narrative literature review vs systematic review

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The Difference Between Narrative Review and Systematic Review

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Reviews in scientific research are tools that help synthesize literature on a topic of interest and describe its current state. Different types of reviews are conducted depending on the research question and the scope of the review. A systematic review is one such review that is robust, reproducible, and transparent. It involves collating evidence by using all of the eligible and critically appraised literature available on a certain topic. To know more about how to do a systematic review , you can check out our article at the link. The primary aim of a systematic review is to recommend best practices and inform policy development. Hence, there is a need for high-quality, focused, and precise methods and reporting. For more exploratory research questions, methods such as a scoping review are employed. Be sure you understand the difference between a systematic review and a scoping review , if you don’t, check out the link to learn more.

When the word “review” alone is used to describe a research paper, the first thing that should come to mind is that it is a literature review. Almost every researcher starts off their career with literature reviews. To know the difference between a systematic review and a literature review , read on here.  Traditional literature reviews are also sometimes referred to as narrative reviews since they use narrative analysis to synthesize data. In this article, we will explore the differences between a systematic review and a narrative review, in further detail.

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Narrative Review vs Systematic Review

Both systematic and narrative reviews are classified as secondary research studies since they both use existing primary research studies e.g. case studies. Despite this similarity, there are key differences in their methodology and scope. The major differences between them lie in their objectives, methodology, and application areas.

Differences In Objective

The main objective of a systematic review is to formulate a well-defined research question and use qualitative and quantitative methods to analyze all the available evidence attempting to answer the question. In contrast, narrative reviews can address one or more questions with a much broader scope. The efficacy of narrative reviews is irreplaceable in tracking the development of a scientific principle, or a clinical concept. This ability to conduct a wider exploration could be lost in the restrictive framework of a systematic review.

Differences in Methodology

For systematic reviews, there are guidelines provided by the Cochrane Handbook, ROSES, and the PRISMA statement that can help determine the protocol, and methodology to be used. However, for narrative reviews, such standard guidelines do not exist. Although, there are recommendations available.

Systematic reviews comprise an explicit, transparent, and pre-specified methodology. The methodology followed in a systematic review is as follows,

• Formulating the clinical research question to answer (PICO approach)
• Developing a protocol (with strict inclusion and exclusion criteria for the selection of primary studies)
• Performing a detailed and broad literature search
• Critical appraisal of the selected studies
• Data extraction from the primary studies included in the review
• Data synthesis and analysis using qualitative or quantitative methods [3].
• Reporting and discussing results of data synthesis.
• Developing conclusions based on the findings.

A narrative review on the other hand does not have a strict protocol to be followed. The design of the review depends on its author and the objectives of the review. As yet, there is no consensus on the standard structure of a narrative review. The preferred approach is the IMRAD (Introduction, Methods, Results, and Discussion) [2]. Apart from the author’s preferences, a narrative review structure must respect the journal style and conventions followed in the respective field.

Differences in Application areas

Narrative reviews are aimed at identifying and summarizing what has previously been published. Their general applications include exploring existing debates, the appraisal of previous studies conducted on a certain topic, identifying knowledge gaps, and speculating on the latest interventions available. They are also used to track and report on changes that have occurred in an existing field of research. The main purpose is to deepen the understanding in a certain research area. The results of a systematic review provide the most valid evidence to guide clinical decision-making and inform policy development [1]. They have now become the gold standard in evidence-based medicine [1].

Although both types of reviews come with their own benefits and limitations, researchers should carefully consider the differences between them before making a decision on which review type to use.

• Aromataris E, Pearson A. The systematic review: an overview. AJN. Am J Nurs. 2014;114(3):53–8.
• Green BN, Johnson CD, Adams A. Writing narrative literature reviews for peer-reviewed journals: secrets of the trade. J Chiropratic Medicine 2006;5:101–117.
• Linares-Espinós E, Hernández V, Domínguez-Escrig JL, Fernández-Pello S, Hevia V, Mayor J, et al. Metodología de una revisión sistemática. Actas Urol Esp. 2018;42:499–506.

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Writing an Effective Narrative Review: Planning the Review

Video (21:53)

Writing an Effective Narrative Review: Drafting and Revising

Before you get started, what is a narrative review.

A narrative review is a type of manuscript whose purpose is to summarize, synthesize, or critique the literature on a topic. Unlike a systematic review, a narrative review has very few formal constraints for selecting studies and assessing their evidence.

Check in with the journal

Before you start writing, it’s best to communicate with the editor of the target journal to establish and define the review topic. For solicited reviews, the topic should be defined in the invitation. For unsolicited reviews, it’s often a good idea to contact the editor of the target journal and ask whether your review would be welcome. Always check journal instructions and scope to see if reviews are accepted.

Define your approach

Articulate the purpose of the review. Summing up recent developments? Interpreting a group of potentially conflicting findings? Identifying gaps that need to be investigated? Consider whether you intend to include a lot of summarization of and details about individual studies, higher-level analysis and synthesis, or something in between. Consider whether you are writing for fellow experts or a broader audience in need of more explanations. Plan the depth of coverage and which related topics you will likely incorporate.

Plan and perform a literature search

Decide what kinds of articles you will look for, considering parameters such as study design, level of evidence, primary outcomes, and time period. Our team of searchers can help.

Plan the overall structure

Once you have selected the studies you will discuss, take detailed notes on each. Group the studies according to themes or a desired structure. It may help to create a table to help organize and compare studies according to their characteristics and findings. From there, outline the main points of the review.

Parts of a Narrative Review

Introduction section.

• Establish the rationale for the review—that is, the need or gap being addressed. Include any background needed for the rationale to be understood.
• State the purpose of the review. This should flow logically from the rationale and guide the rest of the review.

Sequence analysis of cell-free DNA (cfDNA) fragments that circulate in the blood of pregnant women, along with the translation of this method into screening for fetal chromosome abnormalities, is a success story of modern genomic medicine. In less than a decade, prenatal cfDNA testing has gone from small, proof-of-principle studies to a global transformation of prenatal care. As of late 2017, a total of 4 million to 6 million pregnant women had had DNA from their plasma analyzed to screen for fetal aneuploidy. The exponential growth of the test has been a function of the role of the biotechnology industry in its development and marketing. Here we review what has been learned from the wide-scale implementation of this testing, how it has changed prenatal clinical care, and what ethical concerns have arisen, and we speculate about what lies ahead. (From Bianchi DW et al. Sequencing of circulating cell-free DNA during pregnancy . N Engl J Med, 379: 464–473, 2018.)

The set of techniques for writing the body of a review article include paragraphing, transitions, summarizing, paraphrasing, and synthesis. A typical paragraph in a review can be organized a group of studies interpreted as a whole. The paragraph begins by stating the main idea of the paragraph or naming its key themes. Summarize studies by restating their main points in your own words, and paraphrase content by restating the same information in your own words. Strive to synthesize multiple ideas to build a unique perspective.

Write a conclusion that corresponds to the purpose of the review and is based on the presented material. The conclusion may be followed by a few sentences that emphasize areas where more research is needed.

• Background and rationale (essential)
• Purpose statement (essential)
• Key themes or core ideas

Although we have come a long way in our understanding of the signals that drive cancer growth, and how these signals can be targeted, effective control of this disease remains a key scientific and medical challenge. The therapy resistance and relapse that are commonly seen are driven in large part by the inherent heterogeneity within cancers that allows drugs to effectively eliminate some, but not all, malignant cells. Here, we focus on the fundamental drivers of this heterogeneity by examining emerging evidence that shows that these traits are often controlled by the disruption of normal cell fate and aberrant adoption of stem cell signals. We discuss how undifferentiated cells are preferentially primed for transformation and often serve as the cell of origin for cancers. We also consider evidence showing that activation of stem cell programmes in cancers can lead to progression, therapy resistance and metastatic growth and that targeting these attributes may enable better control over a difficult disease. (Lytle NK et al. Stem cell fate in cancer growth, progression and therapy resistance . Nat Rev Cancer. 18: 669–680, 208.)

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Pautasso M. Ten simple rules for writing a literature review . PLoS Computational Biology. 2013;9:e1003149.

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Systematic Reviews

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What Makes a Systematic Review Different from Other Types of Reviews?

• Planning Your Systematic Review
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Reproduced from Grant, M. J. and Booth, A. (2009), A typology of reviews: an analysis of 14 review types and associated methodologies. Health Information & Libraries Journal, 26: 91–108. doi:10.1111/j.1471-1842.2009.00848.x

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Systematic Reviews and Other Evidence Synthesis Types Guide

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• Task 1 - Find Articles
• Task 2 - Formulate Question
• Task 3 - Select Reporting Guideline
• Task 4 - Write and Register Protocol
• Evidence Synthesis - Search (Task 5)
• Screen and Appraise (Tasks 6 – 11)
• Synthesize (Tasks 12 – 15)
• Write Up Review (Task 16)

Systematic Review or Meta-Analysis

• Integrative Review
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Request UT Southwestern Library Evidence Synthesis/Systematic Review Services

The UT Southwestern Librarians provide two levels of Evidence Synthesis/Systematic Review (ES/SR) support.

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• A librarian will provide training about the systematic review process.
• Use the Training Request Form .

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• The librarian is an active contributor.
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• Begin by completing the Evidence Synthesis/Systematic Review Request Form . For more information on the fees ($1,250 per PICO or equivalent question), see the "Costs" section in the form.
• If a Librarian joins the ES/SR Team, the ES/SR Team will complete the Evidence Synthesis/Systematic Review Library Services Agreement .
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Systematic Review – seeks to systematically search for, appraise and synthesize research evidence on a specific question, often adhering to guidelines on the conduct of a review.

Meta-analysis – a technique that statistically combines the results of quantitative studies to provide a more precise effect of the results. A good systematic review is essential to a meta-analysis of the literature.

Standards (see the Books tab) and guidelines have been developed on how to conduct and report systematic reviews and meta analyses.

Guidelines and Best Practices

• Cochrane Handbook for Systematic Reviews of Interventions, Current Version While this Handbook focuses on systematic reviews of interventions, Cochrane publishes five main types of systematic reviews , and has developed a rigorous approach to the preparation of each of the following: ❖ Effects of interventions ❖ Diagnostic test accuracy ❖ Prognosis ❖ Reviews of reviews (umbrella reviews) ❖ Reviews of methodology Part 3 provides considerations for tackling systematic reviews from different perspectives, such as when thinking about specific populations, or complex interventions, or particular types of outcomes. It comprises the following chapters: 16. Equity 17. Intervention complexity 18. Patient-reported outcomes 19. Adverse effects 20. Economic evidence 21. Qualitative evidence
• MECIR Manual The MECIR Standards present a guide to the conduct of new Cochrane Intervention Reviews, and the planning and conduct of updates. This online version will be kept up to date;a PDF of each section can be generated. All substantive changes will be noted here .
• Campbell Collaboration An international social science research network that produces high quality, open and policy-relevant evidence syntheses, plain language summaries and policy briefs.

Reporting Guidelines

• PRISMA 2020 Statement An evidence-based minimum set of items for reporting in systematic reviews and meta-analyses, PRISMA primarily focuses on the reporting of reviews evaluating the effects of interventions, but can also be used as a basis for reporting systematic reviews with objectives other than evaluating interventions (e.g. evaluating etiology, prevalence, diagnosis or prognosis). The PRISMA 2020 Statement is accompanied by the PRISMA 2020 Explanation and Elaboration paper.
• PRISMA 2020 Checklist The 27 checklist items pertain to the content of a systematic review and meta-analysis, which include the title, abstract, methods, results, discussion and funding. Note: As a member of the ES/SR Team, the UT Southwestern Librarian completes Item 7 (Search Strategy) in the checklist.
• PRISMA Flow Diagram The flow diagram depicts the flow of information through the different phases of a systematic review. It maps out the number of records identified, included and excluded, and the reasons for exclusions. Different templates are available depending on the type of review (new or updated) and sources used to identify studies.
• PRISMA for Searching Published in 2021, the checklist includes 16 reporting items, each of which is detailed with exemplar reporting and rationale. The intent of PRISMA-S is to complement the PRISMA Statement and its extensions by providing a checklist that could be used by interdisciplinary authors, editors, and peer reviewers to verify that each component of a search is completely reported and therefore reproducible. For additional information, refer to the PRISMA for searching statement/exploratory paper .

Protocol Guidelines

• PRISMA for Systematic Review Protocols (PRISMA-P) PRISMA-P, published in 2015, includes a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. The developers note that there are many review types outside of this scope. They recommend that due to the general lack of protocol guidance for other types of reviews, reviewers preparing any type of review protocol make use of PRISMA-P as applicable.

Protocol Registration

• PROSPERO An international prospective register of systematic reviews. Key details from new Cochrane protocols are automatically uploaded into PROSPERO. It is produced by the Centre of Reviews and Dissemination, University of York, United Kingdom.

The Cochrane Library includes:

• Cochrane Database of Systematic Reviews – peer-reviewed systematic reviews and protocols)
• Cochrane Central Register of Controlled Trials (CENTRAL) – reports of randomized and quasi-randomized controlled trials
• Cochrane Clinical Answers (CCAs) – developed to inform point-of-care decision-making each CCA contains a clinical question, a short answer, and relevant outcomes data for the clinician
• JBI Systematic Review Register Members of the JBI Collaboration can register their review titles with JBI via completion of the online Systematic Review Title Registration Form. Once titles become registered with JBI, they are listed on the website. Titles are subsequently removed when the full protocol is publicly available, either published or posted to an accessible website.
• Cumpston, M. S., McKenzie, J. E., Welch, V. A., & Brennan, S. E. (2022). Strengthening systematic reviews in public health: guidance in the Cochrane Handbook for Systematic Reviews of Interventions, 2nd edition. J Public Health (Oxf), 44(4), e588-e592. https://doi.org/10.1093/pubmed/fdac036
• Jackson, N., & Waters, E. (2005). Criteria for the systematic review of health promotion and public health interventions. Health Promotion International, 20(4), 367-374. https://doi.org/10.1093/heapro/dai022
• Thomas, B. H., Ciliska, D., Dobbins, M., & Micucci, S. (2004). A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews on Evidence-Based Nursing, 1(3), 176-184. https://doi.org/10.1111/j.1524-475X.2004.04006.x

3 Should I undertake a scoping review or a systematic review? (Ask JBI) on YouTube (12:43).

Agency for Healthcare Research and Quality

• Training Modules for the Systematic Reviews Methods Guide (Agency for Healthcare Research and Quality)

Campbell Collaboration and the Open Learning Initiative

• Systematic Reviews and Meta-Analysis Open & Free (Carnegie Mellon University) Provides an overview of the steps involved in conducting a systematic (scientific) review of results of multiple quantitative studies.
• Cochrane Collaboration Online Training Includes links to learning resources relevant to systematic reviews and evidence-based medicine
• Cochrane Methodology Learning resources on key areas of Cochrane review methodology.

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• JBI SUMARI Knowledge Base

Johns Hopkins University/Coursera

• Introduction to Systematic Review and Meta-Analysis (Johns Hopkins University)

University of North Carolina Health Sciences Library

• Introduction to Conducting a Systematic Review Workshop (University of North Carolina Health Sciences Library) Used with permission from the Systematic Reviews LibGuide developed by the University of North Carolina Health Sciences Library.
• Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., … PRISMA-P Group (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic reviews, 4(1), 1. https://doi.org/10.1186/2046-4053-4-1
• Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., McGuinness, L. A., Stewart, L. A., Thomas, J., Tricco, A. C., Welch, V. A., Whiting, P., & McKenzie, J. E. (2021). PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ, 372, n160. https://doi.org/10.1136/bmj.n160
• Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., Koffel, J. B., & PRISMA-S Group (2021). PRISMA-S: an extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Systematic reviews, 10(1), 39. https://doi.org/10.1186/s13643-020-01542-z
• Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA, the PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 2015;349:g7647. https://doi.org/10.1136/bmj.g7647
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• Systematic Review | Definition, Example, & Guide

Systematic Review | Definition, Example & Guide

Published on June 15, 2022 by Shaun Turney . Revised on November 20, 2023.

A systematic review is a type of review that uses repeatable methods to find, select, and synthesize all available evidence. It answers a clearly formulated research question and explicitly states the methods used to arrive at the answer.

They answered the question “What is the effectiveness of probiotics in reducing eczema symptoms and improving quality of life in patients with eczema?”

In this context, a probiotic is a health product that contains live microorganisms and is taken by mouth. Eczema is a common skin condition that causes red, itchy skin.

Table of contents

What is a systematic review, systematic review vs. meta-analysis, systematic review vs. literature review, systematic review vs. scoping review, when to conduct a systematic review, pros and cons of systematic reviews, step-by-step example of a systematic review, other interesting articles, frequently asked questions about systematic reviews.

A review is an overview of the research that’s already been completed on a topic.

What makes a systematic review different from other types of reviews is that the research methods are designed to reduce bias . The methods are repeatable, and the approach is formal and systematic:

• Formulate a research question
• Develop a protocol
• Search for all relevant studies
• Apply the selection criteria
• Extract the data
• Synthesize the data
• Write and publish a report

Although multiple sets of guidelines exist, the Cochrane Handbook for Systematic Reviews is among the most widely used. It provides detailed guidelines on how to complete each step of the systematic review process.

Systematic reviews are most commonly used in medical and public health research, but they can also be found in other disciplines.

Systematic reviews typically answer their research question by synthesizing all available evidence and evaluating the quality of the evidence. Synthesizing means bringing together different information to tell a single, cohesive story. The synthesis can be narrative ( qualitative ), quantitative , or both.

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Systematic reviews often quantitatively synthesize the evidence using a meta-analysis . A meta-analysis is a statistical analysis, not a type of review.

A meta-analysis is a technique to synthesize results from multiple studies. It’s a statistical analysis that combines the results of two or more studies, usually to estimate an effect size .

A literature review is a type of review that uses a less systematic and formal approach than a systematic review. Typically, an expert in a topic will qualitatively summarize and evaluate previous work, without using a formal, explicit method.

Although literature reviews are often less time-consuming and can be insightful or helpful, they have a higher risk of bias and are less transparent than systematic reviews.

Similar to a systematic review, a scoping review is a type of review that tries to minimize bias by using transparent and repeatable methods.

However, a scoping review isn’t a type of systematic review. The most important difference is the goal: rather than answering a specific question, a scoping review explores a topic. The researcher tries to identify the main concepts, theories, and evidence, as well as gaps in the current research.

Sometimes scoping reviews are an exploratory preparation step for a systematic review, and sometimes they are a standalone project.

A systematic review is a good choice of review if you want to answer a question about the effectiveness of an intervention , such as a medical treatment.

To conduct a systematic review, you’ll need the following:

• A precise question , usually about the effectiveness of an intervention. The question needs to be about a topic that’s previously been studied by multiple researchers. If there’s no previous research, there’s nothing to review.
• If you’re doing a systematic review on your own (e.g., for a research paper or thesis ), you should take appropriate measures to ensure the validity and reliability of your research.
• Access to databases and journal archives. Often, your educational institution provides you with access.
• Time. A professional systematic review is a time-consuming process: it will take the lead author about six months of full-time work. If you’re a student, you should narrow the scope of your systematic review and stick to a tight schedule.
• Bibliographic, word-processing, spreadsheet, and statistical software . For example, you could use EndNote, Microsoft Word, Excel, and SPSS.

A systematic review has many pros .

• They minimize research bias by considering all available evidence and evaluating each study for bias.
• Their methods are transparent , so they can be scrutinized by others.
• They’re thorough : they summarize all available evidence.
• They can be replicated and updated by others.

Systematic reviews also have a few cons .

• They’re time-consuming .
• They’re narrow in scope : they only answer the precise research question.

The 7 steps for conducting a systematic review are explained with an example.

Step 1: Formulate a research question

Formulating the research question is probably the most important step of a systematic review. A clear research question will:

• Allow you to more effectively communicate your research to other researchers and practitioners
• Guide your decisions as you plan and conduct your systematic review

A good research question for a systematic review has four components, which you can remember with the acronym PICO :

• Population(s) or problem(s)
• Intervention(s)
• Comparison(s)

You can rearrange these four components to write your research question:

• What is the effectiveness of I versus C for O in P ?

Sometimes, you may want to include a fifth component, the type of study design . In this case, the acronym is PICOT .

• Type of study design(s)
• The population of patients with eczema
• The intervention of probiotics
• In comparison to no treatment, placebo , or non-probiotic treatment
• The outcome of changes in participant-, parent-, and doctor-rated symptoms of eczema and quality of life
• Randomized control trials, a type of study design

Their research question was:

• What is the effectiveness of probiotics versus no treatment, a placebo, or a non-probiotic treatment for reducing eczema symptoms and improving quality of life in patients with eczema?

Step 2: Develop a protocol

A protocol is a document that contains your research plan for the systematic review. This is an important step because having a plan allows you to work more efficiently and reduces bias.

Your protocol should include the following components:

• Background information : Provide the context of the research question, including why it’s important.
• Research objective (s) : Rephrase your research question as an objective.
• Selection criteria: State how you’ll decide which studies to include or exclude from your review.
• Search strategy: Discuss your plan for finding studies.
• Analysis: Explain what information you’ll collect from the studies and how you’ll synthesize the data.

If you’re a professional seeking to publish your review, it’s a good idea to bring together an advisory committee . This is a group of about six people who have experience in the topic you’re researching. They can help you make decisions about your protocol.

It’s highly recommended to register your protocol. Registering your protocol means submitting it to a database such as PROSPERO or ClinicalTrials.gov .

Step 3: Search for all relevant studies

Searching for relevant studies is the most time-consuming step of a systematic review.

To reduce bias, it’s important to search for relevant studies very thoroughly. Your strategy will depend on your field and your research question, but sources generally fall into these four categories:

• Databases: Search multiple databases of peer-reviewed literature, such as PubMed or Scopus . Think carefully about how to phrase your search terms and include multiple synonyms of each word. Use Boolean operators if relevant.
• Handsearching: In addition to searching the primary sources using databases, you’ll also need to search manually. One strategy is to scan relevant journals or conference proceedings. Another strategy is to scan the reference lists of relevant studies.
• Gray literature: Gray literature includes documents produced by governments, universities, and other institutions that aren’t published by traditional publishers. Graduate student theses are an important type of gray literature, which you can search using the Networked Digital Library of Theses and Dissertations (NDLTD) . In medicine, clinical trial registries are another important type of gray literature.
• Experts: Contact experts in the field to ask if they have unpublished studies that should be included in your review.

At this stage of your review, you won’t read the articles yet. Simply save any potentially relevant citations using bibliographic software, such as Scribbr’s APA or MLA Generator .

• Databases: EMBASE, PsycINFO, AMED, LILACS, and ISI Web of Science
• Handsearch: Conference proceedings and reference lists of articles
• Gray literature: The Cochrane Library, the metaRegister of Controlled Trials, and the Ongoing Skin Trials Register
• Experts: Authors of unpublished registered trials, pharmaceutical companies, and manufacturers of probiotics

Step 4: Apply the selection criteria

Applying the selection criteria is a three-person job. Two of you will independently read the studies and decide which to include in your review based on the selection criteria you established in your protocol . The third person’s job is to break any ties.

To increase inter-rater reliability , ensure that everyone thoroughly understands the selection criteria before you begin.

If you’re writing a systematic review as a student for an assignment, you might not have a team. In this case, you’ll have to apply the selection criteria on your own; you can mention this as a limitation in your paper’s discussion.

You should apply the selection criteria in two phases:

• Based on the titles and abstracts : Decide whether each article potentially meets the selection criteria based on the information provided in the abstracts.
• Based on the full texts: Download the articles that weren’t excluded during the first phase. If an article isn’t available online or through your library, you may need to contact the authors to ask for a copy. Read the articles and decide which articles meet the selection criteria.

It’s very important to keep a meticulous record of why you included or excluded each article. When the selection process is complete, you can summarize what you did using a PRISMA flow diagram .

Next, Boyle and colleagues found the full texts for each of the remaining studies. Boyle and Tang read through the articles to decide if any more studies needed to be excluded based on the selection criteria.

When Boyle and Tang disagreed about whether a study should be excluded, they discussed it with Varigos until the three researchers came to an agreement.

Step 5: Extract the data

Extracting the data means collecting information from the selected studies in a systematic way. There are two types of information you need to collect from each study:

• Information about the study’s methods and results . The exact information will depend on your research question, but it might include the year, study design , sample size, context, research findings , and conclusions. If any data are missing, you’ll need to contact the study’s authors.
• Your judgment of the quality of the evidence, including risk of bias .

You should collect this information using forms. You can find sample forms in The Registry of Methods and Tools for Evidence-Informed Decision Making and the Grading of Recommendations, Assessment, Development and Evaluations Working Group .

Extracting the data is also a three-person job. Two people should do this step independently, and the third person will resolve any disagreements.

They also collected data about possible sources of bias, such as how the study participants were randomized into the control and treatment groups.

Step 6: Synthesize the data

Synthesizing the data means bringing together the information you collected into a single, cohesive story. There are two main approaches to synthesizing the data:

• Narrative ( qualitative ): Summarize the information in words. You’ll need to discuss the studies and assess their overall quality.
• Quantitative : Use statistical methods to summarize and compare data from different studies. The most common quantitative approach is a meta-analysis , which allows you to combine results from multiple studies into a summary result.

Generally, you should use both approaches together whenever possible. If you don’t have enough data, or the data from different studies aren’t comparable, then you can take just a narrative approach. However, you should justify why a quantitative approach wasn’t possible.

Boyle and colleagues also divided the studies into subgroups, such as studies about babies, children, and adults, and analyzed the effect sizes within each group.

Step 7: Write and publish a report

The purpose of writing a systematic review article is to share the answer to your research question and explain how you arrived at this answer.

Your article should include the following sections:

• Abstract : A summary of the review
• Introduction : Including the rationale and objectives
• Methods : Including the selection criteria, search method, data extraction method, and synthesis method
• Results : Including results of the search and selection process, study characteristics, risk of bias in the studies, and synthesis results
• Discussion : Including interpretation of the results and limitations of the review
• Conclusion : The answer to your research question and implications for practice, policy, or research

To verify that your report includes everything it needs, you can use the PRISMA checklist .

Once your report is written, you can publish it in a systematic review database, such as the Cochrane Database of Systematic Reviews , and/or in a peer-reviewed journal.

In their report, Boyle and colleagues concluded that probiotics cannot be recommended for reducing eczema symptoms or improving quality of life in patients with eczema. Note Generative AI tools like ChatGPT can be useful at various stages of the writing and research process and can help you to write your systematic review. However, we strongly advise against trying to pass AI-generated text off as your own work.

If you want to know more about statistics , methodology , or research bias , make sure to check out some of our other articles with explanations and examples.

• Student’s  t -distribution
• Normal distribution
• Null and Alternative Hypotheses
• Chi square tests
• Confidence interval
• Quartiles & Quantiles
• Cluster sampling
• Stratified sampling
• Data cleansing
• Reproducibility vs Replicability
• Peer review
• Prospective cohort study

Research bias

• Implicit bias
• Cognitive bias
• Placebo effect
• Hawthorne effect
• Hindsight bias
• Affect heuristic
• Social desirability bias

A literature review is a survey of scholarly sources (such as books, journal articles, and theses) related to a specific topic or research question .

It is often written as part of a thesis, dissertation , or research paper , in order to situate your work in relation to existing knowledge.

A literature review is a survey of credible sources on a topic, often used in dissertations , theses, and research papers . Literature reviews give an overview of knowledge on a subject, helping you identify relevant theories and methods, as well as gaps in existing research. Literature reviews are set up similarly to other  academic texts , with an introduction , a main body, and a conclusion .

An  annotated bibliography is a list of  source references that has a short description (called an annotation ) for each of the sources. It is often assigned as part of the research process for a  paper .  

A systematic review is secondary research because it uses existing research. You don’t collect new data yourself.

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Systematic Reviews: Narrative Reviews

• Systematic Review Defined
• Guides, Standards and Resources
• Data Extraction
• Risk of Bias
• WCM's Data Retention Policy & Systematic Reviews
• Scoping Reviews
• Narrative Reviews
• Covidence This link opens in a new window
• Collaborations 2022-present
• Collaborations 2012-2021

What is a narrative review?

Narrative reviews (sometimes called a topic or literature review) are general discussions of a topic, often with no stated hypothesis. They are often invited papers written by experts in the field. 

They can provide rationales for future research and can speculate on new types of interventions available. (Ferrari, 2015)

A narrative review is not a "less good" systematic/scoping review. The aims and methodology are different; they are different study types. 

Rossella Ferrari (2015) Writing narrative style literature reviews, Medical Writing, 24:4, 230-235, DOI: 10.1179/2047480615Z.000000000329

What are some limitations of narrative reviews?

Some limitations of narrative reviews are that they often do not include methodology (i.e., how did they get these results?) and therefore can be subjective in study selection, which can potentially lead to bias. This also makes narrative reviews not reproducible. Because it is not necessary for a narrative review to comprehensive, it is often difficult to discern how much weight to apply to their claims. 

However, narrative reviews can be important and necessary contributions to medical literature.

When should I perform a narrative review versus a systematic/scoping review?

It's very important to remember that not all research questions require or are appropriate for a systematic/scoping review (SR).

• When the question is too broad for a comprehensive, methodologically rigorous SR to take place.
• When there is not enough literature yet available to perform a SR. 
• When there is not enough time to perform a SR.
• When there is not a large enough team  available to perform a SR.

How should I write a narrative review?

Because there are no formal guidelines that narrative reviews must adhere to (such as PRISMA for systematic reviews) their quality can vary greatly. However, there are some resources to help you build your review.

• Writing narrative style literature reviews
• SANRA—a scale for the quality assessment of narrative review articles
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• Last Updated: Sep 26, 2024 11:30 AM
• URL: https://med.cornell.libguides.com/systematicreviews

• Library Guides
• Literature Reviews
• Getting Started

Literature Reviews: Getting Started

What is a literature review.

A literature review is an overview of the available research for a specific scholarly topic. Literature reviews summarize existing research to answer a review question, provide context for new research, or identify important gaps in the existing body of literature.

An incredible amount of academic literature is published each year; by some estimates nearly three million articles .

Sorting through and reviewing that literature can be complicated, so this Research Guide provides a structured approach to make the process more manageable.

THIS GUIDE IS AN OVERVIEW OF THE LITERATURE REVIEW PROCESS:

• Getting Started (asking a research question | defining scope)
• Choosing a Type of Review
• Searching the Literature
• Organizing the Literature
• Writing the Literature Review (analyzing | synthesizing)

A  literature search  is a systematic search of the scholarly sources in a particular discipline. A  literature review   is the analysis, critical evaluation and synthesis of the results of that search. During this process you will move from a review  of  the literature to a review  for   your research.   Your synthesis of the literature is your unique contribution to research.

WHO IS THIS RESEARCH GUIDE FOR?

— those new to reviewing the literature

— those that need a refresher or a deeper understanding of writing literature reviews

You may need to do a literature review as a part of a course assignment, a capstone project, a master's thesis, a dissertation, or as part of a journal article. No matter the context, a literature review is an essential part of the research process. 

Literature Review Process

Purpose of a Literature Review

What is the purpose of a literature review.

A literature review is typically performed for a specific reason. Even when assigned as an assignment, the goal of the literature review will be one or more of the following:

• To communicate a project's novelty by identifying a research gap

• An overview of research issues , methodologies or results relevant to field
• To explore the  volume and types of available studies
• To establish familiarity with current research before carrying out a new project
• To resolve conflicts amongst contradictory previous studies

Reviewing the literature helps you understand a research topic and develop your own perspective.

A LITERATURE REVIEW IS NOT :

• An annotated bibliography – which is a list of annotated citations to books, articles and documents that includes a brief description and evaluation for each entry
• A literary review – which is a critical discussion of the merits and weaknesses of a literary work
• A book review – which is a critical discussion of the merits and weaknesses of a particular book

Attribution

Thanks to Librarian Jamie Niehof at the University of Michigan for providing permission to reuse and remix this Literature Reviews guide.

Workshop Materials

• Materials from OSU Literature Review Workshop
• Last Updated: Sep 23, 2024 11:11 AM
• URL: https://info.library.okstate.edu/literaturereviews

• En español – ExME
• Em português – EME

Traditional reviews vs. systematic reviews

Posted on 3rd February 2016 by Weyinmi Demeyin

Millions of articles are published yearly (1) , making it difficult for clinicians to keep abreast of the literature. Reviews of literature are necessary in order to provide clinicians with accurate, up to date information to ensure appropriate management of their patients. Reviews usually involve summaries and synthesis of primary research findings on a particular topic of interest and can be grouped into 2 main categories; the ‘traditional’ review and the ‘systematic’ review with major differences between them.

Traditional reviews provide a broad overview of a research topic with no clear methodological approach (2) . Information is collected and interpreted unsystematically with subjective summaries of findings. Authors aim to describe and discuss the literature from a contextual or theoretical point of view. Although the reviews may be conducted by topic experts, due to preconceived ideas or conclusions, they could be subject to bias.

Systematic reviews are overviews of the literature undertaken by identifying, critically appraising and synthesising results of primary research studies using an explicit, methodological approach(3). They aim to summarise the best available evidence on a particular research topic.

The main differences between traditional reviews and systematic reviews are summarised below in terms of the following characteristics: Authors, Study protocol, Research question, Search strategy, Sources of literature, Selection criteria, Critical appraisal, Synthesis, Conclusions, Reproducibility, and Update.

Traditional reviews

• Authors: One or more authors usually experts in the topic of interest
• Study protocol: No study protocol
• Research question: Broad to specific question, hypothesis not stated
• Search strategy: No detailed search strategy, search is probably conducted using keywords
• Sources of literature: Not usually stated and non-exhaustive, usually well-known articles. Prone to publication bias
• Selection criteria: No specific selection criteria, usually subjective. Prone to selection bias
• Critical appraisal: Variable evaluation of study quality or method
• Synthesis: Often qualitative synthesis of evidence
• Conclusions: Sometimes evidence based but can be influenced by author’s personal belief
• Reproducibility: Findings cannot be reproduced independently as conclusions may be subjective
• Update: Cannot be continuously updated

Systematic reviews

• Authors: Two or more authors are involved in good quality systematic reviews, may comprise experts in the different stages of the review
• Study protocol: Written study protocol which includes details of the methods to be used
• Research question: Specific question which may have all or some of PICO components (Population, Intervention, Comparator, and Outcome). Hypothesis is stated
• Search strategy: Detailed and comprehensive search strategy is developed
• Sources of literature: List of databases, websites and other sources of included studies are listed. Both published and unpublished literature are considered
• Selection criteria: Specific inclusion and exclusion criteria
• Critical appraisal: Rigorous appraisal of study quality
• Synthesis: Narrative, quantitative or qualitative synthesis
• Conclusions: Conclusions drawn are evidence based
• Reproducibility: Accurate documentation of method means results can be reproduced
• Update: Systematic reviews can be periodically updated to include new evidence

Decisions and health policies about patient care should be evidence based in order to provide the best treatment for patients. Systematic reviews provide a means of systematically identifying and synthesising the evidence, making it easier for policy makers and practitioners to assess such relevant information and hopefully improve patient outcomes.

• Fletcher RH, Fletcher SW. Evidence-Based Approach to the Medical Literature. Journal of General Internal Medicine. 1997; 12(Suppl 2):S5-S14. doi:10.1046/j.1525-1497.12.s2.1.x. Available from:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1497222/
• Rother ET. Systematic literature review X narrative review. Acta paul. enferm. [Internet]. 2007 June [cited 2015 Dec 25]; 20(2): v-vi. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0103-21002007000200001&lng=en. http://dx.doi.org/10.1590/S0103-21002007000200001
• Khan KS, Ter Riet G, Glanville J, Sowden AJ, Kleijnen J. Undertaking systematic reviews of research on effectiveness: CRD’s guidance for carrying out or commissioning reviews. NHS Centre for Reviews and Dissemination; 2001.

Weyinmi Demeyin

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No Comments on Traditional reviews vs. systematic reviews

THE INFORMATION IS VERY MUCH VALUABLE, A LOT IS INDEED EXPECTED IN ORDER TO MASTER SYSTEMATIC REVIEW

Thank you very much for the information here. My question is : Is it possible for me to do a systematic review which is not directed toward patients but just a specific population? To be specific can I do a systematic review on the mental health needs of students?

Hi Rosemary, I wonder whether it would be useful for you to look at Module 1 of the Cochrane Interactive Learning modules. This is a free module, open to everyone (you will just need to register for a Cochrane account if you don’t already have one). This guides you through conducting a systematic review, with a section specifically around defining your research question, which I feel will help you in understanding your question further. Head to this link for more details: https://training.cochrane.org/interactivelearning

I wonder if you have had a search on the Cochrane Library as yet, to see what Cochrane systematic reviews already exist? There is one review, titled “Psychological interventions to foster resilience in healthcare students” which may be of interest: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013684/full You can run searches on the library by the population and intervention you are interested in.

I hope these help you start in your investigations. Best wishes. Emma.

La revisión sistemática vale si hay solo un autor?

HI Alex, so sorry for the delay in replying to you. Yes, that is a very good point. I have copied a paragraph from the Cochrane Handbook, here, which does say that for a Cochrane Review, you should have more than one author.

“Cochrane Reviews should be undertaken by more than one person. In putting together a team, authors should consider the need for clinical and methodological expertise for the review, as well as the perspectives of stakeholders. Cochrane author teams are encouraged to seek and incorporate the views of users, including consumers, clinicians and those from varying regions and settings to develop protocols and reviews. Author teams for reviews relevant to particular settings (e.g. neglected tropical diseases) should involve contributors experienced in those settings”.

Thank you for the discussion point, much appreciated.

Hello, I’d like to ask you a question: what’s the difference between systematic review and systematized review? In addition, if the screening process of the review was made by only one author, is still a systematic or is a systematized review? Thanks

Hi. This article from Grant & Booth is a really good one to look at explaining different types of reviews: https://onlinelibrary.wiley.com/doi/10.1111/j.1471-1842.2009.00848.x It includes Systematic Reviews and Systematized Reviews. In answer to your second question, have a look at this Chapter from the Cochrane handbook. It covers the question about ‘Who should do a systematic review’. https://training.cochrane.org/handbook/current/chapter-01

A really relevant part of this chapter is this: “Systematic reviews should be undertaken by a team. Indeed, Cochrane will not publish a review that is proposed to be undertaken by a single person. Working as a team not only spreads the effort, but ensures that tasks such as the selection of studies for eligibility, data extraction and rating the certainty of the evidence will be performed by at least two people independently, minimizing the likelihood of errors.”

I hope this helps with the question. Best wishes. Emma.

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Systematic reviews

What is a systematic review, identifying the need for a systematic review, types of systematic reviews, other reviews, literature review vs systematic review.

• Steps in a systematic review
• Formulate the question
• Create a protocol (plan)
• Sources to search
• Conduct a thorough search
• Post search phase
• Select studies (screening)
• Appraise the quality of the studies
• Extract data, synthesise and analyse
• Interpret results and write
• Guides and manuals
• Training and support

"Systematic reviews aim to identify, evaluate and summarise the findings of all relevant individual studies, thereby making the available evidence more accessible to decisionmakers. When appropriate, combining the results of several studies gives a more reliable and precise estimate of an intervention’s effectiveness than one study alone." 

Centre for Reviews and Dissemination. Systematic Reviews: CRD's guidance for undertaking reviews in health care . York (GB): Centre for Reviews and Dissemination; 2009.

A systematic review is a review that reports or includes the following:

• research question
• sources that were searched, with a reproducible search strategy (naming of databases, naming of search platforms/engines, search date and complete search strategy)
• inclusion and exclusion criteria
• selection (screening) methods
• critically appraises and reports the quality/risk of bias of the included studies
• information about data analysis and synthesis that allows the reproducibility of the results

Krnic Martinic M, Pieper D, Glatt A, Puljak L. Definition of a systematic review used in overviews of systematic reviews, meta-epidemiological studies and textbooks. BMC Med Res Methodol. 2019;19(1):203.

The reasons for a systematic review may include:

• Uncertainty in the research literature where there are conflicting results
• An identified gap in knowledge
• An area in which research and interest are growing
• To prove effectiveness

Watch: Features and benefits of a systematic review (YouTube, 1m 49s)

Part of establishing the need for your planned systematic review is to check that a systematic review doesn't already exist for your topic. See the section of this guide ' Finding existing systematic reviews '.

Systematic reviews have a focused answerable question often developed and defined by a PICO statement. Systematic and transparent methods must be used and reported which enable repeatability and eliminate bias. A rigorous and sensitive search strategy should be developed to attempt to find all published and unpublished relevant literature. Studies for analysis should be chosen using clear, pre-determined inclusion/exclusion criteria. Selected studies should be appraised and all relevant data analysed with the results used to drive policy and practice.

Meta-analysis and systematic review have, in the past, been used interchangeably, however meta-analysis (or meta-synthesis for qualitative research) is now more often used to describe the data analysis that takes place within the systematic review process.

Rapid reviews aim to use the methodology of the systematic review but where a systematic review may take 18 months results may be expected in 6 to 8 weeks. Generally, an effective rapid review requires more subject knowledge and understanding of the systematic review process of the reviewers than does a systematic review. To achieve best results, given the time constraints reviewers could chose to interrogate fewer databases, perhaps 3 as opposed to the 7 or more used in the typical systematic review. Grey literature may not be included and the screening process may be undertaken by a single reviewer after a benchmarking search involving more reviewers looks at a small percentage of the papers to be screened. The aim of a rapid review is to quickly translate findings to policy and practice.

State of the art reviews are very similar to systematic reviews but are interested only in very recent research, more often in emerging areas.

Umbrella reviews undertake much the same process as systematic reviews, however no primary studies are considered, they are reviews of reviews. The aims are the same as systematic reviews, to influence policy and practice but they have the capacity to do so for a broader concept.

Literature reviews  (narrative, critical) have been with us as long as literature and generally seek to find a subset of papers in a selected area and summarise them. 

Scoping reviews , as far as searching, reporting and study selection are concerned, can be much the same as systematic reviews. The question may be much broader than that of a systematic review often considering concepts rather than focused questions. The final analysis and goals of the scoping review are the fundamental differences between scoping and systematic reviews. Charting is the term most often used to describe the “analysis” of the results of a scoping review. The scope or reach of the concept is charted perhaps geographically, socially, temporally or other respects. A scoping review can determine whether a systematic review on the topic is warranted or viable.

Systematic quantitative literature review.  This method developed by Griffith University's School of Environment bridges the gap between traditional narrative review methods and meta-analyses.

Systematised literature review.  This method attempts to include elements of the systematic review process while stopping short of the systematic review. Systematised reviews are typically conducted as a postgraduate student assignment, in recognition that they are not able to draw upon the resources required for a full systematic review (such as two reviewers).

Systematic reviews are very different to narrative (literature) reviews. The list below highlights some of the principle features which set systematic and narrative reviews apart.

Systematic Review

• Has a clear question or hypothesis to be answered
• Searches are rigorous to locate all potentially relevant literature
• Includes explicit inclusion and exclusion criteria
• Assesses study quality for inclusion and provides a synthesis of results

Narrative (Traditional) Review

• Starts with a question but includes general discussion and no hypothesis
• Does not locate all relevant literature
• Does not have explicit inclusion and exclusion criteria
• Does not always require included studies to be methodologically sound or of a certain quality

Mark, P. Systematic reviews from astronomy to zoology: myths and misconceptions.  BMJ. 2001;322(7278):98-101.

