structured abstract for literature review

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What are structured abstracts?

A structured abstract is an abstract with distinct, labeled sections (e.g., Introduction, Methods, Results, Discussion) for rapid comprehension (see Figure 1 ).

What kinds of structures are used?

Standardized formats for structured abstracts have been defined for original research studies, review articles and clinical practice guidelines ( 1 , 2 ). The IMRAD format (INTRODUCTION, METHODS, RESULTS, and DISCUSSION), a defacto standard that reflects the process of scientific discovery ( 3 ), is commonly used as a structure for journal abstracts ( 4 , 5 ). The CONSORT (Consolidated Standards of Reporting Trials) Group issued a guideline for how to report randomized controlled trials (RCTs) in journal and conference abstracts using a structured format ( 6 ).

Why use structured abstracts?

Structured abstracts have several advantages for authors and readers. These formats were developed in the late 1980s and early 1990s to assist health professionals in selecting clinically relevant and methodologically valid journal articles. They also guide authors in summarizing the content of their manuscripts precisely, facilitate the peer-review process for manuscripts submitted for publication, and enhance computerized literature searching ( 1 , 2 ).

The International Committee of Medical Journal Editors (ICMJE, of which NLM is a sitting member), whose "Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals" document provides general guidelines for the format of manuscripts submitted to journals, requires the use of structured abstracts for original research articles, systematic reviews, and meta-analyses. ICMJE does acknowledge that the format required for structured abstracts differs from journal to journal and that some journals use more than one structure ( 7 ).

The substantial growth in both the individual number of PubMed records with structured abstracts and in the number of journals that continuously publish structured abstracts demonstrates widespread adoption of structured abstracts over the years ( 8 ). Structured abstracts perform better than unstructured abstracts for the discovery of corresponding MeSH (Medical Subject Headings®) terms using the Medical Text Indexer (MTI) software application ( 9 ). More information about NLM research on structured abstracts including technical details for the NLM implementation of structured abstracts can be found at Structured Abstracts in MEDLINE .

How are structured abstracts formatted in PubMed?

NLM uses all uppercase letters followed by a colon and space for the labels that appear in structured abstracts in MEDLINE/PubMed ® citations (see Figure 1 ).

How can I search for structured abstracts in PubMed?

In a PubMed search box, type:

See the structured abstract search results in PubMed .

References:

1 . Haynes RB, Mulrow CD, Huth EJ, Altman DG, Gardner MJ. More informative abstracts revisited. Ann Intern Med. 1990 Jul 1;113(1):69-76. PubMed PMID: 2190518 . Available from: https://www.acpjournals.org/doi/10.7326/0003-4819-113-1-69 .

2 . Hayward RS, Wilson MC, Tunis SR, Bass EB, Rubin HR, Haynes RB. More informative abstracts of articles describing clinical practice guidelines. Ann Intern Med. 1993 May 1;118(9):731-7. PubMed PMID: 8460861 . Available from: https://www.acpjournals.org/doi/10.7326/0003-4819-118-9-199305010-00012 .

3 . Sollaci LB, Pereira MG. The introduction, methods, results, and discussion (IMRAD) structure: a fifty-year survey. J Med Libr Assoc. 2004 Jul;92(3):364-7. PubMed PMID: 15243643 ; PubMed Central PMCID: PMC442179 .

4 . Nakayama T, Hirai N, Yamazaki S, Naito M. Adoption of structured abstracts by general medical journals and format for a structured abstract. J Med Libr Assoc. 2005 Apr;93(2):237-42. PubMed PMID: 15858627 ; PubMed Central PMCID: PMC1082941 .

5 . Kulkarni H. Structured abstracts: still more. Ann Intern Med. 1996 Apr 1;124(7):695-6. PubMed PMID: 8607606 . Available from: https://www.acpjournals.org/doi/10.7326/0003-4819-124-7-199604010-00020 .

6 . Hopewell S, Clarke M, Moher D, Wager E, Middleton P, Altman DG, Schulz KF; CONSORT Group. CONSORT for reporting randomized controlled trials in journal and conference abstracts: explanation and elaboration. PLoS Med. 2008 Jan 22;5(1):e20. PubMed PMID: 18215107 ; PubMed Central PMCID: PMC2211558 .

7 . International Committee of Medical Journal Editors. Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals (ICMJE Recommendations). 2013 Aug [cited 2013 Aug 21]. Available from: http://www.icmje.org .

8 . Ripple AM, Mork JG, Rozier JM, Knecht LS. Structured abstracts in MEDLINE: twenty-five years later. Bethesda, MD: National Library of Medicine; 2012 [cited 2014 Sep 17]. Available from: https://structuredabstracts.nlm.nih.gov/Structured_Abstracts_in_MEDLINE_Twenty-Years_Later.pdf .

9 . Ripple AM, Mork JG, Thompson HJ, Schmidt SC, Knecht LS. Performance comparison of MEDLINE structured abstracts to unstructured abstracts. Poster session presented at: National Institutes of Health Research Festival; 2014 Sep 22-24; Bethesda, MD. Available from: https://researchfestival.nih.gov/festival14/poster-RSCHSUPP-19.html .

• Ripple AM, Mork JG, Knecht LS, Humphreys BL. A retrospective cohort study of structured abstracts in MEDLINE, 1992-2006. J Med Libr Assoc. 2011 Apr;99(2):160-3. PubMed PMID: 21464855 ; PubMed Central PMCID: PMC3066587 .

Last Reviewed: December 14, 2023

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Because they facilitate reading and retaining information from articles, many peer-reviewed journals are adopting structured abstract s as their preferred format for abstracts—including the IEEE Transactions on Professional Communication. 

This article:

• Explains what structured abstracts are and how they benefit readers
• Provides a sample structured abstract
• Concludes with a template that authors of Transactions articles should follow when preparing their structured abstracts

About Structured Abstracts

Structured abstracts summarize the key findings reported in an article, as well as the means of reaching them.  Authors write structured abstracts so that readers do not have to read an article in its entirety to learn conclusions or how those conclusions were reached. Certain types of readers find structured abstracts particularly beneficial:

• Those who will not read an article in its entirety but need to know the key facts, such as executives, primary investigators on large scale projects, and people trying to keep abreast of the field.
• Those who have previously read the article in its entirety and need to recall key findings without having to re-read the article, such as researchers conducting a systematic review of the literature.
• Those who are trying to determine whether or not to read a particular article.

Structured abstracts are similar in format and style to Executive Summaries provided with in-depth engineering and recommendation reports.

Structured abstracts contrast with topic abstracts, which tend to be brief (100 to 150 words, about 100 words shorter than a typical structured abstract) and merely identify the themes addressed by an article, but do not report how the article addresses the themes much less the conclusions reached.

Samples and Guidelines

• For a research article or integrative literature review
• For a case study
• For a tutorial
• For a teaching case

Sample Structured Abstract—Research Article  and Integrative Literature Review

The following structured abstract summarizes Chen, I. & Chang, C. (2009). Cognitive load theory: an empirical study of anxiety and task performance in language learning. Electronic Journal of Research in Educational Psychology , 7 (2), 729-746.

Template for Writing a Structured Abstract—Research Article and Integrative Literature Review

Sample Structured Abstract—Case Study

The following structured abstract summarizes Raju, R. (2012). Intercultural communication training in IT outsourcing in India: A Case Study. IEEE Transactions on Professional Communication 55 (3).

Template for Writing a Structured Abstract—Case Study

Sample Structured Abstract—Tutorial

The following structured abstract summarizes

Tuleja, E.A.;   Beamer, L.;   Shum, C.;   & Chan, E.K.Y. (2011.) Designing and Developing Questionnaires for Translation—Tutorial. IEEE Transactions on Professional Communication, 54 (4), 392-405.

Template for Writing a Structured Abstract—Tutorial

Sample Structured Abstract—Teaching Case

The following structured abstract summarizes Bednar, L. (2012). Using a Research in Technical and Scientific Communication Class to teach essential workplace skills. IEEE Transactions on Professional Communication Early Access .

Template for Writing a Structured Abstract—Teaching Case

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Guidelines and Guidance

The Guidelines and Guidance section contains advice on conducting and reporting medical research.

See all article types »

PRISMA for Abstracts: Reporting Systematic Reviews in Journal and Conference Abstracts

* E-mail: [email protected]

Affiliation Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Australia

Affiliation Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom

Affiliations Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom, INSERM, Paris, France

Affiliation National Center for Biotechnology Information, National Library of Medicine, Washington DC, United States of America

Affiliation James Lind Initiative, Oxford, United Kingdom

Affiliation Nordic Cochrane Centre, Copenhagen, Denmark

Affiliation Cochrane Editorial Unit, London, United Kingdom

¶ Membership of the PRISMA for Abstracts Group is provided in the Acknowledgments.

• Elaine M. Beller, 
• Paul P. Glasziou, 
• Douglas G. Altman, 
• Sally Hopewell, 
• Hilda Bastian, 
• Iain Chalmers, 
• Peter C. Gøtzsche, 
• Toby Lasserson, 
• David Tovey, 
• for the PRISMA for Abstracts Group

Published: April 9, 2013

• https://doi.org/10.1371/journal.pmed.1001419
• Reader Comments

Citation: Beller EM, Glasziou PP, Altman DG, Hopewell S, Bastian H, Chalmers I, et al. (2013) PRISMA for Abstracts: Reporting Systematic Reviews in Journal and Conference Abstracts. PLoS Med 10(4): e1001419. https://doi.org/10.1371/journal.pmed.1001419

This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Funding: This research was supported (in part) by the Intramural Research Program of the NIH, National Center for Biotechnology Information (National Library of Medicine). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: TL is employed by The Cochrane Collaboration. TL is an editor (unpaid) for the Cochrane Airways Group. The authors have declared that no other competing interests exist.

Abbreviations: PICOS, participants, interventions, comparators, outcomes, and study designs

Provenance: Not commissioned; externally peer reviewed.

Summary Points

• The abstract of a systematic review should provide a structured summary that enables a quick assessment of the review's validity and applicability, and easy identification in electronic searching.
• Despite published guidance on writing the abstract in the PRISMA Statement guiding the reporting of systematic reviews in general and elsewhere, evaluations show that reporting of systematic reviews in journal and conference abstracts is poor.
• We developed consensus-based reporting guidelines as an extension to the PRISMA Statement on good reporting of systematic reviews and meta-analyses in abstracts.
• The PRISMA for Abstracts checklist gives authors a framework for condensing their systematic review into the essentials for an abstract that will meet the needs of many readers.

Introduction

When readers screen the title of an article, and parts of its abstract, they try to determine whether or not to devote their scarce time to reading on. Some may be screening literature to identify the articles that are systematic reviews. Thus, the main function of an abstract of a systematic review should be to signal its systematic methodology. For most readers, the findings described in the abstract will also be key, either as the sole part of an article that will be read, or to determine whether reading the full text is required. Abstracts of systematic reviews are very important, as some readers cannot access the full paper, such that abstracts may be the only option for gleaning research results. This can be because of a pay wall, low Internet download capacity, or if the full article is only available in a language not understood by the reader. Readers in countries where English is not the primary language may have access to an abstract translated to their own language, but not to a translated full text. Conversely, a large proportion of systematic reviews are published by health technology agencies in non-English speaking countries [1] , many of which provide only the abstract in English.

The predominance of the abstract in biomedical literature use is clear. Within queries to PubMed, most readers look only at titles; only half of searches result in any clicks on content [2] . The average number of titles clicked on to obtain the abstract or full text, even after retrieving several searches in a row, is less than five. Of those clicks, abstracts will be represented about 2.5 times more often than full texts of articles [2] . Even people going straight to a PDF or full text are likely to start, and perhaps end, with reading the abstract. The frequency of viewing full texts is somewhat higher among people searching the Cochrane Database of Systematic Reviews [3] , but the same pattern is clear. After the title, the abstract is the most read part of a biomedical article.

Abstracts can be useful for screening by study type [4] ; facilitating quick assessment of validity [4] , [5] ; enabling efficient perusal of electronic search results [4] , [6] ; clarifying to which patients and settings the results apply [4] , [5] ; providing readers and peer reviewers with explicit summaries of results [5] ; facilitating the pre-publication peer review process [7] ; and increasing precision of computerised searches [6] , [7] .

Structured abstracts were introduced in the medical literature about 25 years ago [4] – [6] . They provide readers with a series of headings, generally about the purpose, methods, results, and conclusions of the report, and have been adopted by many journals and conferences. They act as a prompt to the writer to give more complete information, and facilitate the finding of information by the reader.

Despite the adoption of structured abstracts, studies of the quality of abstracts of clinical trials have demonstrated that improvement is needed [8] , [9] , and a study of systematic review abstracts demonstrated that the direction of the effect or association could not be determined in one in four abstracts from the general and specialty medical literature [10] . The PRISMA Statement [11] gives some guidance for abstracts, closely linked to commonly used headings in structured abstracts. After observing that the quality of abstracts of systematic reviews is still poor [10] , we decided to develop an extension to the PRISMA Statement to provide guidance on writing abstracts for systematic reviews. We also wanted to provide a checklist enabling the items suggested to fit into any set of headings mandated by a journal or conference submission.

Methods for Development of the Checklist

We established a steering committee (EMB, PPG, SH, DGA). In collaboration with the steering group of the PRISMA Statement [11] , we used the Statement to inform our selection of potential items for the checklist of essential items that authors should consider when reporting the primary results of a systematic review in a journal or conference abstract. The committee generated a list of items from PRISMA and other sources of guidance and information on structured abstracts and abstract composition and reporting [7] , [11] , [12] , which were found using a thorough search of the literature.

In preparation for a consensus meeting, we used a modified Delphi consensus survey method [13] to select and reduce the number of possible checklist items. Each item was rated by survey participants as “omit”, “possible”, “desirable”, or “essential” to include in the final checklist. From the first round of the survey, the ranked items were divided into three lists for the second round. The first list contained the items with the highest rankings, and participants for the second round were instructed that these would be contained in the checklist unless they received low rankings in the second round. The second list contained the items with moderate rankings, and participants were instructed that these items were likely to be removed from the checklist unless they received high rankings in the second round. The third list contained the items with low rankings, and participants were instructed that these items would be removed unless they received very high rankings in the second round.

For the third round of the Delphi survey, a draft checklist was presented, which included only the items ranked highest in rounds one and two. The five next highest-ranked items were then presented, giving participants an opportunity to choose to include these in the checklist as well.

One hundred and forty-seven participants, who were authors of research on abstracts, established authors of systematic reviews, methodologists or statisticians related to systematic reviews, and journal editors, were invited by email to complete the three rounds of the web-based survey. The response rate was 68% ( n  = 100) for the first round. Only those who completed round one were invited to participate in rounds two and three. The response rate for round two was 80% ( n  = 80) and for round three 88% ( n  = 88).

The results of the survey were reported at a two-day consensus-style meeting on 13–14 October 2011, in Oxford, United Kingdom. Fifteen invited experts attended, most of whom had participated in the survey. The meeting began with a review of the literature about abstract structure and content, followed by a review of the checklist items as proposed by the survey respondents. Meeting participants discussed the items and agreed whether they should be included and how each item should be worded.

Following the meeting, the checklist was distributed to the participants to ensure it reflected the decisions made. This explanatory document was drafted and circulated through several iterations among members of the writing subcommittee who had all participated in the meeting. We developed this document using the template for the PRISMA Statement [11] , which in turn was based on the methods of the CONSORT Group [14] , [15] .

Scope of PRISMA for Abstracts

The PRISMA for Abstracts checklist focuses on truthful representation of a systematic review in an abstract. We developed the checklist to help authors report all types of systematic reviews, but recognise that the emphasis is on systematic reviews of evaluations of interventions where one or more meta-analyses are conducted. Authors who address questions on aetiology, diagnostic test accuracy, or prognosis may need to modify items or include other items in their abstract to reflect the essentials of the full report.

The PRISMA for Abstracts Checklist

The checklist is shown in Table 1 . An explanation for each item is given below. Citations for the examples of good reporting are in Table 2 .

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https://doi.org/10.1371/journal.pmed.1001419.t001

https://doi.org/10.1371/journal.pmed.1001419.t002

Section 1: TITLE

Item 1: Title.

Identify the report as a systematic review, meta-analysis, or both.

Examples: 1a. “Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction.”

1b. “Inhaled corticosteroids vs placebo for preventing COPD [chronic obstructive pulmonary disease] exacerbations: a systematic review and metaregression of randomized controlled trials.”

Explanation: The abstract should make it clear that the report is a systematic review, meta-analysis, or both (examples 1a and 1b). Search filters have been developed to identify systematic reviews [16] , but inclusion of the words “systematic review” or “meta-analysis” in the title may improve indexing and electronic searching.

We also suggest using informative titles that incorporate the PICOS approach (participants, interventions, comparators, outcomes, and study designs). This provides key information about the scope of the systematic review. As including all elements of the PICOS approach may make the title unwieldy, we suggest including the most important of these elements in the title. These might be the elements that make this review unusual, or that assist readers in searching for the review.

Section 2: BACKGROUND

Item 2: Objectives.

The research question including components such as participants, interventions, comparators, and outcomes.

Examples: 2a. “To assess the effect on survival of supportive care and chemotherapy versus supportive care alone in advanced NSCLC [non-small cell lung cancer].”

2b. “To evaluate the risk of serious asthma-related events among patients treated with formoterol.”

2c. “The objective of this study was to investigate the predictive value of C-reactive protein in critically ill patients.”

Explanation: Irrespective of the strength and nature of the results reported in the abstract, readers should be able to assess the questions that the review intended to address. The objectives in an abstract should convey succinctly the broad aims of the systematic review. Objectives should reflect what the review intended to evaluate, such as benefit (example 2a), harms (example 2b), association, predictive value (example 2c), of the intervention or exposure of interest and the population or context in which this is being studied.

Section 3: METHODS

Item 3: Eligibility criteria.

Study and report characteristics used as criteria for inclusion.

Examples – study characteristics: 3a. “We included randomised controlled trials testing the combination of long-acting ß 2 - agonists in combination with inhaled corticosteroids (ICS) versus the same or an increased dose of ICS for a minimum of at least 28 days in children and adolescents with asthma.”

3b. “… randomized trials of compression stockings versus no stockings in passengers on flights lasting at least four hours. Trials in which passengers wore a stocking on one leg but not the other, or those comparing stockings and another intervention were also eligible.”

Examples – report characteristics: 3c. “… studies published in English, French, Spanish, Italian and German between 1966 and July, 2008 [were included].”

3d. “We performed a literature search of trials using MEDLINE (January 1966–December 2001) … we retrieved English- and non-English-language articles for review… we searched for both published and unpublished trials…”

Explanation: One of the key features distinguishing a systematic review from a narrative review is the pre-specification of eligibility criteria for including and excluding studies. A clear description of these allows the readers to assess the applicability of the systematic review findings [11] . Study eligibility characteristics are likely to include the study questions (PICOS)—types of participants included in the studies (often based on a common clinical diagnosis), the intervention of prime interest and possibly the specific comparison intervention, the main outcome(s) being assessed—and acceptable study designs (examples 3a and 3b).

Eligibility criteria for reports may also include the language of publication, the publication status (e.g., whether to include unpublished materials and abstracts) and the year of publication (example 3d). This is important as inclusion, or not, of studies published in languages other than English (examples 3c and 3d), unpublished data, or older data can influence the estimates of effect or association in meta-analyses [17] , [18] .

Item 4: Information sources.

Key databases searched and date of last search.

Examples: 4a. “PubMed, ERIC and Cochrane Reviews databases from January 1980 to November 2007 were searched for studies…”

4b. “We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), other trial registries and product information sheets through June 2008.”

Explanation: The abstract should briefly indicate how thorough and up-to-date the search was by listing key databases searched, and the date range (example 4a) or date of last search (example 4b). We recommend that if there are three or fewer databases, list them all; otherwise list the three that provided the majority of included studies.

Item 5: Risk of bias assessment.

Methods for assessing risk of bias.

Example: 5a. “Risk of bias was assessed regarding randomisation, allocation sequence concealment, blinding, incomplete outcome data, selective outcome reporting, and other biases.”

Explanation: Problems in the design and conduct of individual studies can raise questions about the validity of their findings [19] . For example, reports of randomised trials with inadequate allocation sequence concealment are more likely to show exaggerated treatment effects [20] . And non-blinded assessors of subjective outcomes generate substantially biased effect estimates [21] , [22] . It is therefore an important part of a systematic review to assess the validity of individual studies, and the risk that they will overestimate the true intervention effect. Authors should describe any methods they used to assess the risk of bias in the included studies (example 5a).

Many tools exist for assessing the overall risk of bias in included studies, including scales, checklists and individual components [23] . Most tools are scales in which various components of quality are scored and combined to give a summary score. This approach can be seriously misleading, however, and should be discouraged. A preferred approach requires authors to specify which individual methodological components they will assess and to provide a description and judgment for each component for each of the studies assessed [19] . For randomised trials, common components include: appropriate generation of the allocation sequence [24] , concealment of the allocation sequence [20] , blinding of participant and health care providers, blinding of outcome assessors [22] , assessment of incomplete outcome data [25] , and selective outcome reporting [26] .

Section 4: RESULTS

Item 6: Included studies.

Number and type of included studies and participants, and relevant characteristics of studies.

Examples: 6a. “We included 22 trials involving 101 507 participants: 11 trials reported on presumptive pneumococcal pneumonia, 19 on all-cause pneumonia and 12 on all-cause mortality. The current 23-valent vaccine was used in 8 trials.”

6b. “Eight studies included in this review (n = 586 patients, median PEDro score = 8.0/10) evaluated various parameters, including the duration of patients' symptoms (0–12 months), duty cycle (20% and 100%), intensity (0.1–2.0 W/cm2), treatment time per session (4.5–15.8 minutes), number of treatments (6–39), and total energy applied per treatment (181–8,152 J).”

Explanation: The number of studies, number of participants, and characteristics of the included studies (examples 6a and 6b) enable readers to gauge the validity and applicability of the systematic review's results. These characteristics might include descriptors of the participants (e.g., age, severity of disease), range of interventions used (e.g., dose and frequency of drug administration), and measurement of outcomes (e.g., follow-up times).

Item 7: Synthesis of results.

Results for main outcomes (benefits and harms), preferably indicating the number of studies and participants for each. If meta-analysis was done, include summary measures and confidence intervals.

Examples: 7a. “… CRT [cardiac resynchonization therapy] reduced all-cause mortality (6 trials, 4572 participants; risk ratio [RR], 0.83 [95% CI, 0.72 to 0.96]) and heart failure hospitalizations (4 trials, 4349 participants; RR, 0.71 [CI, 0.57 to 0.87]) without improving functional outcomes or quality of life.”

7b. “Six studies reported on maternal mortality and our meta-analysis showed a non-significant reduction (three randomised trials, relative risk 0.79, 0.53 to 1.05, P = 0.12; three non-randomised studies, 0.80, 0.44 to 1.15, P = 0.26).”

7c. “Eight studies presented adjusted odds ratios, ranging from 0.3 to 0.9, suggesting a reduced likelihood of self-reported sharing of non-N/S [non-needle/syringe] injecting paraphernalia associated with use of NSP [needle and syringe exchange programmes] or SIF [safer injection facilities].”

Explanation: The results for the main outcomes should be given in the abstract. If meta-analyses have been done, include for each the summary measure (estimated effect) and confidence interval. If the intention had been to perform meta-analysis, but no meta-analysis was done for one or more main outcomes, the reasons should be stated (e.g., heterogeneity too great).

The abstract should make clear the protocol-defined, pre-specified importance of each outcome reported, and should not report only those outcomes that have statistically significant or clinically important results.

Where possible, given space limitations, the number of studies and participants for each main outcome should be stated, particularly if only a small proportion of the total number of studies or patients in the systematic review contributed information on a particular outcome.

If there are no summary measures, some numerical data may still be given (example 7c), although authors should be wary of making this in the form of “vote counting” where the number of “positive” and “negative” studies is given. Vote counting takes no account of weighting of studies according to the amount of information they contain [27] .

Item 8: Description of effect.

Direction of the effect (i.e., which group is favoured) and size of the effect in terms meaningful to patients and clinicians.

Examples: 8a. “Radial access reduced major bleeding by 73% compared to femoral access (0.05% vs 2.3%, OR 0.27 [95% CI 0.16, 0.45], P<0.001).”

8b. “Length of hospital and critical care unit stay were both modestly reduced in the tested group compared with the control group, with a mean difference of −1.22 day (CI, −2.31 to −0.14 day) and −0.56 day (CI, −1.06 to −0.05 day), respectively.”

8c. “A small difference was found between acupuncture and placebo acupuncture: standardised mean difference −0.17 (95% confidence interval −0.26 to −0.08)… [in favour of acupuncture]…, corresponding to 4 mm (2 mm to 6 mm) on a 100 mm visual analogue scale.”

Explanation: The results should summarise the main outcomes in words and numbers. The wording should indicate the direction of the effect (e.g., lower, fewer, reduced; greater, more, increased) and the size of the effect using familiar units such as percentages, days, or kilograms. Example 8a makes clear the size of the effect even for readers who have difficulty interpreting relative risks and confidence intervals. When a percentage is used, the baseline risk should also be shown, which allows the reader to see what the absolute benefit or harm is, and calculate whichever measures they choose (example 8a). Authors should take care to make it clear whether the reported measure is an absolute or a relative one (e.g., where percentage is used as the units of measurement). Where possible, continuous outcome measures should be expressed in familiar units (example 8b), particularly when the standardised mean difference is used (example 8c).

Section 5: DISCUSSION

Item 9: Strengths and limitations of evidence.

Brief summary of strength and limitations of evidence (e.g., inconsistency, imprecision, indirectness, or risk of bias, other supporting or conflicting evidence).

Examples: 9a. “Four potentially eligible trials were not included in the meta-analysis because mortality data by age group were not available.”

9b. “All trials were open label, which may introduce bias. Most of the trials were of 24 weeks' duration or less, limiting assessment of long-term safety.”

9c. “Meta-analyses for some outcomes had large statistical heterogeneity or evidence for publication bias. Only 11 trials followed outcomes beyond 12 months.”

9d. “Meta-regression showed that small, poor-quality studies that assessed outcomes soon after radiocontrast administration were more likely to suggest benefit (P<0.05 for all).”

Explanation: The abstract should briefly describe the strengths and limitations of the evidence across studies [28] . Limitations may include: risk of bias common to many or all studies, such as lack of blinding for subjective outcomes (example 9b) or unavailability of data (example 9a); inconsistency of effect or association, as demonstrated by high heterogeneity (examples 9c and 9d); imprecision, e.g., due to few events or small sample sizes; indirectness of the evidence, such as the use of an intermediate or short-term outcome (examples 9b and 9c); and likely publication bias (example 9c). Potential strengths of the overall body of evidence that might apply for a particular outcome of a systematic review include: a large effect (example 8a); demonstration of a dose-response relationship (example 10a, below); and that all biases would be likely to reduce the effect rather than increase it. One or more of these strengths and limitations may apply to each of the outcomes of the systematic review being described in the abstract. Some of this information may be combined with item 6, above, when describing the included studies, however a summary of the overall strengths and limitations of the evidence might also be helpful.

Item 10: Interpretation.

General interpretation of the results and important implications.

Examples: 10a. “Travel is associated with a nearly 3-fold higher risk for VTE [venous thromoboembolism], with a dose-response relationship of 18% higher risk for each 2-hour increase in travel duration.”

10b. “Housing improvements, especially warmth improvements, can generate health improvements; there is little evidence of detrimental health impacts. The potential for health benefits may depend on baseline housing conditions and careful targeting of the intervention. Investigation of socioeconomic impacts associated with housing improvement is needed to investigate the potential for longer-term health impacts.”

10c. “The cumulative evidence is now conclusive that the addition of cardiac resynchronization to optimal medical therapy or defibrillator therapy significantly reduces mortality among patients with heart failure.”

Explanation: Remembering that some readers may struggle with interpreting the statistical results, an overall summary of the main effects—positive or negative—should be given (example 10a). This could include an indication of what is clear (example 10c), what important uncertainties remain (example 10b), and whether there is ongoing research addressing these.

If there is insufficient evidence from well-conducted studies to answer the review's question, this should be made clear to the reader. When the results are not statistically significant, authors should distinguish between those where there is insufficient evidence to rule out a difference between treatments (wide confidence interval), and those which have sufficient evidence that an important difference is unlikely (narrow confidence interval).

If the conclusions of the review differ substantially from previous systematic reviews, then some explanation might also be provided. Reference could be made to known ongoing studies that have the potential to change the result of the review. Possible implications for policy and practice should be stated.

Section 6: OTHER

Item 11: Funding.

Primary source of funding for the review.

Examples: 11a. “This work was supported, in part, by the Program in Reproductive and Adult Endocrinology, NICHD, NIH, Bethesda, MD. The authors have no competing interests to declare.”

11b. “Funding: National Institute for Health Research Programme Grant for Applied Research.”

Explanation: Studies of the relationship between pharmaceutical company funding and results of clinical trials have shown that sponsored studies are more likely to have outcomes favouring the sponsor [29] , [30] . This is also the case for systematic reviews [31] . Therefore, the abstract should indicate whether the sponsor of the research or the researchers might have a conflict of interest in respect of the findings of the systematic review, for example, as the manufacturer of the intervention being evaluated (examples 11a and 11b). The abstract should include the main source of funding for the systematic review, whether from host institutions or from external bodies.

Item 12: Registration.

Registration number and registry name.

Examples: 12a. “PROSPERO registration: CRD42011001243.”

12b. “PROSPERO 2011:CRD42011001329.”

Explanation: Registration of systematic reviews provides a record of reviews that have been initiated, even if they have not been published. It is therefore a means of alerting researchers to systematic reviews that are in progress, and serves as a public record of the proposed systematic review. It also helps to detect reporting bias by enabling better identification of unpublished systematic reviews, and also to compare the methods or outcomes reported in published reviews with those originally proposed in registered protocols [32] . The abstract should record the name of the database with which the review is registered, and the registration number. Cochrane reviews are an exception to this requirement, as they are preceded by a peer reviewed protocol that is published in the Cochrane Library and can be downloaded from there.

The title of a systematic review is its first signal of its relevance to potential readers. Few titles will entice a reader to invest additional time, but when they do, they ordinarily start—and quite often end—with the abstract. The first impression is therefore crucial.

We strongly recommend the use of structured abstracts for reporting systematic reviews, as does the PRISMA Statement [11] . We recognise that journals have developed their own set of headings that are considered appropriate for reporting systematic reviews, and it is not our intention to suggest changes to these headings, but to recommend what should be reported under them. The order of items and the headings are therefore flexible. For example, the strengths and limitations may be stated at the end of the Results, under a separate heading, or with the Discussion or Conclusions, depending on journal requirements. It may also be possible to combine items from the checklist into one sentence. For example, limitations may be combined with a description of the included studies (i.e., items 6 and 9 from the checklist).

We have suggested reporting a minimum set of items. We do not advocate that abstracts replace full articles in informing decision making, but we recognise that for many time-pressed readers, or for those with limited access to the full texts of reports, it is important that abstracts contain as much information as is feasible within the word limit of abstracts. Indeed, for readers who do not understand the language of publication of the article, the translated abstract may have far more relevance than the full-text article.

A checklist is not sufficient to ensure good abstract writing. For example, the abstract should clearly and truthfully reflect the full report, and not selectively report results that are statistically significant while not referring to those that were not. Similarly, the abstract should only draw conclusions that are substantiated by data from the full report and analyzed as described in the protocol, rather than selectively emphasising interesting results that were a minor or ad hoc component of the analysis. In brief, the abstract should be an unbiased representation of the full report. We also suggest that peer and editorial review processes related to the abstract should explicitly check this.

A particularly difficult area is the Discussion section of an abstract. The checklist includes two items with several elements. We suggest that authors let the reader know whether they feel their question has been answered, or whether there is still uncertainty before presenting practice and policy implications. These statements should be clearly backed by the results given in the abstract, and by presentation of the strengths and limitations of the evidence in the review.

We encourage journals and conference organisers to endorse the use of PRISMA for Abstracts, in a similar way to CONSORT for Abstracts [33] . This may be done by modifying their instructions to authors and including a link to the checklist on their website. It has been demonstrated that the number of checklist items reported is improved in journals that require checklist completion as part of the submission process [34] .

Abstracts should not replace full articles in informing decision making, but for time-pressed readers and those with limited access to full text reports, the abstract must stand alone in presenting a clear and truthful account of the research. The PRISMA for Abstracts checklist will guide authors in presenting an abstract that facilitates a quick assessment of review validity, an explicit summary of results, facilitates pre-publication or conference selection peer review, and enables efficient perusal of electronic search results.

Acknowledgments

We dedicate this paper to the memory of Alessandro Liberati who, among many important achievements, was instrumental in the development and implementation of the PRISMA Statement, and had many thoughtful insights to offer at the PRISMA for Abstracts consensus meeting.

Contributors

We are grateful to the other participants of the consensus meeting for their time and interest: Martin Burton, UK Cochrane Centre, UK; Trish Groves, BMJ, UK; Alessandro Liberati, Italian Cochrane Centre, Italy; Cynthia Mulrow, Annals of Internal Medicine , USA; Melissa Norton, PLOS Medicine , UK; Elizabeth Wager, Sideview, UK; and to everyone who responded to the PRISMA for Abstracts survey.

Author Contributions

Analyzed the data: EMB. Wrote the first draft of the manuscript: EMB. Contributed to the writing of the manuscript: EMB PPG DGA SH HB IC PCG TL DT. ICMJE criteria for authorship read and met: EMB PPG DGA SH HB IC PCG TL DT. Agree with manuscript results and conclusions: EMB PPG DGA SH HB IC PCG TL DT.

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How To Structure Your Literature Review

3 options to help structure your chapter.

By: Amy Rommelspacher (PhD) | Reviewer: Dr Eunice Rautenbach | November 2020 (Updated May 2023)

Writing the literature review chapter can seem pretty daunting when you’re piecing together your dissertation or thesis. As  we’ve discussed before , a good literature review needs to achieve a few very important objectives – it should:

• Demonstrate your knowledge of the research topic
• Identify the gaps in the literature and show how your research links to these
• Provide the foundation for your conceptual framework (if you have one)
• Inform your own  methodology and research design

To achieve this, your literature review needs a well-thought-out structure . Get the structure of your literature review chapter wrong and you’ll struggle to achieve these objectives. Don’t worry though – in this post, we’ll look at how to structure your literature review for maximum impact (and marks!).

But wait – is this the right time?

Deciding on the structure of your literature review should come towards the end of the literature review process – after you have collected and digested the literature, but before you start writing the chapter. 

In other words, you need to first develop a rich understanding of the literature before you even attempt to map out a structure. There’s no use trying to develop a structure before you’ve fully wrapped your head around the existing research.

Equally importantly, you need to have a structure in place before you start writing , or your literature review will most likely end up a rambling, disjointed mess. 

Importantly, don’t feel that once you’ve defined a structure you can’t iterate on it. It’s perfectly natural to adjust as you engage in the writing process. As we’ve discussed before , writing is a way of developing your thinking, so it’s quite common for your thinking to change – and therefore, for your chapter structure to change – as you write. 

Need a helping hand?

Like any other chapter in your thesis or dissertation, your literature review needs to have a clear, logical structure. At a minimum, it should have three essential components – an  introduction , a  body   and a  conclusion . 

Let’s take a closer look at each of these.

1: The Introduction Section

Just like any good introduction, the introduction section of your literature review should introduce the purpose and layout (organisation) of the chapter. In other words, your introduction needs to give the reader a taste of what’s to come, and how you’re going to lay that out. Essentially, you should provide the reader with a high-level roadmap of your chapter to give them a taste of the journey that lies ahead.

Here’s an example of the layout visualised in a literature review introduction:

Your introduction should also outline your topic (including any tricky terminology or jargon) and provide an explanation of the scope of your literature review – in other words, what you  will   and  won’t   be covering (the delimitations ). This helps ringfence your review and achieve a clear focus . The clearer and narrower your focus, the deeper you can dive into the topic (which is typically where the magic lies). 

Depending on the nature of your project, you could also present your stance or point of view at this stage. In other words, after grappling with the literature you’ll have an opinion about what the trends and concerns are in the field as well as what’s lacking. The introduction section can then present these ideas so that it is clear to examiners that you’re aware of how your research connects with existing knowledge .

2: The Body Section

The body of your literature review is the centre of your work. This is where you’ll present, analyse, evaluate and synthesise the existing research. In other words, this is where you’re going to earn (or lose) the most marks. Therefore, it’s important to carefully think about how you will organise your discussion to present it in a clear way. 

The body of your literature review should do just as the description of this chapter suggests. It should “review” the literature – in other words, identify, analyse, and synthesise it. So, when thinking about structuring your literature review, you need to think about which structural approach will provide the best “review” for your specific type of research and objectives (we’ll get to this shortly).

There are (broadly speaking)  three options  for organising your literature review.

Option 1: Chronological (according to date)

Organising the literature chronologically is one of the simplest ways to structure your literature review. You start with what was published first and work your way through the literature until you reach the work published most recently. Pretty straightforward.

The benefit of this option is that it makes it easy to discuss the developments and debates in the field as they emerged over time. Organising your literature chronologically also allows you to highlight how specific articles or pieces of work might have changed the course of the field – in other words, which research has had the most impact . Therefore, this approach is very useful when your research is aimed at understanding how the topic has unfolded over time and is often used by scholars in the field of history. That said, this approach can be utilised by anyone that wants to explore change over time .

For example , if a student of politics is investigating how the understanding of democracy has evolved over time, they could use the chronological approach to provide a narrative that demonstrates how this understanding has changed through the ages.

Here are some questions you can ask yourself to help you structure your literature review chronologically.

• What is the earliest literature published relating to this topic?
• How has the field changed over time? Why?
• What are the most recent discoveries/theories?

In some ways, chronology plays a part whichever way you decide to structure your literature review, because you will always, to a certain extent, be analysing how the literature has developed. However, with the chronological approach, the emphasis is very firmly on how the discussion has evolved over time , as opposed to how all the literature links together (which we’ll discuss next ).

Option 2: Thematic (grouped by theme)

The thematic approach to structuring a literature review means organising your literature by theme or category – for example, by independent variables (i.e. factors that have an impact on a specific outcome).

As you’ve been collecting and synthesising literature , you’ll likely have started seeing some themes or patterns emerging. You can then use these themes or patterns as a structure for your body discussion. The thematic approach is the most common approach and is useful for structuring literature reviews in most fields.

For example, if you were researching which factors contributed towards people trusting an organisation, you might find themes such as consumers’ perceptions of an organisation’s competence, benevolence and integrity. Structuring your literature review thematically would mean structuring your literature review’s body section to discuss each of these themes, one section at a time.

Here are some questions to ask yourself when structuring your literature review by themes:

• Are there any patterns that have come to light in the literature?
• What are the central themes and categories used by the researchers?
• Do I have enough evidence of these themes?

PS – you can see an example of a thematically structured literature review in our literature review sample walkthrough video here.

Option 3: Methodological

The methodological option is a way of structuring your literature review by the research methodologies used . In other words, organising your discussion based on the angle from which each piece of research was approached – for example, qualitative , quantitative or mixed  methodologies.

Structuring your literature review by methodology can be useful if you are drawing research from a variety of disciplines and are critiquing different methodologies. The point of this approach is to question  how  existing research has been conducted, as opposed to  what  the conclusions and/or findings the research were.

For example, a sociologist might centre their research around critiquing specific fieldwork practices. Their literature review will then be a summary of the fieldwork methodologies used by different studies.

Here are some questions you can ask yourself when structuring your literature review according to methodology:

• Which methodologies have been utilised in this field?
• Which methodology is the most popular (and why)?
• What are the strengths and weaknesses of the various methodologies?
• How can the existing methodologies inform my own methodology?

3: The Conclusion Section

Once you’ve completed the body section of your literature review using one of the structural approaches we discussed above, you’ll need to “wrap up” your literature review and pull all the pieces together to set the direction for the rest of your dissertation or thesis.

The conclusion is where you’ll present the key findings of your literature review. In this section, you should emphasise the research that is especially important to your research questions and highlight the gaps that exist in the literature. Based on this, you need to make it clear what you will add to the literature – in other words, justify your own research by showing how it will help fill one or more of the gaps you just identified.

Last but not least, if it’s your intention to develop a conceptual framework for your dissertation or thesis, the conclusion section is a good place to present this.

Example: Thematically Structured Review

In the video below, we unpack a literature review chapter so that you can see an example of a thematically structure review in practice.

Let’s Recap

In this article, we’ve  discussed how to structure your literature review for maximum impact. Here’s a quick recap of what  you need to keep in mind when deciding on your literature review structure:

• Just like other chapters, your literature review needs a clear introduction , body and conclusion .
• The introduction section should provide an overview of what you will discuss in your literature review.
• The body section of your literature review can be organised by chronology , theme or methodology . The right structural approach depends on what you’re trying to achieve with your research.
• The conclusion section should draw together the key findings of your literature review and link them to your research questions.

If you’re ready to get started, be sure to download our free literature review template to fast-track your chapter outline.

Psst… there’s more!

This post is an extract from our bestselling short course, Literature Review Bootcamp . If you want to work smart, you don't want to miss this .

You Might Also Like:

27 Comments

Great work. This is exactly what I was looking for and helps a lot together with your previous post on literature review. One last thing is missing: a link to a great literature chapter of an journal article (maybe with comments of the different sections in this review chapter). Do you know any great literature review chapters?

I agree with you Marin… A great piece

I agree with Marin. This would be quite helpful if you annotate a nicely structured literature from previously published research articles.

Awesome article for my research.

I thank you immensely for this wonderful guide

It is indeed thought and supportive work for the futurist researcher and students

Very educative and good time to get guide. Thank you

Great work, very insightful. Thank you.

Thanks for this wonderful presentation. My question is that do I put all the variables into a single conceptual framework or each hypothesis will have it own conceptual framework?

Thank you very much, very helpful

This is very educative and precise . Thank you very much for dropping this kind of write up .

Pheeww, so damn helpful, thank you for this informative piece.

I’m doing a research project topic ; stool analysis for parasitic worm (enteric) worm, how do I structure it, thanks.

comprehensive explanation. Help us by pasting the URL of some good “literature review” for better understanding.

great piece. thanks for the awesome explanation. it is really worth sharing. I have a little question, if anyone can help me out, which of the options in the body of literature can be best fit if you are writing an architectural thesis that deals with design?

I am doing a research on nanofluids how can l structure it?

Beautifully clear.nThank you!

Lucid! Thankyou!

Brilliant work, well understood, many thanks

I like how this was so clear with simple language 😊😊 thank you so much 😊 for these information 😊

Insightful. I was struggling to come up with a sensible literature review but this has been really helpful. Thank you!

You have given thought-provoking information about the review of the literature.

Thank you. It has made my own research better and to impart your work to students I teach

I learnt a lot from this teaching. It’s a great piece.

I am doing research on EFL teacher motivation for his/her job. How Can I structure it? Is there any detailed template, additional to this?

You are so cool! I do not think I’ve read through something like this before. So nice to find somebody with some genuine thoughts on this issue. Seriously.. thank you for starting this up. This site is one thing that is required on the internet, someone with a little originality!

I’m asked to do conceptual, theoretical and empirical literature, and i just don’t know how to structure it

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• CAREER FEATURE
• 04 December 2020
• Correction 09 December 2020

How to write a superb literature review

Andy Tay is a freelance writer based in Singapore.

You can also search for this author in PubMed   Google Scholar

Literature reviews are important resources for scientists. They provide historical context for a field while offering opinions on its future trajectory. Creating them can provide inspiration for one’s own research, as well as some practice in writing. But few scientists are trained in how to write a review — or in what constitutes an excellent one. Even picking the appropriate software to use can be an involved decision (see ‘Tools and techniques’). So Nature asked editors and working scientists with well-cited reviews for their tips.

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doi: https://doi.org/10.1038/d41586-020-03422-x

Interviews have been edited for length and clarity.

Updates & Corrections

Correction 09 December 2020 : An earlier version of the tables in this article included some incorrect details about the programs Zotero, Endnote and Manubot. These have now been corrected.

Hsing, I.-M., Xu, Y. & Zhao, W. Electroanalysis 19 , 755–768 (2007).

Article   Google Scholar  

Ledesma, H. A. et al. Nature Nanotechnol. 14 , 645–657 (2019).

Article   PubMed   Google Scholar  

Brahlek, M., Koirala, N., Bansal, N. & Oh, S. Solid State Commun. 215–216 , 54–62 (2015).

Choi, Y. & Lee, S. Y. Nature Rev. Chem . https://doi.org/10.1038/s41570-020-00221-w (2020).

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Structured literature reviews – A guide for students

This is a step-by-step guide aimed at Master's students undertaking a structured literature review as part of their Master's thesis.

There are several different kinds of literature reviews, but any literature review typically includes an extensive literature search. Whenever a systematic approach is used, the literature search features a methodical step-by-step procedure. However, as a Master's student, it might not be possible to fulfill all the criteria of a systematic review when writing a literature review-based thesis; you should rather do a structured literature review, which will include only certain aspects of the systematic review methodology.

In this guide we will go through the different steps of a structured literature review and provide tips on how to make your search strategy more structured and extensive. Additionally, make sure to follow any programme and course specific requirements.

Step 1: Formulate and delimit your research question

• It will be much easier for you to perform a structured information search if you first define and delimit your research question in a clear way.
• One way to define and structure your question is to break it down into different parts .
• PICO and PEO are two different frameworks that can be used for breaking down a research question into different parts.
• You also need to define the most important key concepts of your research question.

The formulation of your research question is partly connected to what kind of literature review you are doing. This article by Maria J. Grant and Andrew Booth usefully compares different kinds of reviews . While a systematic literature review is usually grounded in a clearly delimited and structured question, a scoping review may, for instance, feature a wider problem formulation. The wider a research question is, the larger number of search hits it tends to generate.

To be able to perform a literature review, you need to consider a subject area in which there seems to be a sufficiently large number of original research studies. Therefore, it may be a good idea to test search a database for previous research on the subject while you are trying to formulate and delimit your research question.

One way to structure your research question is to break it down into different parts. A well-delimited question often consists of three to four different parts. PICO and PEO are two examples of frameworks that can help you identify and define your research question.

• PICO ( P opulation, I ntervention, C omparison, O utcome) is primarily used for quantitative research questions.
• PEO ( P opulation, E xposure, O utcome) is primarily used for qualitative research questions.

Structuring your research question in accordance with a framework, such as PICO or PEO, will also help you decide on the inclusion and exclusion criteria of your literature review.

PICO & PEO

After you have delimited your research question, you also need to identify the key concepts that make up your question. Based on these key concepts, you will create " search blocks " that you will use to organise your search terms.

Step 2: Find search terms and create search blocks

• Test searching is a good way to investigate the terminology of a subject area and find search terms.
• Reading key articles can help you gather additional search terms for your final search strategy.
• Find subject headings  for PubMed with the help of the US National Library of Medicine's MeSH database.
• Find& free-text search terms by investigating what words that occur in the title and abstract of relevant articles.
• A good way of achieving a structured final search query is to arrange your search terms into search blocks ; these blocks should arise from the key concepts of your research question.

While working on a literature review-based thesis, you will need to search for articles on several occasions. In the beginning of your project, it is often good to do a couple of unstructured and simple search queries, so-called test searches, in academic databases. This way you are off to a good start, as test searching helps you investigate the terminology of your subject area and find relevant search terms. While the final search strategy is typically reported in full, you don't need to present your test queries in your thesis.

Try to find a couple of key articles, that is, articles that correspond to the type of studies that you are planning to include in your review. Use key articles to gather additional search terms for your final search strategy. Analyse the terminology of your key articles by examining what subject headings (MeSH terms, etc.) that the articles have been tagged with and what words that occur in the titles and abstracts.

Test search - find keywords and narrow down your topic

Test search in pubmed & cinahl.

To retrieve as many relevant studies as possible, you will need to include free-text search terms as well as subject headings in your final search strategy. Free-text search terms are words that occur in the article's title and abstract – words used by the authors themselves. Subject headings are subject-related words that an article is tagged with when the article is added to the database.

• In PubMed , articles are tagged with MeSH terms ( Me dical  S ubject  H eadings). You can look up and browse MeSH terms in the US National Library of Medicine's  MeSH database .
• Databases such as CINAHL , PsycInfo , ERIC , and Sociological Abstracts  have their own subject heading lists; look up subject headings in each database's subject heading list.
• There are also so-called free-text databases, such as Web of Science . These databases lack subject heading lists. Hence, when searching a free-text database, you can only use free-text search terms.

Find subject headings

An effective way to increase the structure of your final search strategy is to arrange your search terms in so-called  search blocks . Create your search blocks based on the key concepts of your research question.

Create search blocks

This search strategy worksheet might help you document and organise your search terms.

Download worksheet

• Worksheet for search terms (Word, 30.54 KB)

Step 3: Search in a structured way

• To get a comprehensive search result, you will need to search for articles in  several different databases .
• Your search strategy should be as uniform as possible in every database, but you may have to  adapt your use of subject headings .
• As you search the databases, combine your search terms and blocks with the help of  AND  and  OR .
• Save time by  documenting your search queries .

When doing a literature review-based thesis it is often wise to use at least two different databases. Many databases overlap, but may also contain unique content. At KI it is common for Master's students to use PubMed and Web of Science when doing a structured literature review as part of their Master's thesis. Depending on your research question, other databases may also be appropriate and useful. Read more about the most frequently used databases at KI .

Your search strategy should be as uniform as possible in every database. However, as mentioned in Step 2, databases may use different subject headings, and some databases only let you use free-text search terms. This means that you need to adapt your use of subject headings depending on the database.

Example: How subject headings may differ between databases 

If you want to search for articles about day surgery in PubMed, you should use the MeSH term Ambulatory Surgical Procedures . However, if you also want to perform your search in a database such as CINAHL, you need to use the corresponding CINAHL Headings term instead: Ambulatory Surgery .

There are many different ways of searching databases. Most databases have one simple, basic Google-like search box and one advanced search form. One advantage of the latter is that combining search terms with AND and OR is usually easier in an advanced search form, especially if you will be using both AND and OR within the same search query. However, you can often combine search terms with AND and OR in a basic search box too, and in that case, you often isolate your different search blocks from each other by enclosing each block in parentheses.

Example: A search query that contains AND, OR, and parentheses

( inflammatory bowel diseases OR ulcerative colitis OR crohn disease) AND (adolescent OR child OR young adult OR teenager) AND (self-management OR self care OR self efficacy )

By choosing the advanced search form you will also be able to exert more control over your search process. The advanced search form lets you specify more closely and decide exactly how you want the database to interpret your search terms; this way you can make your search query more precise.

You should always document your search strategy in order to remember what search terms you have used, how these search terms have been combined, and whether you have applied any limits to your search. The easiest way to do this is to copy and paste your search history from the database into a text document. Also, academic databases often let you create a personal account, so that you may save your searches online.

How to do a structured search in PubMed

Step 4: narrowing or broadening your search.

• Briefly examine your search results to see if you need to narrow or broaden your search query.
• Investigate whether your key articles are present in the search results.
• By using the advanced search form you can improve your search.

Prepare yourself for having to modify and redo your search query several times, before deciding on your final search strategy. After you have combined all your search terms and made your very first database search, you should examine the search results and analyse whether your search query is able to generate the type of search hits that you are looking for.

Analyse your search results

• Are all your key articles present in the search results, or are there some key articles that your search query is unable to retrieve?
• Are you getting too few search hits ? Investigate why. Perhaps you need to remove one of your search blocks, add one or several synonyms within a search block, or search for parts of words by truncating one or several of your free-text search terms, in order to broaden your search ?
• Does your search strategy generate too many non-relevant search hits that have nothing to do with your research question? Investigate why. Perhaps you need to add another search block, remove one of the synonyms from one of your search blocks, or search for phrases by enclosing one or several of your free-text terms in quotation marks, in order to narrow your search ?
• More tips on how to improve your search strategy .

It is important to remember that there is nothing wrong, per se, if your search query generates irrelevant hits. This is quite normal when performing a structured literature search. What's important is that your search strategy is able to retrieve the type of articles that you are looking for, and that you are not overwhelmed by the total number of hits (given the time frame of your thesis project).

We recommend that you use the advanced search form when improving your search strategy. By using the advanced search form, you will for example be able to specify which search fields your search terms must be present in.

Narrowing your search 

Broaden your search, how to specify the field you would like to search in pubmed, step 5: select and review articles.

• After you have completed your search, you will need to go through all your search hits and select which articles to include in your review.
• When selecting articles, read through the titles and abstracts of each article to decide its relevancy .
• Check the quality of each study that you include in your review.
• When checking the quality of articles, it is common to use critical appraisal worksheets or checklists .

Selecting articles

When you have completed and feel satisfied with your search, it is time to go through all the search hits and select which studies to include in your review. All relevant studies, that is, those studies that correspond to your research question and your previously set inclusion criteria, should be included. You decide on the relevancy of a study primarily by reading through the title and abstract. If you feel unsure, go through the whole article. You can describe your selection process with the help of a flow chart, such as the frequently used PRISMA flow diagram .

One of the challenges of systematic literature searches is that the search strategy should be exhaustive, but at the same time the number of search hits also needs to be kept within reasonable boundaries. A search query needs to be broad enough to retrieve all relevant studies, but on the other hand, this also means that a large portion of the search results will be irrelevant. Hence, even though your search strategy may have generated hundreds of hits, it is fine to only include ten to twenty articles in your review in the end.

Saving articles

If you create a personal account in a database it will be easier for you to save any references that you may find there. Another way of saving and organising article references is to use reference management software. There are several different reference management software, for example Endnote Online and Zotero.

Read more about reference management and see software guides.

Reviewing articles

When you have made your selection, you should critically examine the quality of all articles included in your review. The assessment is typically performed with the help of a critical appraisal guide or checklist. The purpose is to assess the reliability of the study results and whether there are any methodological flaws that may have impacted the results. Qualitative research articles are often reviewed with a focus on authenticity, credibility, and validity.

There are many different critical appraisal worksheets and checklists. Some examples are the SBU checklists for assessing the quality of randomized studies, observational studies, and qualitative research. In the course book How to do a systematic review in nursing there is a review guide that can be used for assessing different kinds of studies (both qualitative and quantitative); the original source is Caldwell, Henshaw & Taylor, 2011 .

Review worksheets and checklists contain criteria and questions that may help you identify flaws, errors, or bias. Sometimes different aspects of the study are scored separately. Later, all scores make up a final score that indicates whether the study is of high, medium, or low quality.

Many programmes and courses provide instructions on which checklists to use when reviewing articles, so check your course guidelines.

Step 6: Report your search strategy

• Describe your search strategy in a manner that makes it possible for your readers to replicate the search and get the same results.
• The search strategy is often presented in the form of a table .
• Look at the search history to see what words and limits that you have used when searching a database.

An important aspect of doing a structured literature review is transparency. It has to be easy for your readers to follow what you did when you searched and selected the articles that you have included in your review. In the method section of your literature review you should describe how you searched different databases. This is also where you describe any manual searches that you did. Search strategies are commonly reported in the form of tables. Present one table for each database.

You can examine your search terms and any limits you have applied when searching a database by visiting its search history.

Read more about how to report your search strategy and view examples.

Checklist for search strategies

Here is a checklist to help you review your own or someone else's search strategy.

If you would like us to get back to you, please submit your contact information in the form below along with your feeback.

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Writing a Literature Review

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A literature review is a document or section of a document that collects key sources on a topic and discusses those sources in conversation with each other (also called synthesis ). The lit review is an important genre in many disciplines, not just literature (i.e., the study of works of literature such as novels and plays). When we say “literature review” or refer to “the literature,” we are talking about the research ( scholarship ) in a given field. You will often see the terms “the research,” “the scholarship,” and “the literature” used mostly interchangeably.

Where, when, and why would I write a lit review?

There are a number of different situations where you might write a literature review, each with slightly different expectations; different disciplines, too, have field-specific expectations for what a literature review is and does. For instance, in the humanities, authors might include more overt argumentation and interpretation of source material in their literature reviews, whereas in the sciences, authors are more likely to report study designs and results in their literature reviews; these differences reflect these disciplines’ purposes and conventions in scholarship. You should always look at examples from your own discipline and talk to professors or mentors in your field to be sure you understand your discipline’s conventions, for literature reviews as well as for any other genre.

A literature review can be a part of a research paper or scholarly article, usually falling after the introduction and before the research methods sections. In these cases, the lit review just needs to cover scholarship that is important to the issue you are writing about; sometimes it will also cover key sources that informed your research methodology.

Lit reviews can also be standalone pieces, either as assignments in a class or as publications. In a class, a lit review may be assigned to help students familiarize themselves with a topic and with scholarship in their field, get an idea of the other researchers working on the topic they’re interested in, find gaps in existing research in order to propose new projects, and/or develop a theoretical framework and methodology for later research. As a publication, a lit review usually is meant to help make other scholars’ lives easier by collecting and summarizing, synthesizing, and analyzing existing research on a topic. This can be especially helpful for students or scholars getting into a new research area, or for directing an entire community of scholars toward questions that have not yet been answered.

What are the parts of a lit review?

Most lit reviews use a basic introduction-body-conclusion structure; if your lit review is part of a larger paper, the introduction and conclusion pieces may be just a few sentences while you focus most of your attention on the body. If your lit review is a standalone piece, the introduction and conclusion take up more space and give you a place to discuss your goals, research methods, and conclusions separately from where you discuss the literature itself.

Introduction:

• An introductory paragraph that explains what your working topic and thesis is
• A forecast of key topics or texts that will appear in the review
• Potentially, a description of how you found sources and how you analyzed them for inclusion and discussion in the review (more often found in published, standalone literature reviews than in lit review sections in an article or research paper)
• Summarize and synthesize: Give an overview of the main points of each source and combine them into a coherent whole
• Analyze and interpret: Don’t just paraphrase other researchers – add your own interpretations where possible, discussing the significance of findings in relation to the literature as a whole
• Critically Evaluate: Mention the strengths and weaknesses of your sources
• Write in well-structured paragraphs: Use transition words and topic sentence to draw connections, comparisons, and contrasts.

Conclusion:

• Summarize the key findings you have taken from the literature and emphasize their significance
• Connect it back to your primary research question

How should I organize my lit review?

Lit reviews can take many different organizational patterns depending on what you are trying to accomplish with the review. Here are some examples:

• Chronological : The simplest approach is to trace the development of the topic over time, which helps familiarize the audience with the topic (for instance if you are introducing something that is not commonly known in your field). If you choose this strategy, be careful to avoid simply listing and summarizing sources in order. Try to analyze the patterns, turning points, and key debates that have shaped the direction of the field. Give your interpretation of how and why certain developments occurred (as mentioned previously, this may not be appropriate in your discipline — check with a teacher or mentor if you’re unsure).
• Thematic : If you have found some recurring central themes that you will continue working with throughout your piece, you can organize your literature review into subsections that address different aspects of the topic. For example, if you are reviewing literature about women and religion, key themes can include the role of women in churches and the religious attitude towards women.
• Qualitative versus quantitative research
• Empirical versus theoretical scholarship
• Divide the research by sociological, historical, or cultural sources
• Theoretical : In many humanities articles, the literature review is the foundation for the theoretical framework. You can use it to discuss various theories, models, and definitions of key concepts. You can argue for the relevance of a specific theoretical approach or combine various theorical concepts to create a framework for your research.

What are some strategies or tips I can use while writing my lit review?

Any lit review is only as good as the research it discusses; make sure your sources are well-chosen and your research is thorough. Don’t be afraid to do more research if you discover a new thread as you’re writing. More info on the research process is available in our "Conducting Research" resources .

As you’re doing your research, create an annotated bibliography ( see our page on the this type of document ). Much of the information used in an annotated bibliography can be used also in a literature review, so you’ll be not only partially drafting your lit review as you research, but also developing your sense of the larger conversation going on among scholars, professionals, and any other stakeholders in your topic.

Usually you will need to synthesize research rather than just summarizing it. This means drawing connections between sources to create a picture of the scholarly conversation on a topic over time. Many student writers struggle to synthesize because they feel they don’t have anything to add to the scholars they are citing; here are some strategies to help you:

• It often helps to remember that the point of these kinds of syntheses is to show your readers how you understand your research, to help them read the rest of your paper.
• Writing teachers often say synthesis is like hosting a dinner party: imagine all your sources are together in a room, discussing your topic. What are they saying to each other?
• Look at the in-text citations in each paragraph. Are you citing just one source for each paragraph? This usually indicates summary only. When you have multiple sources cited in a paragraph, you are more likely to be synthesizing them (not always, but often
• Read more about synthesis here.

The most interesting literature reviews are often written as arguments (again, as mentioned at the beginning of the page, this is discipline-specific and doesn’t work for all situations). Often, the literature review is where you can establish your research as filling a particular gap or as relevant in a particular way. You have some chance to do this in your introduction in an article, but the literature review section gives a more extended opportunity to establish the conversation in the way you would like your readers to see it. You can choose the intellectual lineage you would like to be part of and whose definitions matter most to your thinking (mostly humanities-specific, but this goes for sciences as well). In addressing these points, you argue for your place in the conversation, which tends to make the lit review more compelling than a simple reporting of other sources.

Write Abstracts, Literature Reviews, and Annotated Bibliographies: Home

• Abstract Guides & Examples
• Literature Reviews
• Annotated Bibliographies & Examples
• Student Research

What is an Abstract?

An abstract is a summary of points (as of a writing) usually presented in skeletal form ; also : something that summarizes or concentrates the essentials of a larger thing or several things. (Merriam-Webster Dictionary Online)  

An abstract is a brief summary of a research article, thesis, review, conference proceeding or any in-depth analysis of a particular subject or discipline, and is often used to help the reader quickly ascertain the paper's purpose. When used, an abstract always appears at the beginning of a manuscript, acting as the point-of-entry for any given scientific paper or patent application. Abstraction and indexing services are available for a number of academic disciplines, aimed at compiling a body of literature for that particular subject. (Wikipedia)

An abstract is a brief, comprehensive summary of the contents of an article. It allows readers to survey the contents of an article quickly. Readers often decide on the basis of the abstract whether to read the entire article. A good abstract should be: ACCURATE --it should reflect the purpose and content of the manuscript. COHERENT --write in clear and concise language. Use the active rather than the passive voice (e.g., investigated instead of investigation of). CONCISE --be brief but make each sentence maximally informative, especially the lead sentence. Begin the abstract with the most important points. The abstract should be dense with information. ( Publication Manual of the American Psychological Association)

Abstract Guidelines

An abstract of a report of an empirical study should describe: (1) the problem under investigation (2) the participants with specific characteristics such as age, sex, ethnic group (3) essential features of the study method (4) basic findings (5) conclusions and implications or applications. An abstract for a literature review or meta-analysis should describe: (1) the problem or relations under investigation (2) study eligibility criteria (3) types of participants (4) main results, including the most important effect sizes, and any important moderators of these effect sizes (5) conclusions, including limitations (6) implications for theory, policy, and practice. An abstract for a theory-oriented paper should describe (1) how the theory or model works and the principles on which it is based and (2) what phenomena the theory or model accounts for and linkages to empirical results. An abstract for a methodological paper should describe (1) the general class of methods being discussed (2) the essential features of the proposed method (3) the range of application of the proposed method (4) in the case of statistical procedures, some of its essential features such as robustness or power efficiency. An abstract for a case study should describe (1) the subject and relevant characteristics of the individual, group, community, or organization presented (2) the nature of or solution to a problem illustrated by the case example (3) questions raised for additional research or theory.

• What is a Literature Review?

A literature review is a body of text that aims to review the critical points of current knowledge including substantive findings as well as theoretical and methodological contributions to a particular topic. Literature reviews are secondary sources, and as such, do not report any new or original experimental work.Most often associated with academic-oriented literature, such as a thesis, a literature review usually precedes a research proposal and results section. Its ultimate goal is to bring the reader up to date with current literature on a topic and forms the basis for another goal, such as future research that may be needed in the area.A well-structured literature review is characterized by a logical flow of ideas; current and relevant references with consistent, appropriate referencing style; proper use of terminology; and an unbiased and comprehensive view of the previous research on the topic. (Wikipedia)

Literature Review: An extensive search of the information available on a topic which results in a list of references to books, periodicals, and other materials on the topic. ( Online Library Learning Center Glossary )

"... a literature review uses as its database reports of primary or original scholarship, and does not report new primary scholarship itself. The primary reports used in the literature may be verbal, but in the vast majority of cases reports are written documents. The types of scholarship may be empirical, theoretical, critical/analytic, or methodological in nature. Second a literature review seeks to describe, summarize, evaluate, clarify and/or integrate the content of primary reports."

Cooper, H. M. (1988), "The structure of knowledge synthesis", Knowledge in Society , Vol. 1, pp. 104-126

• Literature Review Guide
• Literature Review Defined

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• Last Updated: Feb 15, 2024 4:00 PM
• URL: https://library.geneseo.edu/abstracts

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Chapter 1 | Structured Literature Reviews: Background and Definitions

Structured Literature Reviews

Structured literature reviews of the Independent Evaluation Group (IEG) aim to synthesize existing research on a given topic using systematic and transparent procedures. The concept and principles of a systematic review inspire and guide the approach. A systematic review aims to identify, appraise, and synthesize all relevant research that meets explicit prespecified eligibility criteria (Higgins et al. 2019). 1 Because systematic reviews are intended to be exhaustive, proper implementation can require a considerable amount of time, expertise, and resources. Snilstveit et al. (2017) report an average production time of 12–24 months (depending on the scope and resources available) for a systematic review involving a multi-person expert research team. 2

Comprehensively identifying all relevant studies in large volumes of literature can be a particularly challenging and time-intensive task (Thomas, Newman, and Oliver 2013). A broad and fully systematic review often requires searching a variety of literature sources, screening many thousands of studies to identify those relevant to the review. For example, searchable databases do not always use a common set of terms or keywords to index literature. Even when a standardized nomenclature for describing an issue or topic is available, searches on websites such as Google Scholar or the World Bank eLibrary can still yield many irrelevant results. Moreover, such terms likely do not capture the full breadth or nuance of a concept perfectly (Cantrell, Booth, and Chambers, forthcoming). These factors can make it challenging to ensure that a search is comprehensive, and review teams may have to search very large volumes of literature to reach saturation of coverage for the phenomenon of interest. Many systematic reviews even fall short of the mark of conducting truly exhaustive searches (as also highlighted by Evans and Popova 2016).

IEG’s structured literature review approach falls into a subset of more rapid evidence reviews inspired by the concept of a systematic review. Other common terms used for these types of literature reviews include rapid reviews , rapid evidence reviews , and rapid evidence assessments (Littell 2018; Tricco et al. 2015). For the sake of consistency, the type of literature review evaluated in this paper will be referred to as a rapid evidence review for the remainder of the paper. The Agency for Healthcare Research and Quality categorizes such reviews according to the extent of synthesis applied to the material covered in review (AHRQ 2015). In its categorization, inventories provide a list of available evidence, along with other contextual information needed to help inform decisions related to the state of research on a given subject. However, inventories do not synthesize evidence or present conclusions related to the state of the literature. Rapid responses present the user with an answer based on the best available evidence but do not attempt to formally synthesize evidence into conclusions. Rapid reviews perform a synthesis (qualitative, quantitative, or both) to provide an answer about the direction of evidence and possibly its strength.

Though ostensibly less nuanced than a full systematic review, these approaches nonetheless abide by the same basic principles as a systematic review, such as adhering to prespecified criteria for including studies and transparently reporting on the analysis of all relevant studies identified. However, the methods used may streamline the general approach and procedures used. Many rapid evidence reviews aim to deliver results within six months or less (Ganann, Ciliska, and Thomas 2010; Snilstveit et al. 2017; Varker et al. 2015). They may also use a narrower range of search techniques or sources of literature (Haby et al. 2016; Harker and Kleijnen 2012). Such restrictions ensure that the review can be delivered within shorter timeframes and resource constraints or meet deadlines required to feed into policy and decision-making processes (Varker et al. 2015; Watt et al. 2008).

Given that structured literature reviews may be limited in their coverage of the literature and depth of analysis, it is important to understand the caveats associated with applying this approach. Narrow searches of wide-ranging topics and omitting methods of critical appraisal and synthesis may limit what can reliably be said about the state of the literature and research on a particular subject. However, the processes used to conduct structured literature reviews also vary greatly (Ganann, Ciliska, and Thomas 2010; Haby et al. 2016; Hunter et al. 2020; Varker et al. 2015). Each review inevitably establishes its own set of shortcuts and heuristics, delineating the review according to a unique set of project-specific objectives.

To reflect the variety of adjustments a rapid evidence review may adopt, it is important to treat each one as unique. Omitting certain sources of literature, search methods, and analytical approaches will affect different reviews unequally: some shortcuts might be more or less important, representing different levels of risk of bias in different reviews. For example, some sources of literature may be thematically more important regarding some research topics (as would be the case for research on health-related topics, for which searching Medline and PubMed would be intuitively more important). Alternatively, some studies may find citation and reference tracking (a method of searching discussed in “Literature Search and Analysis” in chapter   2) more important for identifying all relevant literature in some contexts (see Cooper et al. 2018; Linder et al. 2015; Papaioannou et al. 2010; and Wright, Golder, and Rodriguez-López 2014). The appropriate choice between the two can depend on the efficacy of search strategies using key terms to identify relevant literature on websites and in databases.

Furthermore, some rapid evidence reviews may also have very good coverage and depth: evidence indicates that a more thorough systematic review does not necessarily always yield different conclusions than a more abbreviated review of the same topic (for example, AHRQ 2015; Haby et al. 2016). Hence, broad-brush statements about the rigor and limitations of rapid evidence reviews do not necessarily reflect authors’ individual work or specific applications of the approach.

This chapter discussed some of the underlying concepts and terminology; the next chapter presents an example of a structured literature review based on a case study assessing the effects of the World Bank’s Doing Business report.

• Oya, Schaefer, and Skalidou (2018; agricultural certification), Snilstveit et al. (2015; education), Vaessen et al. (2014; microcredit), and Waddington et al. (2014; farmer field schools) provide some examples of systematic reviews.
• New technologies are decreasing the time required to complete systematic reviews. However, a systematic review still requires some scoping to adequately delineate what should (and should not) be included in its coverage before production can begin.

How do I Write a Literature Review?: #5 Writing the Review

• Step #1: Choosing a Topic
• Step #2: Finding Information
• Step #3: Evaluating Content
• Step #4: Synthesizing Content
• #5 Writing the Review
• Citing Your Sources

WRITING THE REVIEW 

You've done the research and now you're ready to put your findings down on paper. When preparing to write your review, first consider how will you organize your review.

The actual review generally has 5 components:

Abstract  -  An abstract is a summary of your literature review. It is made up of the following parts:

• A contextual sentence about your motivation behind your research topic
• Your thesis statement
• A descriptive statement about the types of literature used in the review
• Summarize your findings
• Conclusion(s) based upon your findings

Introduction :   Like a typical research paper introduction, provide the reader with a quick idea of the topic of the literature review:

• Define or identify the general topic, issue, or area of concern. This provides the reader with context for reviewing the literature.
• Identify related trends in what has already been published about the topic; or conflicts in theory, methodology, evidence, and conclusions; or gaps in research and scholarship; or a single problem or new perspective of immediate interest.
• Establish your reason (point of view) for reviewing the literature; explain the criteria to be used in analyzing and comparing literature and the organization of the review (sequence); and, when necessary, state why certain literature is or is not included (scope)  - 

Body :  The body of a literature review contains your discussion of sources and can be organized in 3 ways-

• Chronological -  by publication or by trend
• Thematic -  organized around a topic or issue, rather than the progression of time
• Methodical -  the focusing factor usually does not have to do with the content of the material. Instead, it focuses on the "methods" of the literature's researcher or writer that you are reviewing

You may also want to include a section on "questions for further research" and discuss what questions the review has sparked about the topic/field or offer suggestions for future studies/examinations that build on your current findings.

Conclusion :  In the conclusion, you should:

Conclude your paper by providing your reader with some perspective on the relationship between your literature review's specific topic and how it's related to it's parent discipline, scientific endeavor, or profession.

Bibliography :   Since a literature review is composed of pieces of research, it is very important that your correctly cite the literature you are reviewing, both in the reviews body as well as in a bibliography/works cited. To learn more about different citation styles, visit the " Citing Your Sources " tab.

• Writing a Literature Review: Wesleyan University
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• URL: https://libguides.eastern.edu/literature_reviews

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Chaos to Clarity: Structuring Your Literature Review Format

Master literature review format! Learn key sections, effective citation & analysis tips to write a strong academic review.

Ever wondered how to dive into a mountain of books and articles and come up with something that not just makes sense but shines new light on a topic? What if there was a way to neatly tie together all that information, spot what’s missing, and maybe even pave the way for discoveries? 

That’s what you are going to learn in this article, literature reviews—a place where chaos meets order, and where your insights could set the stage for the next big thing. Let’s break down the literature review format , your essential guide to properly writing a literature review.

Dissecting Literature Review Format 

There are 6 main sections to make a note of while writing a literature review. Those are:

The Introduction Section

Topic background, conceptual framework.

• Synthesis and Evaluation in Literature Reviews
• Conclusion for Your Literature Review
• Reference List in Your Literature Review

Also Read: Essential Components of a Literature Review

The introduction of your literature review is where you set the stage for the entire document. It’s your first opportunity to engage your readers and provide a clear blueprint of what your review will cover and why it matters. This section does more than merely introduce the topic; it establishes the context, defines the scope, and outlines the purpose and objectives of your literature review.

Things to keep in mind while writing an introduction:

• Craft a compelling opening
• Establish the Context and Justification
• Define the Scope and Objectives
• Lay out the Structure
• Give an overview of the Structure

The “Topic Background” section of a literature review serves as the cornerstone for understanding the evolution and current state of the subject matter. It is divided into two crucial sub-sections: Historical Context and Current State of the Topic . 

Delving into these areas provides you with a comprehensive backdrop against which the literature review is framed, enriching the reader’s understanding of why the topic is of interest and what has influenced its development to the current state.

Historical Context

The Historical Context is fundamental in setting the stage for the entire literature review. This section is not just a chronology of events or developments; it’s a curated narrative that highlights the key milestones and turning points that have significantly impacted the topic. 

By examining the historical evolution, the review establishes a timeline of how understanding and perspectives have shifted over the years.

Summary Of Key Historical Developments

This involves identifying and summarizing the major breakthroughs, shifts in thinking, or seminal works that have shaped the topic. It’s important to focus on developments that have a direct relevance to the current understanding and state of the subject. For example, if the topic is about the evolution of renewable energy technologies, this part would outline the initial discovery and use of renewable sources, significant technological innovations, and pivotal policy decisions that have influenced the field.

Relevance Of Historical Context To The Topic

After outlining the key historical developments, it’s crucial to connect these events to the present topic. This means discussing how past events have laid the groundwork for current theories, practices, or debates within the field. It involves analyzing the impact of historical milestones on the subject matter, and explaining how they have contributed to current knowledge, challenges, and research questions. This section makes it clear why understanding history is essential for anyone researching or studying the topic today.

Current State Of The Topic

Moving from the historical context, the review transitions to the present with the Current State of the Topic. This part assesses the latest research, trends, debates, and technological advancements that define the subject area at the moment.

Current Trends Or Updates

Here, the focus shifts to what is happening in the field right now. This could include recent research findings, emerging theories, new methodologies, or the latest technological innovations. The aim is to provide a snapshot of the current research landscape, identifying what themes, questions, or problems are being actively explored. For instance, in the context of digital marketing, this might involve discussing the rise of artificial intelligence in customer relationship management or the impact of social media trends on marketing strategies.

Impact Of These Trends On The Subject Matter

The final step is to assess the implications of these current trends for the topic. This includes considering how recent developments have advanced the field, the challenges they present, and the opportunities they open up for future research. It’s about connecting the dots between what’s happening now and what it means for the subject area moving forward. This not only helps to frame the research questions that the literature review will address but also sets the stage for identifying gaps in the current knowledge, thereby guiding the direction of future studies.

Also Read: What is a literature review? Get the concept and start using it

When doing a literature review, it’s essential to lay a solid foundation for your exploration through a well-defined conceptual framework. This framework acts as a compass, guiding your review’s direction by establishing the key concepts, theories, and perspectives that underpin your topic. 

Definitions And Descriptions

Before diving into the depths of your literature review, it’s crucial to start with the basics. This means clearly identifying and defining the key concepts related to your topic. Think of this as setting the stage for your readers, ensuring they have a clear understanding of the fundamental terms and ideas you will be exploring.

Key Concepts Related To The Topic

Begin by listing the essential concepts central to your review. These are the building blocks of your topic, the terms that will repeatedly appear throughout your exploration. 

Detailed Definitions And Their Relevance

Once you’ve identified these concepts, provide precise and comprehensive definitions for each. Don’t hesitate to explore different dimensions or interpretations of these terms, as this can enrich your readers’ understanding. More importantly, discuss why these concepts are crucial to your review. How do they shape the scope of your exploration? How do they relate to each other and to the broader topic? This step ensures that your readers are not just familiar with the terms but also understand their significance within your review’s context.

Theoretical Perspectives

With the key concepts clearly defined, it’s time to frame your literature review within relevant theoretical perspectives. This is where you align your exploration with existing theories, models, or frameworks that provide insights into your topic.

Important Theories Related To The Topic

Identify the theories that are foundational to your topic. These could range from well-established theories that have long guided research in your field to more contemporary models that offer new insights. For example, a review of organizational behavior might draw on theories of motivation, leadership styles, and organizational culture.

Evaluation Of These Theories And Their Influence On The Topic

After pinpointing the relevant theories, critically assess their contributions to the topic. Consider questions like: How have these theories shaped understanding of the topic? What insights do they offer, and where do they fall short? Are there controversies or debates surrounding these theories? This evaluation not only deepens your review’s analytical depth but also positions your work within the larger academic conversation.

Synthesis And Evaluation In Literature Reviews

The “Synthesis and Evaluation” section is where your literature review truly comes to life. Here, you’re not just summarizing what others have said; you’re weaving together diverse strands of research to present a cohesive picture of the topic at hand.

Comparison And Contrast Of Sources

Synthesizing the literature involves more than listing findings from various studies; it’s about drawing connections between them, highlighting areas of agreement and dispute, and weaving these into a narrative that adds depth and breadth to your understanding of the topic.

Comparative Analysis

Start by grouping your sources based on similarities in their findings, methodologies, or theoretical approaches. This clustering will help you identify trends and common themes across the literature. For example, if several studies have found similar outcomes under comparable conditions, these findings can be grouped to strengthen a particular argument or observation about the topic.

Contrasts Or Conflicts Among Sources

Equally important is the identification of discrepancies in the literature. Do some studies present findings that directly contradict others? Are there differences in how researchers have interpreted similar data? Highlighting these conflicts is crucial, as it can indicate areas where the topic is still evolving or where further research is needed. It also shows your ability to critically engage with the material, a hallmark of scholarly rigor.

Analysis Of Gaps In Literature

One of your primary tasks in the synthesis and evaluation section is to identify what’s missing in the current body of research. This requires a critical eye and a deep understanding of both your topic and the broader field in which it resides.

Identification Of Research Gaps

As you comb through the literature, ask yourself: What questions remain unanswered? Are there underexplored areas or populations? Perhaps certain methodologies have been overlooked, or theoretical perspectives have not been considered. Pinpointing these gaps is not a mere exercise in academic critique; it’s a vital step in advancing knowledge within the field.

Implications Of These Gaps For Future Research

Highlighting gaps in the literature sets the stage for future studies. It’s where you, as the reviewer, can suggest new research directions that could fill these voids or further explore the topic. Discussing the implications of these gaps not only enriches your review but also contributes to the ongoing scholarly conversation. 

Conclusion For Your Literature Review

The conclusion of your literature review is where you bring together all the strands of your argument, synthesizing the insights gained and highlighting the significance of your findings. It’s not just a summary of what has been discussed; it’s an opportunity to underscore the relevance of the review, reflect on the broader implications of your synthesis and evaluation, and suggest directions for future research. 

Summary Of Key Points

Start your conclusion by succinctly summarizing the main points and findings of your review. This isn’t about rehashing every detail but rather about distilling the essence of your exploration. Highlight the critical trends, themes, and conflicts you’ve uncovered, and remind your readers of the significance of these discoveries.

Relevance And Implications Of The Literature For The Topic

Next, focus on the relevance and implications of your findings. This involves stepping back to consider the bigger picture—how does your literature review contribute to the understanding of your topic? Discuss the impact of the trends and gaps you’ve identified on the field, and elaborate on how your synthesis of the literature advances or enriches existing knowledge.

Reflection On The Research Process

Reflecting on the research process itself can provide valuable insights. Consider discussing the challenges you encountered in navigating the literature, such as dealing with conflicting findings or the scarcity of research on certain aspects of your topic. 

Directions For Future Research

One of the most critical aspects of your conclusion is to suggest directions for future research. Be as precise as possible, whether suggesting new methodologies, theoretical frameworks, or specific topics that warrant deeper investigation.

Final Thoughts

End your conclusion with a strong closing statement that reiterates the value of your literature review. Emphasize the importance of continued research on your topic and the potential it holds for advanced understanding within your field. A compelling conclusion reaffirms the significance of your work, leaving your readers with a clear sense of its contribution and the urgent need for further exploration.

Reference List In Your Literature Review

The Reference List is the backbone of your literature review, providing a comprehensive compilation of all the sources you’ve cited throughout your exploration. It’s not merely a formality but a crucial component that lends credibility and rigor to your work.

Importance Of Accuracy And Consistency

The cornerstone of a reliable Reference List is accuracy and consistency in citation style. Whether you’re adhering to APA , MLA , Chicago , or another academic citation format, it’s vital to apply the rules with precision. This includes correctly formatting author names, publication dates, titles, and publication details. 

Organizing Your References

While different citation styles have their own rules for listing references, organizing them in a way that enhances readability and accessibility is universally beneficial. Alphabetical order by the author’s last name is the most common method, as it allows readers to easily locate sources.

Comprehensive Coverage

Your Reference List should be exhaustive, including every work you’ve cited in your review. This extends beyond journal articles and books to encompass reports, conference papers, online resources, and any other materials that have informed your analysis.

The Value Of Annotations

While not always required, providing brief annotations for key sources can add tremendous value to your Reference List. An annotated bibliography offers a succinct summary of each source’s main arguments, methodologies, and findings, as well as its relevance to your literature review.

Digital Accessibility

In today’s digital age, considering the accessibility of your referenced works can greatly enhance the utility of your Reference List. Whenever possible, include Digital Object Identifiers (DOIs) or stable URLs for online sources, ensuring readers can directly access the materials. 

Also read: What Is A DOI? Exploring The Purpose And Importance

Reflecting On Ethical Scholarship

Finally, your Reference List is a reflection of ethical scholarship. By accurately citing all the sources that have informed your work, you’re honoring the intellectual property of other researchers and upholding the academic community’s standards of integrity and respect. 

Crafting a meticulous Reference List is an essential aspect of your literature review that underscores the credibility, depth, and ethical foundation of your research. By adhering to the principles of accuracy, comprehensiveness, and accessibility, you not only facilitate further inquiry but also pay homage to the collective endeavor of knowledge advancement in your field.

Related Article: Navigating the AMA Citation Format: Best Tips for Referencing

In conclusion, writing a literature review involves meticulous structuring, beginning with an engaging introduction that sets the stage, followed by a detailed exploration of the topic’s background, including its historical context and current state. 

A robust conceptual framework lays the groundwork for analysis, leading to a critical synthesis and evaluation of relevant literature. 

The conclusion ties together the review’s key findings and implications, while the reference list meticulously catalogs all cited works. Mastering each section ensures a comprehensive and insightful review, essential for advancing academic understanding and contributing to scholarly discussions.

Related Article: Preliminary Literature Review: A Guide for Effective Research

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Research Paper Structure: The Complete Guide

A professional writer with ten years of experience and a Ph.D. in Modern History, Catharine Tawil writes engaging and insightful papers for academic exchange. With deep insight into the impact of historical events on the present, she provides a unique perspective in giving students a feel for the past. Her writing educates and stimulates critical thinking, making her a treasure to those wading through the complexities of history.

A research paper is an academic work depicting the design and results of a study. It can be an academic assignment in undergraduate and postgraduate programs. Moreover, it is an integral requirement in doctoral programs, where postgrads’ research papers are published in reputable journals to add credibility to their research findings. 

Ordering different parts of a research paper is critical for fulfilling academic standards, streamlining your writing, and avoiding distractions and sidetracks. Although outlining may seem like a waste of time, it is the most efficient use of your time at the pre-writing stage, as it will help you order your thoughts and ideas and develop a plan of action to follow throughout the study. 

In this post, we’ll cover the basics of the research paper formatting, provide a basic template of a research paper structure, and provide a detailed description of each section, including the title page and abstract, introduction and literature review, methodology, results, discussion, and conclusion. You can skip to a specific section if you have questions or concerns about it or check out the full article for an in-depth understanding of the full structure. 

Essential Components of a Research Paper

Unlike other types of academic assignments, research papers have a structure more complex than a simple trio of introduction, body, and conclusion. You are expected to follow the established academic norms and include specific information for your paper to have any scientific value. The basic research paper structure example comprises the following parts:

Introduction

• Literature review

Methodology

• Acknowledgments

Please note that some sections of a research paper outlined above are optional. For example, you only need to include appendices if you wish to share a large volume of data that would make the paper unwieldy. You can also adjust this research paper setup to fit your study and word count requirements better. For instance, you can combine the results and discussion sections or the introduction and literature review.

Formatting Requirements

Although the research paper structure is basically the same for all fields of study and topics, the papers can look drastically different when following research paper formatting guidelines of various formatting styles, be it Chicago, MLA, or APA. You must learn the appropriate style at the onset of the writing process, so remember to ask your academic advisor about it if there’s no mention of the formatting style within general requirements.

Once you know which research paper formatting style to use, get your hands on the relevant formatting guidebook. You can find most of the requirements online or sign out a book from a college library. Considering most formatting guidebooks are huge, focus on the main aspects that can make or break your paper, such as:

• Margins, font, and spacing. Most research paper format guidelines require 1-inch margins on all sides, a legible font of at least 12 pt, and double-spaced lines. 
• Page numbering. Requirements vary, but typically, you’ll need to include page numbers in the upper right-hand corner, half an inch from the corner.
• Headings and subheadings. Refer to MLA or APA handbooks to learn specific research paper headings requirements or ask your professor, as the guidelines differ greatly. 
• In-text citations and reference list. In most cases, research paper in-text citations require the name of the main author along with the page number or the publication year. Reference list formatting varies across different styles, but you can use automatic citation generators to speed up the formatting process.

With formatting requirements out of the way, let’s now focus on individual components of a research paper to help you understand what each section should contain to be well received.

Title Page and Abstract

The research paper title page format depends on the required formatting style:

• MLA does not require a separate title page (unless specifically requested). Instead, in the upper left-hand corner of the first page, type your name, your instructor’s name, course name, and date (each on a new line, double-spaced). After that, center the title of the page and include its text.
• APA requires a separate title page, which should include the title of the paper, your name and affiliation, as well as the course name and number, your instructor’s name, and the assignment’s due date. 

A research paper abstract is brief summary of the main points of the research paper. Depending on the formatting style, it can be from 100 to 250 words long, highlighting the research objective, key methodology, and results highlights. An abstract should help readers decide if your work is worth reading at a glance. 

An APA research paper organization requires an abstract on a separate page, with the “Abstract” heading and the paper’s summary (without indent). Below the abstract, type “Keywords:” (in italics) and list the keywords researchers would use to find your paper in the library or online. 

The opening section of the research paper outline gives students pause because they never know what the introduction should entail. If you’re stuck with writer’s block and don’t know how to start the paper, answer these four questions, and you’ll have all the major pieces necessary for the introduction:

• What’s the context of the problem? Open with a general view of the issue and its current state without going into too much detail (that’s what the literature review is for). The background information should fit within one or two paragraphs and lead directly to the next point. 
• What is the issue? The problem statement or question is the core of this part of the research paper structure. Think of it as a thesis statement for an essay. Everything you write in other sections of a research paper should always tie to your problem statement.
• How do you plan to solve the problem? You can formulate research objectives or hypotheses that your study will try to achieve or prove. Short papers typically have one hypothesis, while longer works usually have two or more related objectives.
• How will your study improve the issue? The answer can circle back to the background you laid out at the beginning of the research paper introduction and highlight the benefits (and potential drawbacks and limitations) of your research. It’s the major “selling point” of the study, which should explain why anyone should care about it. 

You can always leave the introduction for last and tackle it once the rest of the paper is done. That’s especially helpful if you use writer’s block as an excuse to procrastinate and put off writing other parts of a research paper.

Literature Review

The primary objective of a research paper literature review is to provide context and prove the relevance of your topic, as specified in the introduction. To that end, you need to find credible, objective, and relevant sources and synthesize any data pertaining to your research. It’s important to avoid simple paraphrasing or summarization of reference data and instead provide its analysis and synthesize your own hypothesis.

Aside from the similarities found in references, this part of the research paper structure should also focus on discrepancies, contradictions, and knowledge gaps. These will prove your study has merit and can resolve the existing issues. Moreover, the knowledge gaps will help lead up to your main research question, which you may repeat near the end of the literature review.

Depending on the topic of your study, you can organize the literature review:

• Chronologically. You can go from the oldest sources published to the latest or from the latest events to situations long past. This approach is often the easiest, but it doesn’t fit all topics and fields of study.
• Thematically. If you wish to cover two or more aspects of the issue, you can dedicate a subsection to each and analyze them together in the final subsection of the literature review. This is the most popular approach, as it can work for most topics.
• Methodologically. If you want to focus on the differences and similarities in research methodology, you can split the literature review into several subsections, devoting each one to a single methodology. This approach works for select subjects and can make the most of systemic studies. 

If you’re working on an empirical study, you can stop there, but if your work is mostly theoretical, this stage of the research paper writing process could also involve developing a theoretical framework. It will help put your findings and results into perspective.

Although it may seem simple at first glance, a literature review takes a long time, most of which you’ll spend looking for reliable sources. Luckily, you can easily outsource this task. All you need to do is say, “Write my paper for me”, and our experts will take over ASAP. 

The research paper methodology section is an integral part of the piece, as it helps ensure the reproducibility of your results and increases your credibility. This part should answer two main questions:

• What? What did your study involve? What resources, software, materials, or samples did you use? What were the ethical considerations of your research?
• How? How much time did your study take? How did you choose participants? How did you collect data and analyze it?

Keep these questions in mind when working out a research design, picking data collection procedures and analysis techniques. If you rely on standard methods, a quick description with a citation would be enough for the methodology part of the research paper structure. But if you employ a unique approach, make sure to describe it in minute detail to ensure anyone can repeat the process and achieve the same results. 

For obvious reasons, the methodology section will differ greatly depending on your field of study and topic. For example, qualitative and quantitative research methods are vastly different. At the same time, quantitative analysis of sociology or linguistics research will be nothing like analyzing blood tests for nursing students or analyzing the success of a marketing campaign for a business and management class. While the tools (i.e., programming language or table processing software) may be similar, the application will be different, and you should highlight these distinctions in your methodology section. 

Although you can put off working on this section of the structure of a research paper, it can be helpful to put your methodology on paper before embarking on the study. A clear idea of the protocols you plan to employ should keep your study on track and minimize methodological errors. 

The research paper results present the study findings as the ultimate product of your research. Instead of the raw data, you can present analysis results and visual aids in the form of tables, figures, and graphs, provide statistical analysis results, and refer interested readers to appendices containing raw data.

Remember to follow the formatting style requirements for tables and figures, which differ for APA and MLA. The same applies to lists and other visual aids. You should also ensure these materials do not destroy your paper’s readability. For example, a three-page table is much more difficult to grasp than a couple of charts highlighting the same data. Moreover, if you plan to present your findings on a poster or a PowerPoint presentation, it pays to work out the best way to present your insights that will fit all formats, including print and projection.

It’s important to draw the line between the results and discussion parts of the research paper structure. The first presents analysis, while the latter relies on interpretations (or implications) of that analysis. Understanding the distinction can be quite challenging, especially if you’re working out the structure of a research paper for the first time.

Discussion and Conclusion

The research paper discussion connects the introduction and research question with the study results. Instead of merely analyzing data, this section should explain whether your initial hypothesis was correct or not. Moreover, the final section, along with the research paper conclusion, should cover the implications of the findings and their potential practical and theoretical applications. This part can also include the limitations of the study and the need for further research if you feel that it could be useful.

It may seem counterproductive, but you shouldn’t shy away from shortcomings, mistakes, and negative results achieved in your study. Instead of waiting for uncomfortable questions from your instructor, present the bad along with the good and hypothesize potential ways of correcting errors or minimizing the negative influences. In some cases, negative results can be just as valuable (if not more so) than positive findings.

Remember to include the research paper references and appendices after the conclusion to wrap up your work and make it better with careful editing, proofreading, and formatting.

What is the purpose of a research paper?

The main objective is to present and share research insights and discoveries, which you should account for when structuring a research paper. Adding literature review and methodology sections is critical for highlighting the study’s relevance and ensuring its reproducibility.

How do I structure the different sections of a research paper?

Structuring a research paper means adding an introduction, literature review, methodology, results, discussion, and conclusion. You can organize each of these sections thematically or chronologically or use a funnel structure, going from the broad context strokes to a narrow view of the problem.

What are the key formatting guidelines for a research paper?

Specific requirements for the structure of a research paper outline and its contents depend on the preferred formatting style. However, at its core, each formatting style focuses on readability. That’s where 12 pt to 14 pt font size and double line spacing come from. Refer to the relevant formatting style handbook for specific recommendations. 

How do I effectively write the introduction and literature review?

The introduction is a critical part of the research paper structure that should include your primary research objective (or question), hypotheses, and the study’s relevance. A literature review is designed to support the claims you make within the introduction by generously using reference data. 

What is the difference between the results and discussion sections?

