Interventions + Comparators

Here’s the most recent version of your question about kidney disease:

There’s a problem with asking for the “best way to manage” any condition. As a clinician or a policy maker, you might be looking for the ideal management option for people with stage 5 CKD, but “ideal” could include several components: what works best, what the patient prefers, what’s easiest to use, what’s most cost effective, what’s safest; the possibilities could go on and on.

Most systematic reviews aren’t designed to determine what is “best” in the sense that they don’t answer all of these questions. Even if they did, most systematic reviews only compare two alternatives, not all possible treatment options.

Also, it’s important to remember that systematic reviews are designed to summarize evidence, not make practice or policy recommendations. That’s the role of policy makers- to take what a systematic review uncovers and use those findings to make a decision.

There are some systematic reviews that DO compare the full range, or network of treatment options. That type of systematic review requires what is called “network meta-analysis.”

For this course, we’ll just focus on comparing two treatments. In other words, to write a question that fits the format of a typical systematic review, you need to frame it as a comparison between:

The Intervention vs The Comparator

The Intervention is the approach you’re evaluating.

The Comparator is the approach you’re comparing the intervention to. The comparator could be a placebo or a control group, but often it’s a different type of medical treatment or the usual form of care.

These are the I and the C in the PICO (D) process

On the next page, you’ll pick an intervention and a comparator for your question.