This framework was originally intended to guide Foundation staff in commissioning and producing decision support syntheses, but it may also be used as a guide to others interested in doing or funding such syntheses.

The framework is designed to be flexible enough to be able to answer different types of questions, each of which may need different research methods, different types of evidence, different audiences, different products and dissemination activities, etc.


  • Decision-maker and researcher involvement
    Creating a decision support synthesis is a team effort where different people participate with varying degrees of intensity, depending on the stage of the process. For example:

    • Decision makers lead in identifying the issue to be addressed, to ensure relevance and impact.
    • Researchers are in charge of conducting the investigation in a way which ensures scientific rigour and should identify the implications for policy and practice from the research. The latter is done with some support from the decision makers to help contextualize the evidence.
    • Decision makers lead in articulating recommendations for policy and management or practice because of their knowledge of the decision-making context. This is done with some guidance from the researchers.

    Note there is not always necessarily a sharp divide between researchers and decision makers. Some people might be considered "hybrids" of researchers and decision makers. Also, some synthesis topics might require the participation of other stakeholders, such as patient representatives or voluntary organizations.

  • Multiple types of evidence
    A synthesis may include different types of evidence which can be clustered around scientific evidence from the clinical and social sciences and other relevant disciplines - including context-free and context-sensitive - and colloquial evidence, such as professional expertise or values. What makes evidence scientific is the manner of study.

    In the Decision Support Synthesis program, the commissioned investigative team collects the scientific evidence (grey and published literature) for scientific review and synthesis. If relevant, the team scientifically collects input from other sources - such as local or international key informants or experts to fill gaps from the literature, identify key contextual factors, such as cost and benefits. With this evidence in hand, the team considers and presents implications for policy and practice from their research. A deliberative process involving both the research team and decision makers is used to determine recommendations for action.

  • Deliberation
    Deliberation is a way of eliciting and combining different inputs to inform a decision. A deliberative process is undertaken at two stages of a Decision Support Synthesis project. First, leading researchers and decision makers with an interest in the topic are brought together to determine the actual research question in response to the health service or policy problem and to frame the scope of the research. Second, a deliberative process involving decision makers and researchers is used following the production of a draft report of the scientific evidence to determine recommendations. This last recommendations phase is where the final combining and ranking of the available evidence occurs.

  • Ranking and combining evidence
    How to rank and combine evidence is an issue yet to be resolved. For the purposes of this program, we consider scientific evidence as the most accurate form of evidence, while colloquial evidence is used to help provide a context or when scientific evidence is not available or incomplete. There is also a hierarchy within colloquial evidence, where expert consensus weighs more than the values of an individual.

    There are core elements that are thought to be needed for a deliberative process to successfully combine evidence. Some of these elements are the presence of a strong chairperson; the engagement of the researcher and decision-maker communities; and face-to-face discussions.

  • Final product
    The final report is written as per the Foundation's 1:3:25 format. The "1" is an overall summary and the "3" presents the key recommendations determined by decision makers through deliberation. The Foundation is responsible for ensuring these are written in plain-language style. The "25" is the investigation report per se, which includes the implications.