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A systematic literature review of empirical research on ChatGPT in education

• Open access
• Published: 26 May 2024
• Volume 3 , article number  60 , ( 2024 )

Cite this article

You have full access to this open access article

• Yazid Albadarin   ORCID: orcid.org/0009-0005-8068-8902 1 ,
• Mohammed Saqr 1 ,
• Nicolas Pope 1 &
• Markku Tukiainen 1  

Over the last four decades, studies have investigated the incorporation of Artificial Intelligence (AI) into education. A recent prominent AI-powered technology that has impacted the education sector is ChatGPT. This article provides a systematic review of 14 empirical studies incorporating ChatGPT into various educational settings, published in 2022 and before the 10th of April 2023—the date of conducting the search process. It carefully followed the essential steps outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, as well as Okoli’s (Okoli in Commun Assoc Inf Syst, 2015) steps for conducting a rigorous and transparent systematic review. In this review, we aimed to explore how students and teachers have utilized ChatGPT in various educational settings, as well as the primary findings of those studies. By employing Creswell’s (Creswell in Educational research: planning, conducting, and evaluating quantitative and qualitative research [Ebook], Pearson Education, London, 2015) coding techniques for data extraction and interpretation, we sought to gain insight into their initial attempts at ChatGPT incorporation into education. This approach also enabled us to extract insights and considerations that can facilitate its effective and responsible use in future educational contexts. The results of this review show that learners have utilized ChatGPT as a virtual intelligent assistant, where it offered instant feedback, on-demand answers, and explanations of complex topics. Additionally, learners have used it to enhance their writing and language skills by generating ideas, composing essays, summarizing, translating, paraphrasing texts, or checking grammar. Moreover, learners turned to it as an aiding tool to facilitate their directed and personalized learning by assisting in understanding concepts and homework, providing structured learning plans, and clarifying assignments and tasks. However, the results of specific studies (n = 3, 21.4%) show that overuse of ChatGPT may negatively impact innovative capacities and collaborative learning competencies among learners. Educators, on the other hand, have utilized ChatGPT to create lesson plans, generate quizzes, and provide additional resources, which helped them enhance their productivity and efficiency and promote different teaching methodologies. Despite these benefits, the majority of the reviewed studies recommend the importance of conducting structured training, support, and clear guidelines for both learners and educators to mitigate the drawbacks. This includes developing critical evaluation skills to assess the accuracy and relevance of information provided by ChatGPT, as well as strategies for integrating human interaction and collaboration into learning activities that involve AI tools. Furthermore, they also recommend ongoing research and proactive dialogue with policymakers, stakeholders, and educational practitioners to refine and enhance the use of AI in learning environments. This review could serve as an insightful resource for practitioners who seek to integrate ChatGPT into education and stimulate further research in the field.

Avoid common mistakes on your manuscript.

1 Introduction

Educational technology, a rapidly evolving field, plays a crucial role in reshaping the landscape of teaching and learning [ 82 ]. One of the most transformative technological innovations of our era that has influenced the field of education is Artificial Intelligence (AI) [ 50 ]. Over the last four decades, AI in education (AIEd) has gained remarkable attention for its potential to make significant advancements in learning, instructional methods, and administrative tasks within educational settings [ 11 ]. In particular, a large language model (LLM), a type of AI algorithm that applies artificial neural networks (ANNs) and uses massively large data sets to understand, summarize, generate, and predict new content that is almost difficult to differentiate from human creations [ 79 ], has opened up novel possibilities for enhancing various aspects of education, from content creation to personalized instruction [ 35 ]. Chatbots that leverage the capabilities of LLMs to understand and generate human-like responses have also presented the capacity to enhance student learning and educational outcomes by engaging students, offering timely support, and fostering interactive learning experiences [ 46 ].

The ongoing and remarkable technological advancements in chatbots have made their use more convenient, increasingly natural and effortless, and have expanded their potential for deployment across various domains [ 70 ]. One prominent example of chatbot applications is the Chat Generative Pre-Trained Transformer, known as ChatGPT, which was introduced by OpenAI, a leading AI research lab, on November 30th, 2022. ChatGPT employs a variety of deep learning techniques to generate human-like text, with a particular focus on recurrent neural networks (RNNs). Long short-term memory (LSTM) allows it to grasp the context of the text being processed and retain information from previous inputs. Also, the transformer architecture, a neural network architecture based on the self-attention mechanism, allows it to analyze specific parts of the input, thereby enabling it to produce more natural-sounding and coherent output. Additionally, the unsupervised generative pre-training and the fine-tuning methods allow ChatGPT to generate more relevant and accurate text for specific tasks [ 31 , 62 ]. Furthermore, reinforcement learning from human feedback (RLHF), a machine learning approach that combines reinforcement learning techniques with human-provided feedback, has helped improve ChatGPT’s model by accelerating the learning process and making it significantly more efficient.

This cutting-edge natural language processing (NLP) tool is widely recognized as one of today's most advanced LLMs-based chatbots [ 70 ], allowing users to ask questions and receive detailed, coherent, systematic, personalized, convincing, and informative human-like responses [ 55 ], even within complex and ambiguous contexts [ 63 , 77 ]. ChatGPT is considered the fastest-growing technology in history: in just three months following its public launch, it amassed an estimated 120 million monthly active users [ 16 ] with an estimated 13 million daily queries [ 49 ], surpassing all other applications [ 64 ]. This remarkable growth can be attributed to the unique features and user-friendly interface that ChatGPT offers. Its intuitive design allows users to interact seamlessly with the technology, making it accessible to a diverse range of individuals, regardless of their technical expertise [ 78 ]. Additionally, its exceptional performance results from a combination of advanced algorithms, continuous enhancements, and extensive training on a diverse dataset that includes various text sources such as books, articles, websites, and online forums [ 63 ], have contributed to a more engaging and satisfying user experience [ 62 ]. These factors collectively explain its remarkable global growth and set it apart from predecessors like Bard, Bing Chat, ERNIE, and others.

In this context, several studies have explored the technological advancements of chatbots. One noteworthy recent research effort, conducted by Schöbel et al. [ 70 ], stands out for its comprehensive analysis of more than 5,000 studies on communication agents. This study offered a comprehensive overview of the historical progression and future prospects of communication agents, including ChatGPT. Moreover, other studies have focused on making comparisons, particularly between ChatGPT and alternative chatbots like Bard, Bing Chat, ERNIE, LaMDA, BlenderBot, and various others. For example, O’Leary [ 53 ] compared two chatbots, LaMDA and BlenderBot, with ChatGPT and revealed that ChatGPT outperformed both. This superiority arises from ChatGPT’s capacity to handle a wider range of questions and generate slightly varied perspectives within specific contexts. Similarly, ChatGPT exhibited an impressive ability to formulate interpretable responses that were easily understood when compared with Google's feature snippet [ 34 ]. Additionally, ChatGPT was compared to other LLMs-based chatbots, including Bard and BERT, as well as ERNIE. The findings indicated that ChatGPT exhibited strong performance in the given tasks, often outperforming the other models [ 59 ].

Furthermore, in the education context, a comprehensive study systematically compared a range of the most promising chatbots, including Bard, Bing Chat, ChatGPT, and Ernie across a multidisciplinary test that required higher-order thinking. The study revealed that ChatGPT achieved the highest score, surpassing Bing Chat and Bard [ 64 ]. Similarly, a comparative analysis was conducted to compare ChatGPT with Bard in answering a set of 30 mathematical questions and logic problems, grouped into two question sets. Set (A) is unavailable online, while Set (B) is available online. The results revealed ChatGPT's superiority in Set (A) over Bard. Nevertheless, Bard's advantage emerged in Set (B) due to its capacity to access the internet directly and retrieve answers, a capability that ChatGPT does not possess [ 57 ]. However, through these varied assessments, ChatGPT consistently highlights its exceptional prowess compared to various alternatives in the ever-evolving chatbot technology.

The widespread adoption of chatbots, especially ChatGPT, by millions of students and educators, has sparked extensive discussions regarding its incorporation into the education sector [ 64 ]. Accordingly, many scholars have contributed to the discourse, expressing both optimism and pessimism regarding the incorporation of ChatGPT into education. For example, ChatGPT has been highlighted for its capabilities in enriching the learning and teaching experience through its ability to support different learning approaches, including adaptive learning, personalized learning, and self-directed learning [ 58 , 60 , 91 ]), deliver summative and formative feedback to students and provide real-time responses to questions, increase the accessibility of information [ 22 , 40 , 43 ], foster students’ performance, engagement and motivation [ 14 , 44 , 58 ], and enhance teaching practices [ 17 , 18 , 64 , 74 ].

On the other hand, concerns have been also raised regarding its potential negative effects on learning and teaching. These include the dissemination of false information and references [ 12 , 23 , 61 , 85 ], biased reinforcement [ 47 , 50 ], compromised academic integrity [ 18 , 40 , 66 , 74 ], and the potential decline in students' skills [ 43 , 61 , 64 , 74 ]. As a result, ChatGPT has been banned in multiple countries, including Russia, China, Venezuela, Belarus, and Iran, as well as in various educational institutions in India, Italy, Western Australia, France, and the United States [ 52 , 90 ].

Clearly, the advent of chatbots, especially ChatGPT, has provoked significant controversy due to their potential impact on learning and teaching. This indicates the necessity for further exploration to gain a deeper understanding of this technology and carefully evaluate its potential benefits, limitations, challenges, and threats to education [ 79 ]. Therefore, conducting a systematic literature review will provide valuable insights into the potential prospects and obstacles linked to its incorporation into education. This systematic literature review will primarily focus on ChatGPT, driven by the aforementioned key factors outlined above.

However, the existing literature lacks a systematic literature review of empirical studies. Thus, this systematic literature review aims to address this gap by synthesizing the existing empirical studies conducted on chatbots, particularly ChatGPT, in the field of education, highlighting how ChatGPT has been utilized in educational settings, and identifying any existing gaps. This review may be particularly useful for researchers in the field and educators who are contemplating the integration of ChatGPT or any chatbot into education. The following research questions will guide this study:

What are students' and teachers' initial attempts at utilizing ChatGPT in education?

What are the main findings derived from empirical studies that have incorporated ChatGPT into learning and teaching?

2 Methodology

To conduct this study, the authors followed the essential steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) and Okoli’s [ 54 ] steps for conducting a systematic review. These included identifying the study’s purpose, drafting a protocol, applying a practical screening process, searching the literature, extracting relevant data, evaluating the quality of the included studies, synthesizing the studies, and ultimately writing the review. The subsequent section provides an extensive explanation of how these steps were carried out in this study.

2.1 Identify the purpose

Given the widespread adoption of ChatGPT by students and teachers for various educational purposes, often without a thorough understanding of responsible and effective use or a clear recognition of its potential impact on learning and teaching, the authors recognized the need for further exploration of ChatGPT's impact on education in this early stage. Therefore, they have chosen to conduct a systematic literature review of existing empirical studies that incorporate ChatGPT into educational settings. Despite the limited number of empirical studies due to the novelty of the topic, their goal is to gain a deeper understanding of this technology and proactively evaluate its potential benefits, limitations, challenges, and threats to education. This effort could help to understand initial reactions and attempts at incorporating ChatGPT into education and bring out insights and considerations that can inform the future development of education.

2.2 Draft the protocol

The next step is formulating the protocol. This protocol serves to outline the study process in a rigorous and transparent manner, mitigating researcher bias in study selection and data extraction [ 88 ]. The protocol will include the following steps: generating the research question, predefining a literature search strategy, identifying search locations, establishing selection criteria, assessing the studies, developing a data extraction strategy, and creating a timeline.

2.3 Apply practical screen

The screening step aims to accurately filter the articles resulting from the searching step and select the empirical studies that have incorporated ChatGPT into educational contexts, which will guide us in answering the research questions and achieving the objectives of this study. To ensure the rigorous execution of this step, our inclusion and exclusion criteria were determined based on the authors' experience and informed by previous successful systematic reviews [ 21 ]. Table 1 summarizes the inclusion and exclusion criteria for study selection.

2.4 Literature search

We conducted a thorough literature search to identify articles that explored, examined, and addressed the use of ChatGPT in Educational contexts. We utilized two research databases: Dimensions.ai, which provides access to a large number of research publications, and lens.org, which offers access to over 300 million articles, patents, and other research outputs from diverse sources. Additionally, we included three databases, Scopus, Web of Knowledge, and ERIC, which contain relevant research on the topic that addresses our research questions. To browse and identify relevant articles, we used the following search formula: ("ChatGPT" AND "Education"), which included the Boolean operator "AND" to get more specific results. The subject area in the Scopus and ERIC databases were narrowed to "ChatGPT" and "Education" keywords, and in the WoS database was limited to the "Education" category. The search was conducted between the 3rd and 10th of April 2023, which resulted in 276 articles from all selected databases (111 articles from Dimensions.ai, 65 from Scopus, 28 from Web of Science, 14 from ERIC, and 58 from Lens.org). These articles were imported into the Rayyan web-based system for analysis. The duplicates were identified automatically by the system. Subsequently, the first author manually reviewed the duplicated articles ensured that they had the same content, and then removed them, leaving us with 135 unique articles. Afterward, the titles, abstracts, and keywords of the first 40 manuscripts were scanned and reviewed by the first author and were discussed with the second and third authors to resolve any disagreements. Subsequently, the first author proceeded with the filtering process for all articles and carefully applied the inclusion and exclusion criteria as presented in Table  1 . Articles that met any one of the exclusion criteria were eliminated, resulting in 26 articles. Afterward, the authors met to carefully scan and discuss them. The authors agreed to eliminate any empirical studies solely focused on checking ChatGPT capabilities, as these studies do not guide us in addressing the research questions and achieving the study's objectives. This resulted in 14 articles eligible for analysis.

2.5 Quality appraisal

The examination and evaluation of the quality of the extracted articles is a vital step [ 9 ]. Therefore, the extracted articles were carefully evaluated for quality using Fink’s [ 24 ] standards, which emphasize the necessity for detailed descriptions of methodology, results, conclusions, strengths, and limitations. The process began with a thorough assessment of each study's design, data collection, and analysis methods to ensure their appropriateness and comprehensive execution. The clarity, consistency, and logical progression from data to results and conclusions were also critically examined. Potential biases and recognized limitations within the studies were also scrutinized. Ultimately, two articles were excluded for failing to meet Fink’s criteria, particularly in providing sufficient detail on methodology, results, conclusions, strengths, or limitations. The review process is illustrated in Fig.  1 .

The study selection process

2.6 Data extraction

The next step is data extraction, the process of capturing the key information and categories from the included studies. To improve efficiency, reduce variation among authors, and minimize errors in data analysis, the coding categories were constructed using Creswell's [ 15 ] coding techniques for data extraction and interpretation. The coding process involves three sequential steps. The initial stage encompasses open coding , where the researcher examines the data, generates codes to describe and categorize it, and gains a deeper understanding without preconceived ideas. Following open coding is axial coding , where the interrelationships between codes from open coding are analyzed to establish more comprehensive categories or themes. The process concludes with selective coding , refining and integrating categories or themes to identify core concepts emerging from the data. The first coder performed the coding process, then engaged in discussions with the second and third authors to finalize the coding categories for the first five articles. The first coder then proceeded to code all studies and engaged again in discussions with the other authors to ensure the finalization of the coding process. After a comprehensive analysis and capturing of the key information from the included studies, the data extraction and interpretation process yielded several themes. These themes have been categorized and are presented in Table  2 . It is important to note that open coding results were removed from Table  2 for aesthetic reasons, as it included many generic aspects, such as words, short phrases, or sentences mentioned in the studies.

2.7 Synthesize studies

In this stage, we will gather, discuss, and analyze the key findings that emerged from the selected studies. The synthesis stage is considered a transition from an author-centric to a concept-centric focus, enabling us to map all the provided information to achieve the most effective evaluation of the data [ 87 ]. Initially, the authors extracted data that included general information about the selected studies, including the author(s)' names, study titles, years of publication, educational levels, research methodologies, sample sizes, participants, main aims or objectives, raw data sources, and analysis methods. Following that, all key information and significant results from the selected studies were compiled using Creswell’s [ 15 ] coding techniques for data extraction and interpretation to identify core concepts and themes emerging from the data, focusing on those that directly contributed to our research questions and objectives, such as the initial utilization of ChatGPT in learning and teaching, learners' and educators' familiarity with ChatGPT, and the main findings of each study. Finally, the data related to each selected study were extracted into an Excel spreadsheet for data processing. The Excel spreadsheet was reviewed by the authors, including a series of discussions to ensure the finalization of this process and prepare it for further analysis. Afterward, the final result being analyzed and presented in various types of charts and graphs. Table 4 presents the extracted data from the selected studies, with each study labeled with a capital 'S' followed by a number.

This section consists of two main parts. The first part provides a descriptive analysis of the data compiled from the reviewed studies. The second part presents the answers to the research questions and the main findings of these studies.

3.1 Part 1: descriptive analysis

This section will provide a descriptive analysis of the reviewed studies, including educational levels and fields, participants distribution, country contribution, research methodologies, study sample size, study population, publication year, list of journals, familiarity with ChatGPT, source of data, and the main aims and objectives of the studies. Table 4 presents a comprehensive overview of the extracted data from the selected studies.

3.1.1 The number of the reviewed studies and publication years

The total number of the reviewed studies was 14. All studies were empirical studies and published in different journals focusing on Education and Technology. One study was published in 2022 [S1], while the remaining were published in 2023 [S2]-[S14]. Table 3 illustrates the year of publication, the names of the journals, and the number of reviewed studies published in each journal for the studies reviewed.

3.1.2 Educational levels and fields

The majority of the reviewed studies, 11 studies, were conducted in higher education institutions [S1]-[S10] and [S13]. Two studies did not specify the educational level of the population [S12] and [S14], while one study focused on elementary education [S11]. However, the reviewed studies covered various fields of education. Three studies focused on Arts and Humanities Education [S8], [S11], and [S14], specifically English Education. Two studies focused on Engineering Education, with one in Computer Engineering [S2] and the other in Construction Education [S3]. Two studies focused on Mathematics Education [S5] and [S12]. One study focused on Social Science Education [S13]. One study focused on Early Education [S4]. One study focused on Journalism Education [S9]. Finally, three studies did not specify the field of education [S1], [S6], and [S7]. Figure  2 represents the educational levels in the reviewed studies, while Fig.  3 represents the context of the reviewed studies.

Educational levels in the reviewed studies

Context of the reviewed studies

3.1.3 Participants distribution and countries contribution

The reviewed studies have been conducted across different geographic regions, providing a diverse representation of the studies. The majority of the studies, 10 in total, [S1]-[S3], [S5]-[S9], [S11], and [S14], primarily focused on participants from single countries such as Pakistan, the United Arab Emirates, China, Indonesia, Poland, Saudi Arabia, South Korea, Spain, Tajikistan, and the United States. In contrast, four studies, [S4], [S10], [S12], and [S13], involved participants from multiple countries, including China and the United States [S4], China, the United Kingdom, and the United States [S10], the United Arab Emirates, Oman, Saudi Arabia, and Jordan [S12], Turkey, Sweden, Canada, and Australia [ 13 ]. Figures  4 and 5 illustrate the distribution of participants, whether from single or multiple countries, and the contribution of each country in the reviewed studies, respectively.

