Stage 4. Form indicative questions

Submissions from patients, carers and clinicians may need to be rewritten or rephrased. This is to clarify the precise uncertainty, which may have been submitted with a lot of narrative text, to ensure consistency in the language used and to make it easier to check the question against the evidence base. Some PSPs have formatted each individual submission and then combined the duplicates. Others have created formatted indicative, or summary, questions based on groups of similar or duplicate submissions.

Duplicates and very similar submissions can be combined within one indicative uncertainty. Combining submissions can greatly reduce the volume of data that need to be checked for systematic reviews.

This process is also likely to be repeated after the verification of uncertainties, and the removal of non-uncertainties, thus reducing the data further.

PSPs may have to interpret what an intervention might be in a question, where the original submission did not indicate one. PSPs and the JLA Adviser should make best efforts to ensure that decisions made about interventions are transparent and fair. Any rewording should ensure that the language is accessible to a lay or non-medical audience but also accurate enough to engage clinicians and specialists. It is suggested that questions may, where possible, be worded using the PICO format, which is described below.

This part of the process is interpretative and subjective. It is therefore vital that Steering Group members are offered opportunities to contribute to and comment on the process to ensure they are satisfied that the interpretation of the submissions is fair, neutral and accurate. Their experiences as patients, carers or clinicians will help ensure the submissions of those groups are interpreted and captured appropriately in the formatted questions.

Steering Groups will also need to make decisions about the extent to which questions are combined. Too many very specific questions will be difficult to prioritise and may risk diluting a key theme across multiple questions in the prioritisation. Conversely, questions that are too broad may be difficult for researchers to interpret or may contain too many elements with no sense of priority between them. It is recommended that the workings of the Information Specialist are brought to the Steering Group at an early stage of the analysis, to ensure it is informed by members' input, advice and scrutiny.

Example indicative questions created from responses to the Mesothelioma survey:

Example indicative question created from responses to the Scoliosis PSP survey: