Into the weeds: Understanding scientific articles Bradley McDowell, PhD Holden Comprehensive Cancer Center University of Iowa

Objectives Learn what kinds of information is found in different types of scientific articles. Learn where to find the information you need in study reports from across the cancer control continuum. Learn how to evaluate a study.

Reasons to read scientific articles Want to become an expert in an area of research as an activist/participant Read everything Have a question that you want answered by an authoritative source Type of article: Secondary source/integrative review https://www.cancer.gov/publications/pdq Your friendly ICC staff member Want to learn more about “the latest study” Type of article: Primary source If you want to be well-versed in an area, read as much as you can about it. If you’re interest is more transitory or specific, though, you can be more selective about what you read.

Primary Source This is a description of a specific study by the team that conducted the study Typical Sections Introduction/Background Methods Results Discussion

Example study

Helpful hints Do not read the article from beginning to end Read for a purpose

Questions to ask What is the purpose of the article? (end of introduction)

Gray et al. (2011) Cancer Dooley et al. (2016) Patient Education and Counseling Chamie et al. (2012) Cancer

Questions to ask What is the purpose of the article? (end of introduction) Who was studied? (Methods) Are the subjects representative of the whole population? Are they different in an important way?

Who was studied? Women with early stage breast cancer who completed primary treatment at least 3 months previously, except for continued use of tamoxifen or an aromatase inhibitor, and who were without recurrent or new primary cancer. Patients were excluded if they were still experiencing complications of primary treatment, did not have a PCP to provide care, were previously enrolled on a study requiring oncology follow-up, were actively followed up for another primary cancer, or had a PCP who already had a patient enrolled on the trial (to avoid contamination).

Questions to ask What is the purpose of the article? (end of introduction) Who was studied? (Methods) Are the subjects representative of the whole population? Are they different in an important way? What was the comparison/relationship? (tables/figures, end of introduction) Does the comparison/design represent real-world or meaningful conditions? Was there random assignment?

Random assignment to these two groups Intervention group received “comprehensive SCP that consisted of the prescribed elements, including a personalized treatment summary, a patient version of the Canadian national follow-up guideline, a summary table of the guideline that served as a reminder system, and a resource kit tailored to the patient’s needs on available supportive care resources.” ALL patients were referred to PCP. Patients and PCPs instructed to schedule a follow-up visit. Supportive care available to all patients.

Questions to ask What is the purpose of the article? (end of introduction) Who was studied? (Methods) Are the subjects representative of the whole population? Are they different in an important way? What was the comparison/relationship? (tables/figures, end of introduction) Does the comparison/design represent real-world or meaningful conditions? Was there random assignment? Are the measures/outcomes valid? (Methods)

Measures “The primary instrument in this trial was the [Impact of Events Scale], which assesses distress anchored to a specific event, defined as breast cancer. Cancer specific distress rather than general distress was considered most relevant, both for this patient population and for the trial intervention.22,26,27 The IES has been validated extensively21 in English and French and has been used widely in breast cancer populations.22,27-29” Found IES with the help of Google [printout] Higher scores indicate more distress

Results Distress for those with SCP declined at higher rate than those without SCP, but not more than expected by random variation (p = .25) “All patients showed a non–clinically important improvement over time in the primary outcome for both IES total scores and subscale scores. At 12 months, changes in the IES total score overall, and within the strata defined by time since diagnosis, were reduced in the intervention group, but the effects were not statistically significant (Table 3).”

Questions to ask What is the purpose of the article? (end of introduction) Who was studied? (Methods) Are the subjects representative of the whole population? Are they different in an important way? What was the comparison/relationship? (tables/figures, end of introduction) Does the comparison/design represent real-world or meaningful conditions? Was there random assignment? Are the measures/outcomes valid? (Methods) Are the conclusions supported by the results? What limitations are noted in the paper? (Discussion)

Article Conclusions “The results of this trial do not support the hypothesis that SCPs are beneficial for improving patient-reported outcomes of breast cancer survivors.”

Limitations (from Discussion) “Alternative explanations for why we found no differences in cancer-related distress and other outcomes need consideration. “…the IES may not have been sensitive enough to capture some intervention effects. “An additional consideration is the choice of patient population. It may be that these patients were better adjusted as a result of the time since their original cancer diagnosis, or that breast cancer patients are relatively well informed and have good access to resources compared with those who have other cancers.”

Questions to ask What is the purpose of the article? (end of introduction) Who was studied? (Methods) Are the subjects representative of the whole population? Are they different in an important way? What was the comparison/relationship? (tables/figures, end of introduction) Does the comparison/design represent real-world or meaningful conditions? Was there random assignment? Are the measures/outcomes valid? (Methods) Are the conclusions supported by the results? What limitations are noted in the paper? (Discussion) Summarize

Where does this leave us? We have a counterintuitive finding that comes with many limitations (as all studies do) What have other investigators found? Population-based, observational studies have shown beneficial outcomes associated with care planning. The only randomized control trial to show a benefit for SCP was for low-income, predominantly Latina breast cancer survivors A study in progress has shown that the benefits of care coordination is greater for those with lower health literacy. Emerging thoughts: SCP is more than a piece of paper; it should be part of overall coordination of care. Some people might benefit more from this coordination than others.

What We Haven’t Talked About How to find articles through a literature search Statistics Multivariate analyses Meta-analyses More sophisticated design/analysis issues “Intention to treat”

Where to Find Articles Finding articles (http://libguides.lib.msu.edu/pubmedvsgooglescholar) PubMed Google Scholar Web of Science Obtaining articles PubMed Central Open Access journals Library and interlibrary loan Directly from authors Local library might be able to provide online access to journal articles. It may be possible to go to your closest university library and use their resources. Unfortunately, you need to be on campus to access many of those resources (or access the resources through a VPN).

Publication Process Process of team writing Peer review Open access vs closed access journals Predatory journals MEDLINE index and PubMed

Other issues Correlation and causation Efficacy vs effectiveness Significant vs nonsignificant