The reviewed studies conducted in single or multiple countries

The Contribution of each country in the studies

3.1.4 Study population and sample size

Four study populations were included: university students, university teachers, university teachers and students, and elementary school teachers. Six studies involved university students [S2], [S3], [S5] and [S6]-[S8]. Three studies focused on university teachers [S1], [S4], and [S6], while one study specifically targeted elementary school teachers [S11]. Additionally, four studies included both university teachers and students [S10] and [ 12 , 13 , 14 ], and among them, study [S13] specifically included postgraduate students. In terms of the sample size of the reviewed studies, nine studies included a small sample size of less than 50 participants [S1], [S3], [S6], [S8], and [S10]-[S13]. Three studies had 50–100 participants [S2], [S9], and [S14]. Only one study had more than 100 participants [S7]. It is worth mentioning that study [S4] adopted a mixed methods approach, including 10 participants for qualitative analysis and 110 participants for quantitative analysis.

3.1.5 Participants’ familiarity with using ChatGPT

The reviewed studies recruited a diverse range of participants with varying levels of familiarity with ChatGPT. Five studies [S2], [S4], [S6], [S8], and [S12] involved participants already familiar with ChatGPT, while eight studies [S1], [S3], [S5], [S7], [S9], [S10], [S13] and [S14] included individuals with differing levels of familiarity. Notably, one study [S11] had participants who were entirely unfamiliar with ChatGPT. It is important to note that four studies [S3], [S5], [S9], and [S11] provided training or guidance to their participants before conducting their studies, while ten studies [S1], [S2], [S4], [S6]-[S8], [S10], and [S12]-[S14] did not provide training due to the participants' existing familiarity with ChatGPT.

3.1.6 Research methodology approaches and source(S) of data

The reviewed studies adopted various research methodology approaches. Seven studies adopted qualitative research methodology [S1], [S4], [S6], [S8], [S10], [S11], and [S12], while three studies adopted quantitative research methodology [S3], [S7], and [S14], and four studies employed mixed-methods, which involved a combination of both the strengths of qualitative and quantitative methods [S2], [S5], [S9], and [S13].

In terms of the source(s) of data, the reviewed studies obtained their data from various sources, such as interviews, questionnaires, and pre-and post-tests. Six studies relied on interviews as their primary source of data collection [S1], [S4], [S6], [S10], [S11], and [S12], four studies relied on questionnaires [S2], [S7], [S13], and [S14], two studies combined the use of pre-and post-tests and questionnaires for data collection [S3] and [S9], while two studies combined the use of questionnaires and interviews to obtain the data [S5] and [S8]. It is important to note that six of the reviewed studies were quasi-experimental [S3], [S5], [S8], [S9], [S12], and [S14], while the remaining ones were experimental studies [S1], [S2], [S4], [S6], [S7], [S10], [S11], and [S13]. Figures  6 and 7 illustrate the research methodologies and the source (s) of data used in the reviewed studies, respectively.

Research methodologies in the reviewed studies

Source of data in the reviewed studies

3.1.7 The aim and objectives of the studies

The reviewed studies encompassed a diverse set of aims, with several of them incorporating multiple primary objectives. Six studies [S3], [S6], [S7], [S8], [S11], and [S12] examined the integration of ChatGPT in educational contexts, and four studies [S4], [S5], [S13], and [S14] investigated the various implications of its use in education, while three studies [S2], [S9], and [S10] aimed to explore both its integration and implications in education. Additionally, seven studies explicitly explored attitudes and perceptions of students [S2] and [S3], educators [S1] and [S6], or both [S10], [S12], and [S13] regarding the utilization of ChatGPT in educational settings.

3.2 Part 2: research questions and main findings of the reviewed studies

This part will present the answers to the research questions and the main findings of the reviewed studies, classified into two main categories (learning and teaching) according to AI Education classification by [ 36 ]. Figure  8 summarizes the main findings of the reviewed studies in a visually informative diagram. Table 4 provides a detailed list of the key information extracted from the selected studies that led to generating these themes.

The main findings in the reviewed studies

4 Students' initial attempts at utilizing ChatGPT in learning and main findings from students' perspective

4.1 virtual intelligent assistant.

Nine studies demonstrated that ChatGPT has been utilized by students as an intelligent assistant to enhance and support their learning. Students employed it for various purposes, such as answering on-demand questions [S2]-[S5], [S8], [S10], and [S12], providing valuable information and learning resources [S2]-[S5], [S6], and [S8], as well as receiving immediate feedback [S2], [S4], [S9], [S10], and [S12]. In this regard, students generally were confident in the accuracy of ChatGPT's responses, considering them relevant, reliable, and detailed [S3], [S4], [S5], and [S8]. However, some students indicated the need for improvement, as they found that answers are not always accurate [S2], and that misleading information may have been provided or that it may not always align with their expectations [S6] and [S10]. It was also observed by the students that the accuracy of ChatGPT is dependent on several factors, including the quality and specificity of the user's input, the complexity of the question or topic, and the scope and relevance of its training data [S12]. Many students felt that ChatGPT's answers were not always accurate and most of them believed that it requires good background knowledge to work with.

4.2 Writing and language proficiency assistant

Six of the reviewed studies highlighted that ChatGPT has been utilized by students as a valuable assistant tool to improve their academic writing skills and language proficiency. Among these studies, three mainly focused on English education, demonstrating that students showed sufficient mastery in using ChatGPT for generating ideas, summarizing, paraphrasing texts, and completing writing essays [S8], [S11], and [S14]. Furthermore, ChatGPT helped them in writing by making students active investigators rather than passive knowledge recipients and facilitated the development of their writing skills [S11] and [S14]. Similarly, ChatGPT allowed students to generate unique ideas and perspectives, leading to deeper analysis and reflection on their journalism writing [S9]. In terms of language proficiency, ChatGPT allowed participants to translate content into their home languages, making it more accessible and relevant to their context [S4]. It also enabled them to request changes in linguistic tones or flavors [S8]. Moreover, participants used it to check grammar or as a dictionary [S11].

4.3 Valuable resource for learning approaches

Five studies demonstrated that students used ChatGPT as a valuable complementary resource for self-directed learning. It provided learning resources and guidance on diverse educational topics and created a supportive home learning environment [S2] and [S4]. Moreover, it offered step-by-step guidance to grasp concepts at their own pace and enhance their understanding [S5], streamlined task and project completion carried out independently [S7], provided comprehensive and easy-to-understand explanations on various subjects [S10], and assisted in studying geometry operations, thereby empowering them to explore geometry operations at their own pace [S12]. Three studies showed that students used ChatGPT as a valuable learning resource for personalized learning. It delivered age-appropriate conversations and tailored teaching based on a child's interests [S4], acted as a personalized learning assistant, adapted to their needs and pace, which assisted them in understanding mathematical concepts [S12], and enabled personalized learning experiences in social sciences by adapting to students' needs and learning styles [S13]. On the other hand, it is important to note that, according to one study [S5], students suggested that using ChatGPT may negatively affect collaborative learning competencies between students.

4.4 Enhancing students' competencies

Six of the reviewed studies have shown that ChatGPT is a valuable tool for improving a wide range of skills among students. Two studies have provided evidence that ChatGPT led to improvements in students' critical thinking, reasoning skills, and hazard recognition competencies through engaging them in interactive conversations or activities and providing responses related to their disciplines in journalism [S5] and construction education [S9]. Furthermore, two studies focused on mathematical education have shown the positive impact of ChatGPT on students' problem-solving abilities in unraveling problem-solving questions [S12] and enhancing the students' understanding of the problem-solving process [S5]. Lastly, one study indicated that ChatGPT effectively contributed to the enhancement of conversational social skills [S4].

4.5 Supporting students' academic success

Seven of the reviewed studies highlighted that students found ChatGPT to be beneficial for learning as it enhanced learning efficiency and improved the learning experience. It has been observed to improve students' efficiency in computer engineering studies by providing well-structured responses and good explanations [S2]. Additionally, students found it extremely useful for hazard reporting [S3], and it also enhanced their efficiency in solving mathematics problems and capabilities [S5] and [S12]. Furthermore, by finding information, generating ideas, translating texts, and providing alternative questions, ChatGPT aided students in deepening their understanding of various subjects [S6]. It contributed to an increase in students' overall productivity [S7] and improved efficiency in composing written tasks [S8]. Regarding learning experiences, ChatGPT was instrumental in assisting students in identifying hazards that they might have otherwise overlooked [S3]. It also improved students' learning experiences in solving mathematics problems and developing abilities [S5] and [S12]. Moreover, it increased students' successful completion of important tasks in their studies [S7], particularly those involving average difficulty writing tasks [S8]. Additionally, ChatGPT increased the chances of educational success by providing students with baseline knowledge on various topics [S10].

5 Teachers' initial attempts at utilizing ChatGPT in teaching and main findings from teachers' perspective

5.1 valuable resource for teaching.

The reviewed studies showed that teachers have employed ChatGPT to recommend, modify, and generate diverse, creative, organized, and engaging educational contents, teaching materials, and testing resources more rapidly [S4], [S6], [S10] and [S11]. Additionally, teachers experienced increased productivity as ChatGPT facilitated quick and accurate responses to questions, fact-checking, and information searches [S1]. It also proved valuable in constructing new knowledge [S6] and providing timely answers to students' questions in classrooms [S11]. Moreover, ChatGPT enhanced teachers' efficiency by generating new ideas for activities and preplanning activities for their students [S4] and [S6], including interactive language game partners [S11].

5.2 Improving productivity and efficiency

The reviewed studies showed that participants' productivity and work efficiency have been significantly enhanced by using ChatGPT as it enabled them to allocate more time to other tasks and reduce their overall workloads [S6], [S10], [S11], [S13], and [S14]. However, three studies [S1], [S4], and [S11], indicated a negative perception and attitude among teachers toward using ChatGPT. This negativity stemmed from a lack of necessary skills to use it effectively [S1], a limited familiarity with it [S4], and occasional inaccuracies in the content provided by it [S10].

5.3 Catalyzing new teaching methodologies

Five of the reviewed studies highlighted that educators found the necessity of redefining their teaching profession with the assistance of ChatGPT [S11], developing new effective learning strategies [S4], and adapting teaching strategies and methodologies to ensure the development of essential skills for future engineers [S5]. They also emphasized the importance of adopting new educational philosophies and approaches that can evolve with the introduction of ChatGPT into the classroom [S12]. Furthermore, updating curricula to focus on improving human-specific features, such as emotional intelligence, creativity, and philosophical perspectives [S13], was found to be essential.

5.4 Effective utilization of CHATGPT in teaching

According to the reviewed studies, effective utilization of ChatGPT in education requires providing teachers with well-structured training, support, and adequate background on how to use ChatGPT responsibly [S1], [S3], [S11], and [S12]. Establishing clear rules and regulations regarding its usage is essential to ensure it positively impacts the teaching and learning processes, including students' skills [S1], [S4], [S5], [S8], [S9], and [S11]-[S14]. Moreover, conducting further research and engaging in discussions with policymakers and stakeholders is indeed crucial for the successful integration of ChatGPT in education and to maximize the benefits for both educators and students [S1], [S6]-[S10], and [S12]-[S14].

6 Discussion

The purpose of this review is to conduct a systematic review of empirical studies that have explored the utilization of ChatGPT, one of today’s most advanced LLM-based chatbots, in education. The findings of the reviewed studies showed several ways of ChatGPT utilization in different learning and teaching practices as well as it provided insights and considerations that can facilitate its effective and responsible use in future educational contexts. The results of the reviewed studies came from diverse fields of education, which helped us avoid a biased review that is limited to a specific field. Similarly, the reviewed studies have been conducted across different geographic regions. This kind of variety in geographic representation enriched the findings of this review.

In response to RQ1 , "What are students' and teachers' initial attempts at utilizing ChatGPT in education?", the findings from this review provide comprehensive insights. Chatbots, including ChatGPT, play a crucial role in supporting student learning, enhancing their learning experiences, and facilitating diverse learning approaches [ 42 , 43 ]. This review found that this tool, ChatGPT, has been instrumental in enhancing students' learning experiences by serving as a virtual intelligent assistant, providing immediate feedback, on-demand answers, and engaging in educational conversations. Additionally, students have benefited from ChatGPT’s ability to generate ideas, compose essays, and perform tasks like summarizing, translating, paraphrasing texts, or checking grammar, thereby enhancing their writing and language competencies. Furthermore, students have turned to ChatGPT for assistance in understanding concepts and homework, providing structured learning plans, and clarifying assignments and tasks, which fosters a supportive home learning environment, allowing them to take responsibility for their own learning and cultivate the skills and approaches essential for supportive home learning environment [ 26 , 27 , 28 ]. This finding aligns with the study of Saqr et al. [ 68 , 69 ] who highlighted that, when students actively engage in their own learning process, it yields additional advantages, such as heightened motivation, enhanced achievement, and the cultivation of enthusiasm, turning them into advocates for their own learning.

Moreover, students have utilized ChatGPT for tailored teaching and step-by-step guidance on diverse educational topics, streamlining task and project completion, and generating and recommending educational content. This personalization enhances the learning environment, leading to increased academic success. This finding aligns with other recent studies [ 26 , 27 , 28 , 60 , 66 ] which revealed that ChatGPT has the potential to offer personalized learning experiences and support an effective learning process by providing students with customized feedback and explanations tailored to their needs and abilities. Ultimately, fostering students' performance, engagement, and motivation, leading to increase students' academic success [ 14 , 44 , 58 ]. This ultimate outcome is in line with the findings of Saqr et al. [ 68 , 69 ], which emphasized that learning strategies are important catalysts of students' learning, as students who utilize effective learning strategies are more likely to have better academic achievement.

Teachers, too, have capitalized on ChatGPT's capabilities to enhance productivity and efficiency, using it for creating lesson plans, generating quizzes, providing additional resources, generating and preplanning new ideas for activities, and aiding in answering students’ questions. This adoption of technology introduces new opportunities to support teaching and learning practices, enhancing teacher productivity. This finding aligns with those of Day [ 17 ], De Castro [ 18 ], and Su and Yang [ 74 ] as well as with those of Valtonen et al. [ 82 ], who revealed that emerging technological advancements have opened up novel opportunities and means to support teaching and learning practices, and enhance teachers’ productivity.

In response to RQ2 , "What are the main findings derived from empirical studies that have incorporated ChatGPT into learning and teaching?", the findings from this review provide profound insights and raise significant concerns. Starting with the insights, chatbots, including ChatGPT, have demonstrated the potential to reshape and revolutionize education, creating new, novel opportunities for enhancing the learning process and outcomes [ 83 ], facilitating different learning approaches, and offering a range of pedagogical benefits [ 19 , 43 , 72 ]. In this context, this review found that ChatGPT could open avenues for educators to adopt or develop new effective learning and teaching strategies that can evolve with the introduction of ChatGPT into the classroom. Nonetheless, there is an evident lack of research understanding regarding the potential impact of generative machine learning models within diverse educational settings [ 83 ]. This necessitates teachers to attain a high level of proficiency in incorporating chatbots, such as ChatGPT, into their classrooms to create inventive, well-structured, and captivating learning strategies. In the same vein, the review also found that teachers without the requisite skills to utilize ChatGPT realized that it did not contribute positively to their work and could potentially have adverse effects [ 37 ]. This concern could lead to inequity of access to the benefits of chatbots, including ChatGPT, as individuals who lack the necessary expertise may not be able to harness their full potential, resulting in disparities in educational outcomes and opportunities. Therefore, immediate action is needed to address these potential issues. A potential solution is offering training, support, and competency development for teachers to ensure that all of them can leverage chatbots, including ChatGPT, effectively and equitably in their educational practices [ 5 , 28 , 80 ], which could enhance accessibility and inclusivity, and potentially result in innovative outcomes [ 82 , 83 ].

Additionally, chatbots, including ChatGPT, have the potential to significantly impact students' thinking abilities, including retention, reasoning, analysis skills [ 19 , 45 ], and foster innovation and creativity capabilities [ 83 ]. This review found that ChatGPT could contribute to improving a wide range of skills among students. However, it found that frequent use of ChatGPT may result in a decrease in innovative capacities, collaborative skills and cognitive capacities, and students' motivation to attend classes, as well as could lead to reduced higher-order thinking skills among students [ 22 , 29 ]. Therefore, immediate action is needed to carefully examine the long-term impact of chatbots such as ChatGPT, on learning outcomes as well as to explore its incorporation into educational settings as a supportive tool without compromising students' cognitive development and critical thinking abilities. In the same vein, the review also found that it is challenging to draw a consistent conclusion regarding the potential of ChatGPT to aid self-directed learning approach. This finding aligns with the recent study of Baskara [ 8 ]. Therefore, further research is needed to explore the potential of ChatGPT for self-directed learning. One potential solution involves utilizing learning analytics as a novel approach to examine various aspects of students' learning and support them in their individual endeavors [ 32 ]. This approach can bridge this gap by facilitating an in-depth analysis of how learners engage with ChatGPT, identifying trends in self-directed learning behavior, and assessing its influence on their outcomes.

Turning to the significant concerns, on the other hand, a fundamental challenge with LLM-based chatbots, including ChatGPT, is the accuracy and quality of the provided information and responses, as they provide false information as truth—a phenomenon often referred to as "hallucination" [ 3 , 49 ]. In this context, this review found that the provided information was not entirely satisfactory. Consequently, the utilization of chatbots presents potential concerns, such as generating and providing inaccurate or misleading information, especially for students who utilize it to support their learning. This finding aligns with other findings [ 6 , 30 , 35 , 40 ] which revealed that incorporating chatbots such as ChatGPT, into education presents challenges related to its accuracy and reliability due to its training on a large corpus of data, which may contain inaccuracies and the way users formulate or ask ChatGPT. Therefore, immediate action is needed to address these potential issues. One possible solution is to equip students with the necessary skills and competencies, which include a background understanding of how to use it effectively and the ability to assess and evaluate the information it generates, as the accuracy and the quality of the provided information depend on the input, its complexity, the topic, and the relevance of its training data [ 28 , 49 , 86 ]. However, it's also essential to examine how learners can be educated about how these models operate, the data used in their training, and how to recognize their limitations, challenges, and issues [ 79 ].