For more information on how to search for, store, organise, evaluate and critique information for your literature review (any type) see our  Literature reviews guide . Includes techniques, books, articles and more to help you do your literature review. If your project requires a systematic approach then the information in this guide (Systematic Reviews) may be the most helpful.

• Next: Steps in a systematic review >>
• Last Updated: Sep 16, 2024 4:41 PM
• URL: https://guides.library.uq.edu.au/research-techniques/systematic-reviews

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Article Contents

Balancing the strengths of systematic and narrative reviews.

• Article contents
• Figures & tables
• Supplementary Data

John A. Collins, Bart C.J.M. Fauser, Balancing the strengths of systematic and narrative reviews, Human Reproduction Update , Volume 11, Issue 2, March/April 2005, Pages 103–104, https://doi.org/10.1093/humupd/dmh058

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The mandate of Human Reproduction Update involves several roles: (i) to provide a synthesis of evidence that can aid scientists and clinicians in their daily work; (ii) to help reproductive specialists understand concepts from related disciplines; and (iii) to summarize current knowledge generated by basic science as the foundation of future scientific and clinical advancement. Given that review and synthesis are central to good scientific and clinical practice, and that a grasp of the current state of knowledge is a prerequisite to designing new studies, it is pertinent to ask which reviews are most likely to fulfil the needs of readers. A related question concerns whether systematic reviews meet the needs of all review topics and all readers.

Summarizing evidence or knowledge is a difficult problem in reproductive medicine, as in other branches of science and medical care ( Eddy et al. , 1992 ). For each question there may be multiple studies that use different designs and inclusion criteria. For clinical questions, the interventions, outcomes and measures of effect may vary: the effect measures in treatment studies include odds ratios, relative risks and absolute differences. For scientific questions, the experimental species, models and designs may differ. Moreover, it is always uncertain whether all of the relevant evidence has been evaluated. Even when the search has been exhaustive, there are no simple guides on how to interpret conflicting results and whether to accept apparently outlying studies. The choices that the reviewer makes to address the variable conditions and uncertainties may be conservative, strict and exclusive, or liberal, open and inclusive. The decisions made by the reviewer may not be consistent throughout and these choices may or may not satisfy the reader who seeks out the review to address a clinical or research question. Faced with uncertainty and doubt, readers nonetheless must form an impression of the evidence and synthesize the state of knowledge in order to address the clinical or research question that stimulated their interest in the review. We argue that the reader is better served when the choices made in the review, regardless of whether they are strict or open, should be explicit, transparent, clearly stated and reproducible by interested readers.

This list of objectives for reviews is more easily satisfied by systematic reviews, which use explicit methods to methodically search, critically appraise and synthesize the available literature on a specific issue. The question or issue need not be clinical: indeed, the concept evolved primarily in psychology studies ( Light and Pillemer, 1984 ). The systematic review attempts to reduce reviewer bias through the use of objective, reproducible criteria to select relevant individual publications and assess their validity. A systematic review may include a meta-analysis or statistical summary of the individual study results: the aggregate of effects from several studies yields an average treatment effect that is more precise than the individual study results ( Schlesselman and Collins, 2003 ). Thus, the systematic review involves explicit, transparent methods which are clearly stated, and reproducible by others. Whether a systematic review of randomized controlled trials adheres to the guidelines can easily be evaluated by means of a widely used checklist (the QUORUM statement) ( Moher et al. , 1999 ). The strengths of the systematic review include the narrow focus of the question, the comprehensive search for evidence, the criterion-based selection of relevant evidence, the rigorous appraisal of validity, the objective or quantitative summary, and the evidence-based inferences ( Cook et al. , 1997 ).

For some review topics, however, the strengths of the systematic review may turn into weaknesses. The primary problem is that the narrow focus and prescribed methods of the systematic review do not allow for comprehensive coverage. For example, the historical review is an irreplaceable means of tracing the development of a scientific principle or clinical concept, but the narrative thread could be lost in the strict rules of systematic review. As other examples, it would be burdensome to apply systematic methods to a survey on aneuploidy and fertility in the aging female or to an assessment of mouse knockout models and polycystic ovarian phenotype. Such topics would require the wider scope of a traditional narrative review, in which less explicit methods are the trade-off for broader coverage.

The majority of review articles are narrative rather than systematic. Narrative reviews generally are comprehensive and cover a wide range of issues within a given topic, but they do not necessarily state or follow rules about the search for evidence. Also, typical narrative reviews do not reveal how the decisions were made about relevance of studies and the validity of the included studies. Of course, the results of the search, selection and assessment procedures must meet the referees’ and editors’ sense of propriety, but readers may not be privy to the methods and thus could not make judgments about the authors choices.

Neither the systematic reviews with their narrow scope nor the narrative reviews with their individuality can satisfy the range of topics for review. Currently, progress in reproductive medicine depends primarily on knowledge of developments in molecular biology, genetics and pharmacology. Background knowledge, evolving concepts and controversy require the flexibility of a narrative review with broad coverage and situational choices about the inclusion of evidence. In contrast, the rigour of a systematic review is needed for effectiveness of diagnostic and treatment interventions and for the outcomes of natural and therapeutic exposures, including adverse events and costs. The choice is more open for many other scientific and clinical topics.

Recognizing that there is a need for both systematic and narrative reviews, could one review type learn from the other? Because readers value transparency and reproducibility, some narrative reviews could gain by drawing from the rigour of systematic reviews. Authors could arrange the subject matter in a series of objective questions, each section based on specified procedures for search, relevance and validity and tied to other sections by appropriate descriptive links. One of the many types of statistical summarization would be helpful to readers. Inferences would adhere to the cited evidence and abstain from opinion. Systematic reviews, on the other hand, could adopt some of the strengths of the narrative review without compromising validity. Their formulaic nature can be boring to read, but this could be countered by non-technical idiomatic language, novel approaches to graphics, and new ways to deal with the baggage of massive tables. Also the excessive concentration in systematic reviews on odds ratios and relative risks is anachronistic, now that absolute differences and numbers needed to treat are the preferred measures of treatment effects ( Sackett and Cook, 1994 ). The procedures for calculating summary absolute effects and their heterogeneity are similar to those for relative effects ( Greenland, 1987 ; Deeks et al. , 2001 ).

Review journals such as Human Reproduction Update have high impact factors because readers need and appreciate comprehensive, relevant, valid summaries that clearly synthesize scientific and clinical evidence. While systematic reviews are more appropriate for focused topics and traditional narrative reviews are better suited to comprehensive topics, either approach can be adapted to clinical or scientific subjects. An infusion of systematic review methods would strengthen narrative reviews and in turn systematic reviews could benefit from the presentation strengths of narrative reviews. The goal is to ensure that the methods of all reviews should be explicit, transparent, clearly stated and reproducible by interested readers.

Cook DJ, Mulrow CD and Haynes RB ( 1997 ) Systematic reviews: synthesis of best evidence for clinical decisions. Ann Intern Med 126 , 376 –380.

Google Scholar

Deeks JJ, Altman DG and Bradburn MJ ( 2001 ) Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In Egger M, Davey Smith G, and Altman DG (eds) Systematic Reviews in Health Care: Meta-analysis in Context. BMJ Publishing Group, London, pp 285 –312.

Eddy DM, Hasselblad V and Shachter R ( 1992 ) Meta-analysis by the Confidence Profile Method. Academic Press, Boston.

Greenland S ( 1987 ) Quantitative methods in the review of epidemiologic literature. Epidemiol Rev 9 , 1 –30.

Light RJ and Pillemer DB ( 1984 ) Summing Up: The Science of Reviewing Research. Harvard University Press, Boston.

Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D and Stroup DF ( 1999 ) Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Lancet 354 , 1896 –1900.

Sackett DL and Cook RJ ( 1994 ) Understanding clinical trials: what measures of efficacy should journal articles provide busy clinicians? Br Med J 309 , 755 –756.

Schlesselman JJ and Collins JA ( 2003 ) Evaluating systematic reviews and meta-analyses. Semin Reprod Med 21 , 95 –105.

Author notes

1Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, 2Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada and 3Department of Reproductive Medicine, University Medical Center, Utrecht, The Netherlands

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Systematic and scoping reviews: A comparison and overview

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• 1 Division of Vascular Surgery, Western University, London, Ontario, Canada.
• 2 Division of Vascular Surgery, Western University, London, Ontario, Canada. Electronic address: [email protected].
• PMID: 36414363
• DOI: 10.1053/j.semvascsurg.2022.09.001

In this article, we compare and contrast methods of reviewing, summarizing, and synthesizing the literature, including systematic reviews, scoping reviews, and narrative reviews. Review articles are essential to help investigators wade through the plethora of exponentially growing medical literature. In the era of evidence-based medicine, a systematic approach is required. A systematic review is a formalized method to address a specific clinical question by analyzing the breadth of published literature while minimizing bias. Systematic reviews are designed to answer narrow clinical questions in the PICO (population, intervention, comparison, and outcome) format. Alternatively, scoping reviews use a similar systematic approach to a literature search in order to determine the breadth and depth of knowledge on a topic; to clarify definitions, concepts, and themes; or sometimes as a precursor to a systematic review or hypothesis generator to guide future research. However, scoping reviews are less constrained by a priori decisions about which interventions, controls, and outcomes may be of interest. Traditional narrative reviews still have a role in informing practice and guiding research, particularly when there is a paucity of high-quality evidence on a topic.

Copyright © 2022. Published by Elsevier Inc.

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Systematic Review Process: Types of Reviews

• Definitions of a Systematic Review

Types of Reviews

• Systematic Review Planning Process
• Resources Needed to Conduct a Review
• Reporting Guidelines
• Where to Search
• How to Search
• Screening and Study Selection
• Data Extraction
• Appraisal and Analysis
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Narrative vs. Systematic Reviews

People often confuse systematic and literature (narrative) reviews. They both are used to provide a summary of the existing literature or research on a specific topic.

A narrative or traditional literature review is a comprehensive, critical, and objective analysis of the current knowledge on a topic. They are an essential part of the research process and help to establish a theoretical framework and focus or context for your research. A literature review will help you to identify patterns and trends in the literature so that you can identify gaps or inconsistencies in a body of knowledge. This should lead you to a sufficiently focused research question that justifies your research.

A systematic review is comprehensive and has minimal bias. It is based on a specific question and uses eligibility criteria and a pre-planned protocol. This type of study evaluates the quality of evidence. 

A systematic review can be either quantitative or qualitative:

• If quantitative, the review will include studies that have numerical data.
• If qualitative, the review derives data from observation, interviews, or verbal interactions and focuses on the meanings and interpretations of the participants. It will include focus groups, interviews, observations and diaries.

Narrative reviews in comparison provide a perspective on topic (like a textbook chapter), may have no specified search strategy, might have significant bias issues, and may not evaluate quality of evidence.

This table provides a detailed comparison of systematic and literature (narrative) reviews.

Tools to Help You Choose a Review Type

There are other comprehensive literature reviews of similar methodology to the systematic review. These tools can help you determine which type of review you may want to conduct. 

