–Transparent Transdisciplinary Reporting in Geriatric Research Using the EQUATOR Network

In this issue of the Journal of the American Geriatrics Society (JAGS), the journal in collaboration with the Clinician-Scientists Transdisciplinary Aging Research (Clin-STAR) team introduces a new series called “Around the EQUATOR with Clin-STAR”.¹ The objective of this series is to highlight existing reporting standards while addressing transdisciplinary challenges that may arise when these standards are applied to research involving older participants.

During the first decade of JAGS, most manuscripts were single-authored narrative reviews. When original data were published, the research was usually observational, and the methods in the corresponding manuscript lacked important details and uniform reporting standards. For example, in 1953 Dr. Arkell Vaughn reported on a consecutive set of 100 vagotomy procedures for the treatment of gastrointestinal ulcerations, but the manuscript neglected to explicitly identify the study design as a case series, to report patients’ eligibility criteria or to contemplate potential sources of bias.² That same year, Rafsky and colleagues reported on the effect of methium chloride for older adults with hypertension.³ Their study lacked a control group, and the manuscript did not include reproducible details about the outcomes assessment, subgroup considerations, or statistical analysis. More than twenty years later, epidemiologists were still raising concerns about the quality of research designs in prestigious medical journals based upon unjustifiably small sample sizes and haphazard descriptions of data collection.⁴ In fact, key information needed to fully evaluate and replicate published research was not included in hundreds of original reports over decades across multiple medical fields.⁵ One consequence of this challenge to scientific rigor was a perception that medical research remained irreparably disconnected from bedside care,⁶ leading to significant waste in research spending.⁷

Epidemiologists and journal editors began to coalesce around the concept that more structured scientific research reporting was needed across specialties.⁸ Initial counterarguments included that the “sterilization” of literary style would reduce readers’ interest in the scientific reporting and that consensus among investigators and journal editors about the most appropriate reporting framework could not be achieved.⁹ However, beginning with the Consolidated Standards of Reporting Trials (CONSORT) in 1996, standardized checklists for research reporting began to appear.¹⁰ At the present time, 535 different reporting guidelines are housed by the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network (https://www.equator-network.org/), including standards for observational research, diagnostic and prognostic studies, qualitative research, systematic reviews, quality improvement, economic evaluations, and clinical practice guidelines.^11–18 Most reporting guidelines are available in non-English formats, and many have been updated over the years. Some reporting guidelines include “extensions” for subtypes of research or unique populations. For example, Standards for Studies of Diagnostic Test Accuracy in Dementia (STARDdem) recommendations for accuracy studies in persons living with dementia have been developed.¹⁹

In the years following the release of CONSORT, the thoroughness of randomized controlled trial reporting has steadily improved in general medical journals, but this trend for improvement was not observed in specialized journals, including those in the fields of Geriatrics and Pharmacology.^20,21 CONSORT is not the only EQUATOR Network reporting standard associated with more thorough scientific reporting. Newer EQUATOR reporting standards such as Standards for Reporting of Diagnostic Accuracy Studies (STARD) are gradually demonstrating improvements in the transparency of research reporting.^22,23 Enhanced attention to these standards by investigators and editorial boards could accelerate the acquisition of new knowledge and reduce the quantity or premature adoption of less useful research. For example, stricter adherence to other EQUATOR reporting standards such as the Recording of studies Conducted using Observational Routinely collected Data for Pharmacoepidemiology (RECORD-PE) may have reduced the proportion of COVID-19 research that was subsequently retracted.^24,25

Although JAGS recommends that authors submitting manuscripts of original research should adhere to the appropriate EQUATOR Network reporting standard, most of the standards have not been adapted to account for the complex issues that often characterize research of older participants;^26,27 nor has the overall value of adherence to these standards been conclusively demonstrated. In other disciplines, significant misunderstandings exist between and within editorial boards regarding the correct reporting standard to use and the most appropriate manner in which to adhere to individual EQUATOR reporting standard recommendations.²⁸ Moreover, peer-reviewers for journals receive relatively little guidance about how to evaluate adherence to EQUATOR standards.²⁹ The Clin-STAR “Around the EQUATOR” series is designed to pre-emptively address challenges that may arise across disciplines for authors, reviewers, and editors for incorporating and suitably evaluating individual reporting standards based on lessons learned from frontline clinical researchers in aging. This new series starts with a contribution by Carpenter and colleagues on EQUATOR reporting standards for Implementation Science research involving older participants.¹ Additional potential topics for this series are provided in the Table, which is organized according to those standards that may be most relevant to JAGS authors. Suggestions are welcome, however, from readers about other EQUATOR standards that are particularly challenging for researchers in aging. We believe that this series will accelerate adherence to appropriate EQUATOR Network standards, while simultaneously providing a roadmap for those who develop the reporting standards to “geriatricize” them with robust exemplars and toolkits in the future.^30,31

Table.

Potential Topics for the Around the EQUATOR with Clin-STAR Series

EQUATOR Reporting Standard	Hyperlink
Strengthening of Reporting of Observational Studies in Epidemiology	https://www.equator-network.org/reporting-guidelines/strobe/
Standards for Reporting of Diagnostic Accuracy Studies	https://www.equator-network.org/reporting-guidelines/stard/
Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis (TRIPOD)	https://www.equator-network.org/reporting-guidelines/tripod-statement/
Consolidated Health Economic Evaluation Reporting (CHEERS 2022)	https://www.equator-network.org/reporting-guidelines/cheers/
Consolidated Criteria for Reporting Qualitative Research (COREQ)	https://www.equator-network.org/reporting-guidelines/coreq/
Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020)	https://www.equator-network.org/reporting-guidelines/prisma/
Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0)	https://www.equator-network.org/reporting-guidelines/squire/
Reporting Elements for Practice Guidelines in Healthcare (RIGHT)	https://www.equator-network.org/reporting-guidelines/right-statement/
Template for Intervention Description and Replication (TIDier)	https://www.equator-network.org/reporting-guidelines/tidier/
Consolidated Standards of Reporting Trials (CONSORT)-Pragmatic	https://www.equator-network.org/reporting-guidelines/consort-pragmatic/
CONSORT-Routine	https://www.equator-network.org/reporting-guidelines/consort-routine/
CONSORT-Equity	https://www.equator-network.org/reporting-guidelines/consort-equity/
CONSORT-Artificial Intelligence	https://www.equator-network.org/reporting-guidelines/consort-artificial-intelligence/