: 19.
Whiting PF, Davenport C, Jameson C, Burke M, Sterne JA, Hyde C, Ben-
Shlomo Y. How well
do health professionals interpret diagnostic information? A systematic review. BMJ Open
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Langendam MW. GRADE Guidance: 31. Assessing the certainty across a body of evidence
for comparative test accuracy. Journal of Clinical Epidemiology 2021; 136: 146–156.
Zhelev Z, Garside R, Hyde C. A qualitative study into the difficulties experienced by
healthcare decision makers when reading a Cochrane diagnostic test accuracy review.
Systematic Reviews 2013; 2: 32.
Zifodya JS, Kreniske JS, Schiller I, Kohli M, Dendukuri N, Schumacher SG, Ochodo EA,
Haraka F, Zwerling AA, Pai M, Steingart KR, Horne DJ. Xpert Ultra versus Xpert MTB/RIF
for pulmonary tuberculosis and rifampicin resistance in adults with presumptive
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Writing aplain language summary
Penny Whiting and Clare Davenport
KEY POINTS
A plain language summary is a standalone summary of a Cochrane systematic review
•
written in plain English. It
Measures of accuracy such as sensitivity and specificity are poorly understood, both by
•
lay audiences and by health professionals.
Explaining the results of a systematic review of test accuracy in plain language is
•
challenging, particularly the numerical findings of the review.
Reporting test accuracy measures using natural frequencies and linking test results to
•
the potential consequences of testing for patients can improve understanding.
Generic guidance for writing a Cochrane plain language summary exists and can be
•
applied to a Cochrane Review of diagnostic test accuracy.
13.1 Introduction
A plain language summary is a standalone summary of a Cochrane systematic review
written in plain language. It provides rapid access to the contents of the review. Plain
language summaries can be used to facilitate shared decision- making between individuals and their healthcare providers. The plain language summary aims to summarize the review in a straightforward style that can be understood by consumers of health
care. Because of the lack of familiarity with test accuracy methods and measures, the
potential plain language summary audience for a systematic review of test accuracy is
likely to be broad and include policy makers, doctors, nurses and journalists. Cochrane
plain language summaries are made freely available on the internet, so will often be
read as standalone documents.
provides rapid access to the contents of the review.
This chapter should be cited as: Whiting P, Davenport C. Chapter 13: Writing a plain language summary.
In:Deeks JJ, Bossuyt PM, Leeflang MM, Takwoingi Y, editors. Cochrane Handbook for Systematic Reviews of
Diagnostic Test Accuracy. 1st edition. Chichester (UK): John Wiley & Sons, 2023: 377–398.
Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, First Edition. Edited by
Jonathan J. Deeks, Patrick M. Bossuyt, Mariska M. Leeflang and Yemisi Takwoingi.
© 2023 The Cochrane Collaboration. Published 2023 by John Wiley & Sons Ltd.
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A clear plain language summary is essential to ensure that a systematic review is
useful to users who are not familiar with the more technical content of the review.
Plain language summaries are mandatory for all Cochrane systematic reviews. The
generic guidance for writing a Cochrane plain language summary guides review authors
through the steps of preparing the summary with advice on how to write in plain language (Pitcher 2021). The guidance also includes a template that can be used for all
types of Cochrane Reviews and explains what to include in each section of the summary, with examples. We recommend that review authors consult the guidance and use
it in conjunction with this chapter.
Explaining the results of a systematic review of test accuracy in plain language
ischallenging. The review methodology and results are less familiar than reviews
of interventions. The two accuracy (e.g. sensitivity and specificity) introduces further complexity (Leeflang
2008). Research has shown that even readers familiar with systematic review methods and interpretation of results have difficulties understanding test accuracy
reviews and that experience with intervention reviews may even be a disadvantage
(Zhelev 2013).
Commonly used measures of test accuracy are often poorly understood by health
professionals (Whiting 2015). For example, sensitivity and specificity are not easily
translated into the proportion of test results that are correct (true positives and true
negatives) and those that are incorrect (false positives and false negatives).
Reporting test accuracy using natural frequencies and visual aids may facilitate
improved understanding. Additionally, test accuracy reviews are characterized by a
large degree of heterogeneity in results across studies. The reason for this variation
is not always clear and explaining this to readers, especially lay readers, is difficult.
Ideally, a plain language summary should be easily understandable to all target
audiences and provide the information they need to understand the findings of
thereview.
The recommended structure, content and writing style for a plain language summary
for a Cochrane Review of diagnostic test accuracy described in this chapter are based
primarily on research undertaken with patient, media and health professional representatives (Whiting 2018a) and guidance on how to structure a plain language summary
for Cochrane Reviews (Pitcher 2021). Drawing on this guidance, we discuss the challenges and suggested approaches for writing plain language summaries for different
types of systematic review of test accuracy questions (for example, multiple index tests
or multiple population subgroups).
dimensional nature of common measures of a test’s
13.2 Audience andwriting style
Because of the difficulties in understanding measures of test accuracy, the potential
audience for a plain language summary for a systematic review of test accuracy is likely
to be wide, including the public, policy makers and anyone who talks to the public
about health, for example doctors, nurses, journalists and patient groups. The guidance
for writing plain language summaries for Cochrane Reviews includes helpful guidance
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