• The Review Ready Reckoner - Assessment Tool (RRRsAT) is a chart created as an adaptation of Andrew Booth's article on review typology. The chart that describes the features of multiple review types listing characteristics that distinguish each type and including sample of each type of review.
• The What Review is Right for You tool asks five short questions to help you identify the most appropriate method for a review.

Use this chart  to determine the type of review you are interested in writing and to learn the differences in the stages and processes of various reviews compared to systematic reviews.

Source: Yale University

The type of review you conduct will depend on the purpose of the review, your question, your resources, expertise, and type of data.

Here are two suggested articles to consult if you want to know more about review types:

Grant, M. J., & Booth, A. (2009). A typology of reviews: an analysis of 14 review types and associated methodologies.   Health information & libraries journal ,  26 (2), 91-108. This article defines 14 types of reviews. There is a helpful summary table on pp.94-95

Sutton A, Clowes M, Preston L, Booth A.  Meeting the review family: exploring review types and associated information retrieval requirements.   Health information & libraries journal . 2019;36(3):202–222. doi:10.1111/hir.12276

This Comparison table is derived from a guide which is licensed under Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International license , and was originally included in a workbook by Amanda Wanner at Plymouth University for Systematic Reviews and Scoping Reviews. Stephanie Roth at Temple University remixed the original version. Many thanks and much appreciation to Amanda Wanner and Stephanie Roth for allowing me to create a derivative of their work.

Funaro, M., Nyhan, K., & Brackett, A. (n.d.).   What type of review could you write?  Yale Harvey Cushing/John Hay Whitney Medical Library.

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• Next: Systematic Review Planning Process >>
• Last Updated: Jul 1, 2024 9:51 AM
• URL: https://library.aah.org/guides/systematicreview

• Open access
• Published: 27 September 2024

Narrative Medicine: theory, clinical practice and education - a scoping review

• Ilaria Palla 1 ,
• Giuseppe Turchetti 1 &
• Stefania Polvani 2 , 3  

BMC Health Services Research volume  24 , Article number:  1116 ( 2024 ) Cite this article

Metrics details

The origin of Narrative Medicine dates back to more than 20 years ago at an international level. Narrative Medicine is not an alternative to evidence-based medicine, however these two approaches are integrated. Narrative Medicine is a methodology based on specific communication skills where storytelling is a fundamental tool to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Narrative Medicine, henceforth NM, represents a union between disease and illness between the doctor’s clinical knowledge and the patient’s experience. According to Byron Good, “we cannot have direct access to the experience of others’ illness , not even through in-depth investigations: one of the ways in which we can learn more from the experience of others is to listen to the stories of what has happened to other people.” Several studies have been published on NM; however, to the best of our knowledge, no scoping review of the literature has been performed.

This paper aims to map and synthetize studies on NM according to theory, clinical practice and education/training.

The scoping review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) checklist. A search was conducted in PubMed, APA PsycNet and Jstor. Two authors independently assessed the eligibility and methodological quality of the studies and extracted the data. This review refers to the period from 1998 to 2022.

A total of 843 abstracts were identified of which 274 papers were selected based on the title/abstract. A total of 152 papers in full text were evaluated and 76 were included in the review. Papers were classified according to three issues:

✘ Nineteen studies focused on the definition and concept of NM (Theoretical).

✘ Thirty-eight papers focused on the collection of stories, projects and case reports (Clinical practice).

✘ Nineteen papers focused on the implementation of the Narrative Medicine approach in the education and training of medical doctors (Education and training).

Conclusions

This scoping review presents an overview of the state of the art of the Narrative Medicine. It collect studies performed mainly in Italy and in the United States as these are the countries developing the Narrative Medicine approach in three identified areas, theoretical, clinical practice and education and training. This scoping review will help to promote the power of Narrative Medicine in all three areas supporting the development of methods to evaluate and to measure the Narrative Medicine approach using key performance indicators.

Peer Review reports

Introduction

The role and involvement of patients in healthcare have changed, as has their relationship with healthcare professionals. The patient is no longer a passive subject but part of the healthcare process. Over the years, many approaches to patients’ involvement in healthcare have been developed in the literature, with significant differences in terms of concept and significance.

NM represents a focus on the patient’s needs and the empowerment of their active participation in the healthcare process.

Narrative Medicine enables patients to share their stories with healthcare professionals so that the latter can gain the necessary skills to recognize, interpret and relate to patients [ 1 ]. Stories of illness have an important impact on patients and their caregivers, healthcare professionals and organisational systems [ 2 ].

Trisha Greenhalgh, an academic in primary healthcare who trained as a General Practitioner, and Brian Hurwitz, an Emeritus Professor of Medicine and The Arts at King’s College (London) [ 3 , 4 ], affirmed that the core clinical skills in terms of listening, questioning, outlining, collecting, explaining and interpreting can provide a way of navigating among the very different worlds of patients and health professionals. These tasks need to be performed well because they can affect disease outcomes from the patient’s perspective and the scientific aspects of diagnosis and treatment.

In 2013, Rita Charon, a general internist and professor at Columbia University (New York), and Brian Hurwitz promoted “a narrative future for healthcare” , the first global conference on Narrative Based Medicine (NBM). The global conference took place in London in June 2013, where experts in humanities, social sciences and professionals interested in shaping a narrative future for healthcare discussed several topics, such as increasing the visibility of narrative-based concepts and methods; developing strategies that can influence traditional clinical institutions; spreading appreciation for the role of creativity in caring for the sick; articulating the risks of narrative practices in health care; providing a space for Narrative Medicine in the context of other fields, including personalized medicine; and sharing goals for training, research, and clinical care. The conference was the first important opportunity to share different points of view and perspectives at the global level involving several stakeholders with different backgrounds [ 5 ].

In the early 2000s, the first Italian experience of Narrative Medicine occurred in Florence with NaMe, a project endorsed by the Local Health Authority aimed at diffusing the culture of patient-centered medicine and integrating strategies to improve doctor‒patient communication in clinical practice [ 6 ]. This project was inspired by the articles of Hurwitz and Greenhalgh [ 3 , 4 ]. In addition, significant input was derived from Arthur Kleinman [ 7 ] and Byron Good [ 8 ], psychiatrists and anthropologists who studied medicine as a cultural system, as a set of symbolic meanings involving the story of the sick person. Health and illness represent the subjective experience of the person.

Kleinmann [ 7 ] defines three dimensions to explain the illness using three different significances:

✘ Disease: “only as an alteration in biological structure or functioning” .

✘ Illness: the subjective experience of suffering and discomfort.

✘ Sickness: the social representation.

Narrative Medicine can be used in several areas such as prevention, diagnosis, treatment, and rehabilitation; adherence to treatment; organization of the care team; awareness of the professional role and the emotional world by health and social workers; prevention of the burnout of professionals and caregivers; promotion and implementation of Patient Care Pathways (PCPs); and prevention of legal disputes and defensive medicine.

The Italian guidelines established by the National Institute of Health in 2015 [ 9 ] represent a fundamental step in the process of diffusion and implementation of Narrative Medicine in Italy and currently represents the only document. The guidelines define Narrative Medicine as an intervention methodology based on specific communication skills. Storytelling is a fundamental instrument for acquiring, understanding and integrating the different perspectives of those involved in the disease and in the healthcare process. Storytelling represents a moment of contact between a healthcare professional and the patient’s world. The story told involves people, those who narrate and those who listen. Telling stories is a way of transferring knowledge and experience, connecting, reflecting and feeling emotions.

In the last few years, several studies have been carried out with different objectives and perspectives, but no literature review on Medicine Narrative has been performed. We founded the study of Rui et al. [ 10 ] performing a bibliometric analysis of the literature on medical narratives published from 2011 to 2021 showing that the field of narrative medicine is dominated by a few countries. Respect to 736 studies included in the review, 48% (369) are performed in US and 98 papers in Italy.

The objective of scoping review was to map and synthetize studies on NM according to theory, clinical practice and education/training, three settings where NM was developed.

The research questions formulated: (1) What is Narrative Medicine?; (2) How is Narrative Medicine implemented in clinical practice?; (3) What is the role of Narrative Medicine in education and training for medical doctors?

The study protocol follows the PRISMA-ScR checklist (PRISMA extension for Scoping Reviews) but it is not registered (Additional file 1).

We included peer-reviewed papers published from 1998 to December 2022 written in Italian or in English. We excluded papers written in other languages. We included articles according to one of these issues: studies on theory of Narrative Medicine, on clinical practice or education/training of Narrative Medicine. We excluded books, case reports, reviews. To identify potentially relevant studies, the following databases were searched from 1998 to December 2022: PubMed, APA PsycNet and Jstor. The search strategy can be founded in Additional file 2. A data charting form was developed by two reviewers to define which variables can be extracted. The reviewers independently charted the data and discussed the results. We grouped the studies by type of application related to the Narrative Medicine and summarized objective, methods and reflections/conclusions. The scoping review maps the evidence on Narrative Medicine according one of the three fields of diffusion and implementation (Fig.  1 ). Furthermore, the studies classified in “theoretical field “are grouped in subcategories to explain in best way the concepts and permit a clearer and more streamlined reading.

Categories of Narrative Medicine

Review process

After removing duplicates, 843 abstracts from PubMed, Jstor and APA PsycNet were screened. A total of 274 papers were screened based on the abstracts, of which 122 were excluded. A total of 152 full texts were evaluated, and 76 were included in the review (Fig.  2 ).

PRISMA Flow-chart

The studies included were classified into the three fields where the Narrative Medicine is implemented:

✘ Theoretical studies: 19.

✘ Clinical Practice: 38.

✘ Education and training: 19.

The scoping review did not present the results of papers included but the main objectives and the methods used as the aim of the scoping review was to map the studies performed in terms of theory, clinical practice and education/training. We have tried to organize the studies published so far, making it increasingly clear how Narrative Medicine has developed.

Theoretical studies

This section presents the 19 selected theoretical studies grouped into subcategories (Additional file 3).

Narrative Medicine: advantages

In this section, we present seven papers that highlight the benefits of narrative medicine.

Of the seven papers considered, four were performed by Rita Charon emphasizing the value of Narrative Medicine in four different contexts. In the first [ 11 ], the study by Goupy et al. evaluated a Narrative Medicine elective course at the Paris-Descartes School of Medicine. In the second [ 12 ], Charon rewrote a patient’s family illness to demonstrate how medicine that respects the narrative dimension of illness and care can improve the care of individual patients, their colleagues and effective medical practice. The third paper [ 13 ] describes a visit to the Rothko Room at the Tate Modern in London as a pretext to emphasize how for narrative medicine, creativity is at the heart of health care and that the care of the sick is a work of art.

In the fourth [ 14 ], Charon provides the elements of narrative theory through a careful reading of the form and content of an excerpt from a medical record. This is part of an audio-recorded interview with a medical student and a reflection on a short section of a modernist novel to show how to determine the significance of patients’ situations.

According to Abettan [ 15 ], Narrative Medicine can play a key role in the reform of current medical practice, although to date, there has been little focus on how and why it can deliver results and be cost-effective.

