Leveraging co-production in the systematic review of evidence to update the pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides.

We used co-production: I) to conduct a systematic review to update the evidence on assessment, triage, and management in 17 pan-Canadian Oncology Symptom Triage and Remote Support (COSTaRS) practice guides; and II) to evaluate the co-production approach used by our team to contribute evidence on the impact of engaging knowledge users (patients, caregivers, nurses, managers, policy-makers). Of 17,618 citations, 175 were eligible, including 124 clinical practice guidelines and 51 systematic reviews with meta-analysis since the last update published in 2020. Findings were used to update the 17 COSTaRS practice guides and add one new COSTaRS practice guide for difficulty swallowing. Evidence was removed from 32 outdated sources. The COSTaRS practice guides required a few updates in the assessment, triage, medications, and self-care domains to reflect the new identified evidence. A baseline survey assessed our team members' previous experience with the COSTaRS practice guides, previous experience with conducting systematic reviews, and their preferred level of involvement for each step of the systematic review. The baseline survey yielded a response rate of 14/15 team members (93.3%). The follow-up survey including the Patient Engagement in Research Scale (PEIRS-22), completed by 12 team members (2 patient/caregivers, 5 researchers and 5 nurses), showed an extremely high level of meaningful engagement on all sub scores and the total PEIRS-22 score. Narrative feedback from participants indicated that they felt valued as equal partners and engaged through regular project updates. They enjoyed being able to select individual levels of involvement. The inclusion of multiple perspectives enhanced the richness of the final product, according to participants. While their involvement was influenced by workload time constraints, a strong sense of ownership of the final product was identified as a positive impact of the co-production process.