A transdisciplinary team approach to scoping reviews: the case of pediatric polypharmacy

Exposure to multiple medications is common among pediatric patients in both inpatient and outpatient settings [1‐4]. Using multiple medications can have benefits such as augmentation, tolerability, and efficacy [5‐7], or harms such as adverse drug reactions, drug-drug interactions, difficulty adhering to complex regimens, toxicity, overdose, and increased cost [8‐12]. Balancing harms and benefits is challenging for prescribers, especially with limited evidence to guide treatment in pediatric patients, and varying definitions and methodologies for pediatric polypharmacy [7, 13, 14]. In the pediatric literature, the term polypharmacy is commonly used when more than one medication is prescribed for a single disease, despite the reality that it is more common to use multiple medications in patients with comorbid diagnoses [15‐18]. In this context, we conducted a transdisciplinary scoping review to map the pediatric polypharmacy literature, identify gaps in literature, clarify the definition, and describe the prevalence of pediatric polypharmacy. Transdisciplinary team science is the most integrated form of collaborative research, after interdisciplinary and multidisciplinary approaches [19]. The three terms refer to the involvement of multiple disciplines interacting in different ways while examining aspects of the same larger question or problem. Multidisciplinary is the most basic level of involvement where each discipline independently applies knowledge and approaches, often in a sequential fashion. Interdisciplinary involves concurrent reciprocal interaction among disciplines, necessitating a degree of blurring of disciplinary boundaries. Transdisciplinary transcends disciplinary boundaries to consider the dynamics of systems in a holistic way [20]. To achieve the highest level of collaboration over the broad topic of pediatric polypharmacy, we selected the transdisciplinary team approach for our scoping review.

A scoping review is a form of knowledge synthesis that addresses an exploratory research question aimed at mapping key concepts, types of evidence, and gaps in research related to a defined area or field [21‐23]. Like a systematic review, a scoping review uses transparent and reproducible processes to define a research question, search for studies, and synthesize findings. However, a systematic review typically focuses on a well-defined question and aims to provide answers to questions from a relatively narrow range of studies assessed for quality. A scoping study, in contrast, uses the literature to address a broader research question, typically without assessing quality of studies [21, 24, 25]. Scoping reviews seek to reveal patterns that emerge from the literature and are more likely to be hypothesis generating, whereas systematic reviews often are hypothesis testing [26].

We believe that applying a transdisciplinary approach to a scoping review is novel in pediatric literature synthesis. A transdisciplinary team approach is holistic in that team members from different disciplines exchange expertise, knowledge and skills around a complex problem, resulting in integrated insights not easily assigned to a particular discipline [19, 20]. Representatives of different disciplines transcend their separate conceptual, theoretical, and methodological orientations in order to develop a common conceptual framework, in ways that go beyond multidisciplinary and interdisciplinary approaches [27‐29]. In multidisciplinary approaches, different disciplines work in parallel or sequentially with the research questions and methods staying within the boundaries of each discipline [20, 28]. Interdisciplinary approaches harmonize links between, typically two, disciplines while mostly maintaining disciplinary identities without a common framework [20]. Success of these collaborative initiatives depends on the extent to which cross disciplinary integrations are actually achieved by research teams [30].

A common feature of scoping studies has been the need to engage researchers from a wide range of academic disciplines [31]. Additionally, authors may find it appropriate to search multiple sources of literature— quantitative, qualitative, text, opinion pieces, or summaries [32‐34].

Multidisciplinary approaches have been widely used in scoping studies [35, 36]. A multidisciplinary team provides the required specialist knowledge to map a subject that is not necessarily always found in one field [22, 31]. This approach can, however, create problems as researchers from very different theoretical perspectives often have difficulty in working together [31]. Because of its intentional integrational nature, the transdisciplinary approach may be better suited to handle the broad research questions and types of literature of scoping studies [37]. Similar to the transdisciplinary approach, an integrated knowledge translation approach [38] is a collaborative research process whereby researchers and knowledge users work together from developing the question through designing, completing the literature search, analyzing and interpreting the data and disseminating the results [26].

While multiple research teams have conducted narrative, scoping, and systematic reviews on polypharmacy among adults and the elderly [39‐42], we were unable to find transdisciplinary teams that conducted systematic or scoping reviews of studies involving pediatric polypharmacy. In this manuscript, we report the methods of our transdisciplinary scoping review of pediatric polypharmacy. To facilitate potential replication by others, we also describe the key roles of our transdisciplinary team members.

In this project, we established a transdisciplinary team of experts that conducted a large scoping review in order to map the pediatric polypharmacy literature, identify research gaps, clarify the definition of pediatric polypharmacy, and describe the prevalence of pediatric polypharmacy. In addition to reviewing studies, the team also provided internal consultation to one another throughout the project cycle.

In conclusion, we completed a scoping review as a transdisciplinary team. Our team efforts have enabled us to implement a project of considerable magnitude, as well as benefit from all team members’ skills and efforts. Our transdisciplinary review team provided inbuilt expert consultation which complemented that from external stakeholders. We found holding regular meetings, producing SOPs, and continually assessing internal validity to be helpful.

We recommend that researchers conducting large scoping reviews consider using a transdisciplinary approach to elevate the breadth and focus of the questions; enhance the scoping review decisions and iterations; and enrich review conclusions. We hope the detailed description provided in this paper will help others conducting future scoping reviews when designing their studies and planning for necessary resource requirements.