Cenci [ 16 ] underlines that the existential objective of the patient is fundamental to know the person’s life project and how they would like to live their future years.

Zaharias [ 17 ], whose main sources are Charon and Launer, has published three articles on NM as a valid approach that, if practiced more widely by general practitioners, could significantly benefit both patients and doctors. If the patient’s condition is central, the NM shifts the doctor’s focus from the need to solve the problem to the need to understand. Consequently, the patient‒physician relationship is strengthened, and patients’ needs and concerns are addressed more effectively and with better results.

Narrative Medicine: the role of digital technologies

This section includes 3 papers on the role of digital technologies in Narrative Medicine. Digital narrative medicine is diffusing in care relationship as presents an opportunity for the patient and the clinician. The patient has more time to reflect on his/her needs and communicate in best way with the healthcare professionals. The clinician can access to more information as quantitative and qualitative information and data provided by the patient. These information represent an instrument for the clinician to personalize the care and respond to patient’s unmet needs.

The use of digital technologies, particularly the digital health storymap tool described by Cenci [ 16 ], for obtaining a multidisciplinary understanding of the patient’s medical history facilitates communication between the patient and caregiver. According to Charon [ 18 ], the relentless specialization and technologization of medicine damages the therapeutic importance of recognizing the context of patients’ lives and witnessing their suffering.

Rosti [ 19 ] affirms that e-health technologies will build new bridges and permit professionals to have more time to use narrative techniques with patients.

The increased use of digital technologies could reduce the opportunity for narrative contact but provide a starting point for discussion through the use of electronically transmitted patient pain diaries.

Narrative Medicine: integration with evidence-based medicine

Greenhalgh’s [ 20 ] and Rosti’s [ 19 ] studies address one of the most significant issues, the integration of Narrative Medicine with Evidence Based Medicine. Narrative Medicine is not an alternative to Evidence Based Medicine, they coexist and can complement each other in clinical practice.

Greenhalgh’s work [ 20 ] clearly shows how NM and EBM can be integrated. EBM requires an interpretative paradigm in which the patient experiences the disease in a unique and contextual way and the clinician can draw on all aspects of the evidence and thus arrive at an integrated clinical judgement.

Rosti [ 19 ] believes that even “evidence-based” physicians sustain the importance of competence and clinical judgement. Clinicians also need to rely on patients’ narratives to integrate more objective clinical results. Clinical methods are not without their limitations, which Narrative Medicine can help to overcome. Lederman [ 21 ] enphatises the importance of social sciences to analyze the stories and to improve the care.

Narrative-based Medicine: insidious

Three papers in this section focus on the possible risks of the Narrative Medicine approach. It is needing a more awareness on role of Narrative Medicine as a robust methodology.

The study by Kalitzus [ 22 ] shows how a narrative approach in medicine will be successful only if it has a positive effect on daily clinical practice instead of merely increasing existing problems.

Complex narratives on diseases published in biographies or collected by social scientists are useful only for training and research purposes. NM requires time and effort and cannot be considered the only important issue in medicine. According to Abettan [ 15 ], Narrative Medicine can make the treatment more personalised for each patient, but it is not the only way.

Zaharias [ 17 ] affirms that Narrative Medicine is often described simplistically as listening to the patient’s story, whereas it is much more common and requires special communication skills. Perhaps for these reasons, and despite its advantages, NM is not as widely practiced as it could be. Narrative skills are an integral part of practice and learning them takes time. As the author also states, “the healing power of storytelling is repeatedly attested to while evidence of effectiveness is scarce”. Lanphier [ 23 ] underlines the need to explain the term "narrative medicine" to avoid misunderstandings and to analyze the use of narrative as a tool.

Narrative Medicine: training

Liao et al. [ 24 ] presented a study aimed at helping students improve their relationships with patients by listening to them. These results, similar to those described by Charon [ 25 ], suggest that Narrative Medicine is worth recommending in academic training. The essay by O’Mahony [ 26 ] aims to provoke a debate on how and what the medical humanities should teach. Narratology and narrative medicine are linked to empathy.

Narrative Medicine: clinician-patient communication

Papers included within this category focus on the relationship between the clinician and patient, which is important in the healthcare context.

American healthcare institutions recognize the use of the Narrative Medicine approach to develop quality patient care. As a gastroenterologist at a health centre in Minnesota (US), Rian [ 27 ] concluded that the practice of Narrative Medicine should not be kept on the fringes of medicine as a hobby or ancillary treatment for the benefit of the patients but should be considered key to the healthcare process. Improving doctor‒patient communication merits more attention.

According to Rosti [ 19 ], NM can be seen as a tool to promote better communication. Although time constraints are often mentioned as an obstacle, the time needed to listen to patients is not excessive, and all healthcare professionals should consider giving patients more freedom from time constraints during consultations by encouraging them to talk about their experiences. The use of NM may also be associated with better diagnosis and treatment of pain.

Zaharias [ 28 ] underlines that communication skills are crucial. General practitioners can further develop the strong communication skills they already possess by practicing NM through neutrality, circular questions and hypotheses, and reflective skills.

Narrative Medicine: bioethics in qualitative research

The use of qualitative research in bioethics and narrative approaches to conducting and analysing qualitative interviews are becoming increasingly widespread. As Roest [ 29 ] states, this approach enables more “diagnostic thinking”. It is about promoting listening skills and the careful reading of people and healthcare practices, as well as quality criteria for the ethical evaluation of research and training.

• Clinical practice

In this classification, we included case studies performed in clinical care. We focused on methods used to guide the patients’ stories or narratives written by healthcare professionals. We analysed how Narrative Medicine has been implemented in clinical healthcare practice.

The studies included (38) were performed in the following countries: Italy (28), USA (4), Australia (1), Canada (1), China (1), Colombia (1), Norway (1), and several European countries (1) (Table  1 ). The main methods used were semi-structured interviews that guided the patient’s and physician’s narration [ 30 , 31 , 32 , 33 ], narrative diaries written by patients [ 34 ], and paper parallel charts (an instrument to integrate the patients’ stories in clinical practice) written by clinicians [ 34 , 35 , 36 ].

The studies underlined the usefulness of narrative medicine not only in qualitative research but also in integration with quantitative analysis. Gargiulo et al. [ 45 ] highlighted the importance of integrating narrative medicine and evidence-based approaches to improve therapeutic effectiveness and organizational pathways. Cappuccio et al. [ 36 ] affirmed that narrative medicine can be effective in supporting clinicians in their relationships with patients and caregivers.

Narrative Medicine is an important instrument for patients, caregivers and healthcare professionals [ 63 ]. Suter et al. [ 60 ] affirmed that patients’ stories can help other patients with similar experiences. The studies performed by Cercato [ 39 , 40 ] and Zocher [ 67 ] highlighted the role of digital diaries in the care process from the perspective of healthcare professionals and patients. Sansone et al. [ 55 ] highlighted that the use of diaries in the intensive care unit is helpful in facilitating communication between healthcare professionals and the family.

Education and training

This section includes studies on the role of Narrative Medicine in the education and training of medical students and healthcare professionals. The studies discuss the experiences, roles and programmes of the Narrative Medicine programme in education and training. Nineteen studies were carried out, 10 of which were in the USA (Table  2 ). Only two studies were carried out in Europe, 4 in Taiwan, 1 in Canada, 1 in Iran and 1 in Israel. Seven studies focused on the role of narrative medicine for healthcare professionals [ 68 , 69 , 70 , 71 , 72 , 73 , 74 ], and 11 were aimed at medical students from different disciplines. All studies underlined the positive role of Narrative Medicine in training. Chou et al. [ 75 ] affirmed that the new model of narrative medicine training, “community-based participatory narrative medicine”, which focuses on shared narrative work between healthcare trainees and patients, facilitates the formation of therapeutic patient-clinician relationships but also creates new opportunities to evaluate those relationships. Darayazadeh et al. [ 70 ] underlined the effectiveness of Narrative Medicine in improving students’ reflections and empathy with patients. Additionally, Lam et al. [ 76 ] highlighted that Narrative Medicine could be a useful tool for improving clinical empathy skills. The studies used different approaches to implement the Narrative Medicine method. Arntfield et al. [ 77 ] proposed three tools at different steps of the study (survey, focus group and open-ended questions). Chou et al. [ 75 ] asked participants to write a personal narrative. DasGupta and Charon [ 78 ] used a reflective writing exercise to analyse personal experiences of illness.

In this scoping review we identified 76 studies addressing dissemination and implementation of Narrative Medicine across three settings between 1998 and 2022. The studies performed by Hurwitz [ 3 ] and Greenhalgh [ 4 ] provide a path towards the Narrative Medicine affirm that sickness episodes are important milestones in patient life stories. Not only we live through storytelling, but often, with our doctor or nurse as a witness, we get sick, we improve, we get worse, we are stable and finally we also die through the story. affirms that the stories are often evocative and memorable. They are image rich, action packed and laden with emotions. Most people recall them better than they recall lists, graphs or numbers. Stories can convey important elements of nuance, including mood, tone and urgency. We learn through stories because the story form allows our existing schemas to be modified in the light of emerging experiential knowledge. The stories can capture tacit knowledge: in healthcare organizations they can bridge the gap between explicit, codified and formal knowledge (job descriptions, guidelines and protocols) and informal, not codified knowledge (knowing how to get things done in a particular organization or team, sometimes referred to as knowing the ropes). The “story” is the focal point in the studies related to the clinical practice as these discuss about the patient’s experience, illness story thought tools as questionnaires, narrative diary, chart parallels. The patient is an expert patient able to interact with the healthcare professionals, he/she had not a passive role; the patient is part of the process with the other involved stakeholders. Also, the Italian guidelines on Narrative Medicine [ 9 ] considers the storytelling as a fundamental instrument to acquire, understand and integrate several points of view related to persons involving in the disease and in the healthcare process. Storytelling represents the interaction between a healthcare professional and the patient’s world. According to this perspective, it is useful to educate in Narrative Medicine the healthcare professionals from the University to provide instruments to communicate and interact with their patients. Charon [ 11 ] emphasizes the role of training in narrative skills as an important tool permitting to physicians and medical students to improve their care. Charon [ 24 ] underlines that narrative training permits to explore the clinician’s attention to patients and to establish a relationship with patients, colleagues, and the self. The study of Liao [ 22 ] underlines that Narrative Medicine is worth recommending for healthcare education as resource for interdisciplinary collaboration among students from different discipline.

John Launer in The Art of Medicine. Narrative medicine , narrative practice , and the creation of meaning (2023) [ 87 ] affirm that Narrative Medicine could be complemented by the skills and pedagogy of narrative practice. In addition to the creation and study of words on the page, learners could bring their spoken accounts of their experiences at work and interview each other using narrative practice techniques. He also affirms that narrative practice and narrative medicine could both do more to build alliances with advocacy groups.

We have performed a picture of Narrative Medicine from its origin to today hoping that it will help to promote the power of Narrative Medicine in all three areas becoming increasingly integrated.

