Dr Marie Misso is the Head of the Evidence Synthesis Program at Monash Centre for Health Research and Implementation (MCHRI) and the lead for evidence synthesis and guideline development within the Centre for Research Excellence in Polycystic Ovary Syndrome (CRE). Marie has a background in basic research of molecular mechanisms of metabolic disease; translating research into practice and policy; and she now educates medical students, PhD students and health professionals to conduct rigorous systematic reviews and guidelines. Marie has played key roles in 14 evidence-based guidelines at the state, national and international level, including with the World Health Organisation. Marie tells us about her involvement in the latest PCOS Guideline.
In 2011, Marie was in the systematic review team and a guideline developer for the original PCOS Australian Alliance guideline. Using the topic areas and research gaps from this work, Marie led a five-round Delphi survey exercise to identify and prioritise topics in Polycystic Ovary Syndrome (PCOS) care among 700 clinical and academic opinion leaders and consumers worldwide. The results from this exercise informed the scope of the International evidence-based guideline for the assessment and management of Polycystic Ovary Syndrome. Additional steps were conducted within the guideline development process to further prioritise topics and key outcomes to guide the systematic evidence synthesis underpinning guideline recommendations.
Marie led the evidence synthesis, the GRADEing of articles, and the recommendation development using the GRADE Evidence to Decision framework.
In nine months Marie and her team:
- addressed 60 clinical questions and prepared more than 40 systematic reviews
- addressing 55 comparisons
- screening over 17,000 articles
- as well as extracting and statistically analysing data and preparing risk of bias and GRADE assessments for 192 articles.
Marie then gathered clinical input from more than 60 academic leaders in the area of PCOS into international gold standard GRADE Evidence to Decision recommendation frameworks to ensure that judgments and considerations leading to development of recommendations were documented transparently. Each framework and corresponding recommendations were subjected to thorough consensus discussion online and during face-to-face meetings.
Discussion included aspects such as:
- assessment of the evidence
- desirable and undesirable effects of the intervention
- certainty of the evidence
- values associated with the recommended intervention
- balance of effects
- resource requirements
- cost effectiveness
- equity, acceptability and feasibility
- subgroup considerations
- implementation considerations
- monitoring and evaluation
- and research priorities.
From these online and face-to-face meetings, 170 recommendations were developed to address diagnosis, assessment and management of features and complications of PCOS.
Detailed methods and results for the above processes can be found in the technical report and here – Misso ML, Tassone EC, Costello MF, Dokras A, Laven J, Moran LJ, Teede HJ on behalf of the International PCOS Network. 2018 Large-Scale Evidence-Based Guideline Development Engaging the International PCOS Community. Seminars in Reproductive Medicine. 36(1): 28-34
Marie is now involved in guideline translation activities; and with many lessons learnt, looks forward to the next guideline.