The importance of logic when choosing how to approach a systematic review: lessons from a meta-ethnography of how healthcare professionals and patients understand placebos and their effects in primary care

As part of a PhD exploring placebo effects in general practice, we conducted a systematic review of how healthcare professionals and patients understand placebos and their effects in primary care. However, there is significant ambiguity and disagreement in the literature on the nature, efficacy, and ethics of placebo treatment. This made it difficult to establish how to approach and design our review. Given such an uncertain environment, it was difficult for us to establish the orientation of our review and even more difficult to choose from the myriad possible methodologies for conducting it. In this case, we outline how by focussing on and refining a distinct logical mode of inquiry, we were able to better understand the different types of possible review and effectively evaluate and select a methodology. In a sense, this case is not about how to conduct a review, it is about how to get to the start line. We posit that having a coherent theoretical grasp of one's review orientation is as important as the procedural conduct of the review. We think that this initial phase could be better explained and that the implications of getting it wrong can resonate through the whole review process