Strengths and limitations

The scoping review does not present the results of studies included but objectives, methodology and conclusions/suggestions as it aims to map the evidence related to the Narrative Medicine using a classification defined for the review. This classification had permit to make even clearer the “world” of Narrative Medicine and present a mapping.

English- and Italian-language articles were included because, as seen from the preceding pages, most of the studies were carried out in the United States and Italy.

This could be a limitation, as we may have excluded papers written in other languages. However, the United States and Italy are the countries where Narrative Medicine has developed the most.

The scoping review presents an overview of the literature considering three settings in which Narrative Medicine has emerged from its origins until today highlighting evidence in terms of theory, clinical practice, and education. Currently, a methodology to “measure” Narrative Medicine with indicators, a method assessing the effectiveness and promoting a greater diffusion of Narrative Medicine using objective and measurable indicators, is not available. Furthermore, the literature analysis doesn’t show an integration across three settings. We hope that the review will be a first step towards future projects in which it will be possible to measure Narrative Medicine according to an integrated approach between clinical practice and education/training.

Availability of data and materials

Availability of data and materials: All data generated or analysed during this study are included in this published article.

Abbreviations

• Narrative Medicine

Narrative-Based Medicine

Evidence-Based Medicine

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Palla, I., Turchetti, G. & Polvani, S. Narrative Medicine: theory, clinical practice and education - a scoping review. BMC Health Serv Res 24 , 1116 (2024). https://doi.org/10.1186/s12913-024-11530-x

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Systematic and other reviews: Criteria and complexities

Review articles can be extremely valuable. They synthesize information for readers, often provide clarity and valuable insights into a topic; and good review articles tend to be cited frequently. Review articles do not require Institutional Review Board (IRB) approval if the data reviewed are public (including private and government databases) and if the articles reviewed have received IRB approval previously. However, some institutions require IRB review and exemption for review articles. So, authors should be familiar with their institution's policy. In assessing and interpreting review articles, it is important to understand the article's methodology, scholarly purpose and credibility. Many readers, and some journal reviewers, are not aware that there are different kinds of review articles with different definitions, criteria and academic impact. 1 In order to understand the importance and potential application of a review article, it is valuable for readers and reviewers to be able to classify review articles correctly.

Systematic reviews

Authors often submit articles that include the term “systematic” in the title without realizing that that term requires strict adherence to specific criteria. A systematic review follows explicit methodology to answer a well-defined research question by searching the literature comprehensively, evaluating the quantity and quality of research evidence rigorously, and analyzing the evidence to synthesize an answer to the research question. The evidence gathered in systematic reviews can be qualitative or quantitative. However, if adequate and comparable quantitative data are available then a meta-analysis can be performed to assess the weighted and summarized effect size of the studies included. Depending on the research question and the data collected, systematic reviews may or may not include quantitative meta-analyses; however, meta-analyses should be performed in the setting of a systematic review to ensure that all of the appropriate data were accessed. The components of a systematic review can be found in an important article by Moher et al published in 2009 that defined requirements for systematic reviews and meta-analyses. 2

In order to optimize reporting of meta-analyses, an international group developed the Quality of Reporting of Meta-Analyses (QUOROM) statement at a meeting in 1996 that led to publication of the QUOROM statement in 1999. 3 Moher et al revised that document and re-named the guidelines the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PRISMA statement included both meta-analyses and systematic reviews, and the authors incorporated definitions established by the Cochrane Collaboration. 4 The PRISMA statement established the current standard for systematic reviews. To qualify as a systematic review, the methods section should acknowledge use of the PRISMA guidelines, and all PRISMA components should be incorporated strictly in all facets of the paper from the research question to the discussion. The PRISMA statement includes a checklist of 27 items that must be included when reporting a systematic review or meta-analysis. 2 A downloadable version of this checklist can be used by authors, reviewers, and journal editorial staff to ensure compliance with recommended components. 5 All 27 will not be listed in this brief editorial (although authors and reviewers are encouraged to consult the article by Moher et al and familiarize themselves with all items), but a few will be highlighted.

The research question, as reflected in the title, should be a hypothesis-based specific research inquiry. The introduction must describe the rationale for the review and provide a specific goal or set of goals to be addressed. The type of systematic review, according to the Cochrane Collaboration, is based on the research question being asked and may assess diagnostic test accuracy, review prognostic studies evidence, evaluate intervention effect, scrutinize research methodology, or summarize qualitative evidence. 6

In the methods section, the participants, interventions, comparisons, outcomes and study design (PICOS) must be put forward. In addition to mentioning compliance with PRISMA, the methods section should state whether a review protocol exists and, if so, where it can be accessed (including a registration number). Systematic reviews are eligible for registration in the International Prospective Register of Systematic Reviews (PROSPERO) as established at the University of York (York, UK). When PROSPERO is used (it is available but not required for systematic reviews), registration should occur at the initial protocol stage of the review, and the final paper should direct to the information in the register. The methods section also must include specific study characteristics including databases used, years considered, languages of articles included, specific inclusion and exclusion criteria for studies; and rationale for each criterion must be included. Which individuals specifically performed searches should be noted. Electronic search strategy (with a full description of at least one electronic search strategy sufficient to allow replication of the search), process for article selection, data variables sought, assumptions and simplifications, methods for assessing bias risk of each individual study (such as selective reporting in individual studies) and utilization of this information in data synthesis, principal summary measures (risk ratio, hazard ratio, difference in means, etc.), methods of data management and combining study results, outcome level assessment, and other information should be reported.

The results section should include the number of studies identified, screened, evaluated for eligibility (including rationale for exclusion), and those included in the final synthesis. A PRISMA flow diagram should be included to provide this information succinctly. 7 The results also should include the study characteristics, study results, risk of bias within and across studies, and a qualitative or quantitative synthesis of the results of the included studies. This level of rigor in acquiring and evaluating the evidence of each individual study is one of the criteria that distinguishes systematic reviews from other categories. If the systematic review involves studies with paired samples and quantitative data, a summary of data should be provided for each intervention group along with effect estimates and confidence intervals for all outcomes of each study. If a meta-analysis is performed, then synthesized effect size should be reported with confidence intervals and measures of consistency (i.e. – data heterogeneity such as I 2 ) for each meta-analysis, and assessment of bias risk across studies. A forest plot, which provides a graphical presentation of the meta-analysis results, should be included.

The discussion section should summarize the main findings commenting on the strength of evidence for each outcome, as well as relevance to healthcare providers, policymakers and other key stake-holders; limitations of the study and outcomes; and conclusions highlighting the interpretation of results in the context of other research, and implications for future research.

Without adhering to of all of these criteria and the others listed in the PRISMA statement and checklist, the review does not qualify to be classified as “systematic”.

Meta-analyses

Meta-analyses, when feasible based on available and comparable quantitative data, supplement a systematic review evaluation, by adding a secondary statistical analysis of the pooled weighted outcomes of similar studies. This adds a level of objectivity in the synthesis of the review's findings. Meta-analyses are appropriate when at least 2 individual studies contain paired samples (experimental group and control group) and provide quantitative outcome data and sample size. Studies that lack a control group may over-estimate the effect size of the experimental intervention or condition being studied and are not ideal for meta-analyses. 8 It also should be remembered that the conclusions of a meta-analysis are only as valid as the data on which the analysis is based. If the articles included are flawed, then the conclusions of the meta-analysis also may be flawed. Systematic reviews and meta-analyses are the most rigorous categories of review.

Other types of reviews

Mixed methods reviews.

Systematic reviews typically contain a single type of data, either qualitative or quantitative; however, mixed methods reviews bring together a combination of data types or study types. This approach may be utilized when quantitative data, in the setting of an intervention study, only provide a narrow perspective of the efficacy or effectiveness of the intervention. The addition of qualitative data or qualitative studies may provide a more complete picture of the knowledge, attitudes, and behaviors of clinicians, patients or researchers regarding that intervention. This type of review could involve collecting either the quantitative or the qualitative data using systematic review methodology, but often the qualitative data are gathered using a convenience sampling. Many qualitative studies provide useful insights into clinical management and/or implementation of research interventions; and incorporating them into a mixed methods review may provide valuable perspective on a wide range of literature. Mixed methods reviews are not necessarily systematic in nature; however, authors conducting mixed methods reviews should follow systematic review methodology, when possible.

Literature and narrative reviews

Literature reviews include peer-reviewed original research, systematic reviews, and meta-analyses, but also may include conference abstracts, books, graduate degree theses, and other non-peer reviewed publications. The methods used to identify and evaluate studies should be specified, but they are less rigorous and comprehensive than those required for systematic reviews. Literature reviews can evaluate a broad topic but do not specifically articulate a specific question, nor do they synthesize the results of included studies rigorously. Like mixed method reviews, they provide an overview of published information on the topic, although they may be less comprehensive than integrative reviews; and, unlike systematic reviews, they do not need to support evidence-based clinical or research practices, or highlight high-quality evidence for the reader. Narrative reviews are similar to literature reviews and evaluate the same scope of literature. The terms sometimes are used interchangeably, and author bias in article selection and data interpretation is a potential concern in literature and narrative reviews.

Umbrella reviews

An umbrella review integrates previously published, high-quality reviews such as systematic reviews and meta-analyses. Its purpose is to synthesize information in previously published systematic reviews and meta-analyses into one convenient paper.

Rapid reviews

A rapid review uses systematic review methodology to evaluate existing research. It provides a quick synthesis of evidence and is used most commonly to assist in emergent decision-making such as that required to determine whether COVID-19 vaccines should receive emergent approval.

Scoping, mapping, and systematized reviews

If literature has not been reviewed comprehensively in a specific subject that is varied and complex, a mapping review (also called scoping review) may be useful to organize initial understanding of the topic and its available literature. While mapping reviews may be helpful in crystallizing research findings and may be published, they are particularly useful in helping to determine whether a topic is amenable to systematic review, and to help organize and direct the approach of the systematic review or other reviews of the subject. Systematized reviews are used most commonly by students. The systematized review provides initial assessment of a topic that is potentially appropriate for a systematic review, but a systematized review does not meet the rigorous criteria of a systematic review and has substantially more limited value. Additional types of reviews exist including critical review, state-of-the-art review, and others.

Conclusions

Reviews can be invaluable; but they also can be misleading. Systematic reviews and meta-analyses provide readers with the greatest confidence that rigorous efforts have attempted to eliminate bias and ensure validity, but even they have limitations based upon the strengths and weaknesses of the literature that they have assessed (and the skill and objectivity with which the authors have executed the review). Risks of bias, incomplete information and misinformation increase as the rigor of review methodology decreases. While review articles may summarize research related to a topic for readers, non-systematic reviews lack the rigor to answer adequately hypothesis-driven research questions that can influence evidence-based practice. Journal authors, reviewers, editorial staff, and should be cognizant of the strengths and weaknesses of review methodology and should consider them carefully as they assess the value of published review articles, particularly as they determine whether the information presented should alter their patient care.

Declaration of competing interest

The authors declare no competing interests.

Peer review under responsibility of Chinese Medical Association.