Furthermore, chatbots present a substantial challenge concerning maintaining academic integrity [ 20 , 56 ] and copyright violations [ 83 ], which are significant concerns in education. The review found that the potential misuse of ChatGPT might foster cheating, facilitate plagiarism, and threaten academic integrity. This issue is also affirmed by the research conducted by Basic et al. [ 7 ], who presented evidence that students who utilized ChatGPT in their writing assignments had more plagiarism cases than those who did not. These findings align with the conclusions drawn by Cotton et al. [ 13 ], Hisan and Amri [ 33 ] and Sullivan et al. [ 75 ], who revealed that the integration of chatbots such as ChatGPT into education poses a significant challenge to the preservation of academic integrity. Moreover, chatbots, including ChatGPT, have increased the difficulty in identifying plagiarism [ 47 , 67 , 76 ]. The findings from previous studies [ 1 , 84 ] indicate that AI-generated text often went undetected by plagiarism software, such as Turnitin. However, Turnitin and other similar plagiarism detection tools, such as ZeroGPT, GPTZero, and Copyleaks, have since evolved, incorporating enhanced techniques to detect AI-generated text, despite the possibility of false positives, as noted in different studies that have found these tools still not yet fully ready to accurately and reliably identify AI-generated text [ 10 , 51 ], and new novel detection methods may need to be created and implemented for AI-generated text detection [ 4 ]. This potential issue could lead to another concern, which is the difficulty of accurately evaluating student performance when they utilize chatbots such as ChatGPT assistance in their assignments. Consequently, the most LLM-driven chatbots present a substantial challenge to traditional assessments [ 64 ]. The findings from previous studies indicate the importance of rethinking, improving, and redesigning innovative assessment methods in the era of chatbots [ 14 , 20 , 64 , 75 ]. These methods should prioritize the process of evaluating students' ability to apply knowledge to complex cases and demonstrate comprehension, rather than solely focusing on the final product for assessment. Therefore, immediate action is needed to address these potential issues. One possible solution would be the development of clear guidelines, regulatory policies, and pedagogical guidance. These measures would help regulate the proper and ethical utilization of chatbots, such as ChatGPT, and must be established before their introduction to students [ 35 , 38 , 39 , 41 , 89 ].

In summary, our review has delved into the utilization of ChatGPT, a prominent example of chatbots, in education, addressing the question of how ChatGPT has been utilized in education. However, there remain significant gaps, which necessitate further research to shed light on this area.

7 Conclusions

This systematic review has shed light on the varied initial attempts at incorporating ChatGPT into education by both learners and educators, while also offering insights and considerations that can facilitate its effective and responsible use in future educational contexts. From the analysis of 14 selected studies, the review revealed the dual-edged impact of ChatGPT in educational settings. On the positive side, ChatGPT significantly aided the learning process in various ways. Learners have used it as a virtual intelligent assistant, benefiting from its ability to provide immediate feedback, on-demand answers, and easy access to educational resources. Additionally, it was clear that learners have used it to enhance their writing and language skills, engaging in practices such as generating ideas, composing essays, and performing tasks like summarizing, translating, paraphrasing texts, or checking grammar. Importantly, other learners have utilized it in supporting and facilitating their directed and personalized learning on a broad range of educational topics, assisting in understanding concepts and homework, providing structured learning plans, and clarifying assignments and tasks. Educators, on the other hand, found ChatGPT beneficial for enhancing productivity and efficiency. They used it for creating lesson plans, generating quizzes, providing additional resources, and answers learners' questions, which saved time and allowed for more dynamic and engaging teaching strategies and methodologies.

However, the review also pointed out negative impacts. The results revealed that overuse of ChatGPT could decrease innovative capacities and collaborative learning among learners. Specifically, relying too much on ChatGPT for quick answers can inhibit learners' critical thinking and problem-solving skills. Learners might not engage deeply with the material or consider multiple solutions to a problem. This tendency was particularly evident in group projects, where learners preferred consulting ChatGPT individually for solutions over brainstorming and collaborating with peers, which negatively affected their teamwork abilities. On a broader level, integrating ChatGPT into education has also raised several concerns, including the potential for providing inaccurate or misleading information, issues of inequity in access, challenges related to academic integrity, and the possibility of misusing the technology.

Accordingly, this review emphasizes the urgency of developing clear rules, policies, and regulations to ensure ChatGPT's effective and responsible use in educational settings, alongside other chatbots, by both learners and educators. This requires providing well-structured training to educate them on responsible usage and understanding its limitations, along with offering sufficient background information. Moreover, it highlights the importance of rethinking, improving, and redesigning innovative teaching and assessment methods in the era of ChatGPT. Furthermore, conducting further research and engaging in discussions with policymakers and stakeholders are essential steps to maximize the benefits for both educators and learners and ensure academic integrity.

It is important to acknowledge that this review has certain limitations. Firstly, the limited inclusion of reviewed studies can be attributed to several reasons, including the novelty of the technology, as new technologies often face initial skepticism and cautious adoption; the lack of clear guidelines or best practices for leveraging this technology for educational purposes; and institutional or governmental policies affecting the utilization of this technology in educational contexts. These factors, in turn, have affected the number of studies available for review. Secondly, the utilization of the original version of ChatGPT, based on GPT-3 or GPT-3.5, implies that new studies utilizing the updated version, GPT-4 may lead to different findings. Therefore, conducting follow-up systematic reviews is essential once more empirical studies on ChatGPT are published. Additionally, long-term studies are necessary to thoroughly examine and assess the impact of ChatGPT on various educational practices.

Despite these limitations, this systematic review has highlighted the transformative potential of ChatGPT in education, revealing its diverse utilization by learners and educators alike and summarized the benefits of incorporating it into education, as well as the forefront critical concerns and challenges that must be addressed to facilitate its effective and responsible use in future educational contexts. This review could serve as an insightful resource for practitioners who seek to integrate ChatGPT into education and stimulate further research in the field.

Data availability

The data supporting our findings are available upon request.

Abbreviations

• Artificial intelligence

AI in education

Large language model

Artificial neural networks

Chat Generative Pre-Trained Transformer

Recurrent neural networks

Long short-term memory

Reinforcement learning from human feedback

Natural language processing

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

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The process of synthesizing the data presented in Table  4 involved identifying the relevant studies through a search process of databases (ERIC, Scopus, Web of Knowledge, Dimensions.ai, and lens.org) using specific keywords "ChatGPT" and "education". Following this, inclusion/exclusion criteria were applied, and data extraction was performed using Creswell's [ 15 ] coding techniques to capture key information and identify common themes across the included studies.

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Systematic literature review of real-world evidence for treatments in HR+/HER2- second-line LABC/mBC after first-line treatment with CDK4/6i

• Veronique Lambert   ORCID: orcid.org/0000-0002-6984-0038 1 ,
• Sarah Kane   ORCID: orcid.org/0009-0006-9341-4836 2   na1 ,
• Belal Howidi   ORCID: orcid.org/0000-0002-1166-7631 2   na1 ,
• Bao-Ngoc Nguyen   ORCID: orcid.org/0000-0001-6026-2270 2   na1 ,
• David Chandiwana   ORCID: orcid.org/0009-0002-3499-2565 3 ,
• Yan Wu   ORCID: orcid.org/0009-0008-3348-9232 1 ,
• Michelle Edwards   ORCID: orcid.org/0009-0001-4292-3140 3 &
• Imtiaz A. Samjoo   ORCID: orcid.org/0000-0003-1415-8055 2   na1  

BMC Cancer volume  24 , Article number:  631 ( 2024 ) Cite this article

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Cyclin-dependent kinase 4 and 6 inhibitors (CDK4/6i) combined with endocrine therapy (ET) are currently recommended by the National Comprehensive Cancer Network (NCCN) guidelines and the European Society for Medical Oncology (ESMO) guidelines as the first-line (1 L) treatment for patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, locally advanced/metastatic breast cancer (HR+/HER2- LABC/mBC). Although there are many treatment options, there is no clear standard of care for patients following 1 L CDK4/6i. Understanding the real-world effectiveness of subsequent therapies may help to identify an unmet need in this patient population. This systematic literature review qualitatively synthesized effectiveness and safety outcomes for treatments received in the real-world setting after 1 L CDK4/6i therapy in patients with HR+/ HER2- LABC/mBC.

MEDLINE®, Embase, and Cochrane were searched using the Ovid® platform for real-world evidence studies published between 2015 and 2022. Grey literature was searched to identify relevant conference abstracts published from 2019 to 2022. The review was conducted in accordance with PRISMA guidelines (PROSPERO registration: CRD42023383914). Data were qualitatively synthesized and weighted average median real-world progression-free survival (rwPFS) was calculated for NCCN/ESMO-recommended post-1 L CDK4/6i treatment regimens.

Twenty records (9 full-text articles and 11 conference abstracts) encompassing 18 unique studies met the eligibility criteria and reported outcomes for second-line (2 L) treatments after 1 L CDK4/6i; no studies reported disaggregated outcomes in the third-line setting or beyond. Sixteen studies included NCCN/ESMO guideline-recommended treatments with the majority evaluating endocrine-based therapy; five studies on single-agent ET, six studies on mammalian target of rapamycin inhibitors (mTORi) ± ET, and three studies with a mix of ET and/or mTORi. Chemotherapy outcomes were reported in 11 studies. The most assessed outcome was median rwPFS; the weighted average median rwPFS was calculated as 3.9 months (3.3-6.0 months) for single-agent ET, 3.6 months (2.5–4.9 months) for mTORi ± ET, 3.7 months for a mix of ET and/or mTORi (3.0–4.0 months), and 6.1 months (3.7–9.7 months) for chemotherapy. Very few studies reported other effectiveness outcomes and only two studies reported safety outcomes. Most studies had heterogeneity in patient- and disease-related characteristics.

Conclusions

The real-world effectiveness of current 2 L treatments post-1 L CDK4/6i are suboptimal, highlighting an unmet need for this patient population.

Peer Review reports

Introduction

Breast cancer (BC) is the most diagnosed form of cancer in women with an estimated 2.3 million new cases diagnosed worldwide each year [ 1 ]. BC is the second leading cause of cancer death, accounting for 685,000 deaths worldwide per year [ 2 ]. By 2040, the global burden associated with BC is expected to surpass three million new cases and one million deaths annually (due to population growth and aging) [ 3 ]. Numerous factors contribute to global disparities in BC-related mortality rates, including delayed diagnosis, resulting in a high number of BC cases that have progressed to locally advanced BC (LABC) or metastatic BC (mBC) [ 4 , 5 , 6 ]. In the United States (US), the five-year survival rate for patients who progress to mBC is three times lower (31%) than the overall five-year survival rate for all stages (91%) [ 6 , 7 ].

Hormone receptor (HR) positive (i.e., estrogen receptor and/or progesterone receptor positive) coupled with negative human epidermal growth factor 2 (HER2) expression is the most common subtype of BC, accounting for ∼ 60–70% of all BC cases [ 8 , 9 ]. Historically, endocrine therapy (ET) through estrogen receptor modulation and/or estrogen deprivation has been the standard of care for first-line (1 L) treatment of HR-positive/HER2-negative (HR+/HER2-) mBC [ 10 ]. However, with the approval of the cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) palbociclib in combination with the aromatase inhibitor (AI) letrozole in 2015 by the US Food and Drug Administration (FDA), 1 L treatment practice patterns have evolved such that CDK4/6i (either in combination with AIs or with fulvestrant) are currently considered the standard of care [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Other CDK4/6i (ribociclib and abemaciclib) in combination with ET are approved for the treatment of HR+/HER2- LABC/mBC; 1 L use of ribociclib in combination with an AI was granted FDA approval in March 2017 for postmenopausal women (with expanded approval in July 2018 for pre/perimenopausal women and for use in 1 L with fulvestrant for patients with disease progression on ET as well as for postmenopausal women), and abemaciclib in combination with fulvestrant was granted FDA approval in September 2017 for patients with disease progression following ET and as monotherapy in cases where disease progression occurs following ET and prior chemotherapy in mBC (with expanded approval in February 2018 for use in 1 L in combination with an AI for postmenopausal women) [ 18 , 19 , 20 , 21 ].

Clinical trials investigating the addition of CDK4/6i to ET have demonstrated significant improvement in progression-free survival (PFS) and significant (ribociclib) or numerical (palbociclib and abemaciclib) improvement in overall survival (OS) compared to ET alone in patients with HR+/HER2- advanced or mBC, making this combination treatment the recommended option in the 1 L setting [ 22 , 23 , 24 , 25 , 26 , 27 ]. However, disease progression occurs in a significant portion of patients after 1 L CDK4/6i treatment [ 28 ] and the optimal treatment sequence after progression on CDK4/6i remains unclear [ 29 ]. At the time of this review (literature search conducted December 14, 2022), guidelines by the National Comprehensive Cancer Network (NCCN) and the European Society for Medical Oncology (ESMO) recommend various options for the treatment of HR+/HER2- advanced BC in the second-line (2 L) setting, including fulvestrant monotherapy, mammalian target of rapamycin inhibitors (mTORi; e.g., everolimus) ± ET, alpelisib + fulvestrant (if phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha mutation positive [PIK3CA-m+]), poly-ADP ribose polymerase inhibitors (PARPi) including olaparib or talazoparib (if breast cancer gene/partner and localizer of BRCA2 positive [BRCA/PALB2m+]), and chemotherapy (in cases when a visceral crisis is present) [ 15 , 16 ]. CDK4/6i can also be used in 2 L [ 16 , 30 ]; however, limited data are available to support CDK4/6i rechallenge after its use in the 1 L setting [ 15 ]. Depending on treatments used in the 1 L and 2 L settings, treatment in the third-line setting is individualized based on the patient’s response to prior treatments, tumor load, duration of response, and patient preference [ 9 , 15 ]. Understanding subsequent treatments after 1 L CDK4/6i, and their associated effectiveness, is an important focus in BC research.

Treatment options for HR+/HER2- LABC/mBC continue to evolve, with ongoing research in both clinical trials and in the real-world setting. Real-world evidence (RWE) offers important insights into novel therapeutic regimens and the effectiveness of treatments for HR+/HER2- LABC/mBC. The effectiveness of the current treatment options following 1 L CDK4/6i therapy in the real-world setting highlights the unmet need in this patient population and may help to drive further research and drug development. In this study, we conducted a systematic literature review (SLR) to qualitatively summarize the effectiveness and safety of treatment regimens in the real-world setting after 1 L treatment with CDK4/6i in patients with HR+/HER2- LABC/mBC.

Literature search

An SLR was performed in accordance with the Cochrane Handbook for Systematic Reviews of Interventions [ 31 ] and reported in alignment with the Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses (PRISMA) statement [ 32 ] to identify all RWE studies assessing the effectiveness and safety of treatments used for patients with HR+/HER2- LABC/mBC following 1 L CDK4/6i therapy and received subsequent treatment in 2 L and beyond (2 L+). The Ovid® platform was used to search MEDLINE® (including Epub Ahead of Print and In-Process, In-Data-Review & Other Non-Indexed Citations), Ovid MEDLINE® Daily, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews by an experienced medical information specialist. The MEDLINE® search strategy was peer-reviewed independently by a senior medical information specialist before execution using the Peer Review of Electronic Search Strategies (PRESS) checklist [ 33 ]. Searches were conducted on December 14, 2022. The review protocol was developed a priori and registered with the International Prospective Register of Systematic Review (PROSPERO; CRD42023383914) which outlined the population, intervention, comparator, outcome, and study design (PICOS) criteria and methodology used to conduct the review (Table  1 ).

Search strategies utilized a combination of controlled vocabulary (e.g., “HER2 Breast Cancer” or “HR Breast Cancer”) and keywords (e.g., “Retrospective studies”). Vocabulary and syntax were adjusted across databases. Published and validated filters were used to select for study design and were supplemented using additional medical subject headings (MeSH) terms and keywords to select for RWE and nonrandomized studies [ 34 ]. No language restrictions were included in the search strategy. Animal-only and opinion pieces were removed from the results. The search was limited to studies published between January 2015 and December 2022 to reflect the time at which FDA approval was granted for the first CDK4/6i agent (palbociclib) in combination with AI for the treatment of LABC/mBC [ 35 ]. Further search details are presented in Supplementary Material 1 .

Grey literature sources were also searched to identify relevant abstracts and posters published from January 2019 to December 2022 for prespecified relevant conferences including ESMO, San Antonio Breast Cancer Symposium (SABCS), American Society of Clinical Oncology (ASCO), the International Society for Pharmacoeconomics and Outcomes Research (ISPOR US), and the American Association for Cancer Research (AACR). A search of ClinicalTrials.gov was conducted to validate the findings from the database and grey literature searches.

Study selection, data extraction & weighted average calculation

Studies were screened for inclusion using DistillerSR Version 2.35 and 2.41 (DistillerSR Inc. 2021, Ottawa, Canada) by two independent reviewers based on the prespecified PICOS criteria (Table  1 ). A third reviewer was consulted to resolve any discrepancies during the screening process. Studies were included if they reported RWE on patients aged ≥ 18 years with HR+/HER2- LABC/mBC who received 1 L CDK4/6i treatment and received subsequent treatment in 2 L+. Studies were excluded if they reported the results of clinical trials (i.e., non-RWE), were published in any language other than English, and/or were published prior to 2015 (or prior to 2019 for conference abstracts and posters). For studies that met the eligibility criteria, data relating to study design and methodology, details of interventions, patient eligibility criteria and baseline characteristics, and outcome measures such as efficacy, safety, tolerability, and patient-reported outcomes (PROs), were extracted (as available) using a Microsoft Excel®-based data extraction form (Microsoft Corporation, WA, USA). Data extraction was performed by a single reviewer and was confirmed by a second reviewer. Multiple publications identified for the same RWE study, patient population, and setting that reported data for the same intervention were linked and extracted as a single publication. Weighted average median real-world progression-free survival (rwPFS) values were calculated by considering the contribution to the median rwPFS of each study proportional to its respective sample size. These weighted values were then used to compute the overall median rwPFS estimate.

Quality assessment

The Newcastle-Ottawa scale (NOS) for nonrandomized (cohort) studies was used to assess the risk of bias for published, full-text studies [ 36 ]. The NOS allocates a maximum of nine points for the least risk of bias across three domains: (1) Formation of study groups (four points), (2) Comparability between study groups (two points), (3) Outcome ascertainment (three points). NOS scores can be categorized in three groups: very high risk of bias (0 to 3 points), high risk of bias (4 to 6), and low risk of bias (7 to 9) [ 37 ]. Risk of bias assessment was performed by one reviewer and validated by a second independent reviewer to verify accuracy. Due to limited methodological data by which to assess study quality, risk of bias assessment was not performed on conference abstracts or posters. An amendment to the PROSPERO record (CRD42023383914) for this study was submitted in relation to the quality assessment method (specifying usage of the NOS).

The database search identified 3,377 records; after removal of duplicates, 2,759 were screened at the title and abstract stage of which 2,553 were excluded. Out of the 206 reports retrieved and assessed for eligibility, an additional 187 records were excluded after full-text review; most of these studies were excluded for having patients with mixed lines of CDK4/6i treatment (i.e., did not receive CDK4/6i exclusively in 1 L) (Fig.  1 and Table S1 ). The grey literature search identified 753 records which were assessed for eligibility; of which 752 were excluded mainly due to the population not meeting the eligibility criteria (Fig.  1 ). In total, the literature searches identified 20 records (9 published full-text articles and 11 conference abstracts/posters) representing 18 unique RWE studies that met the inclusion criteria. The NOS quality scores for the included full-text articles are provided in Table S2 . The scores ranged from four to six points (out of a total score of nine) and the median score was five, indicating that all the studies suffered from a high risk of bias [ 37 ].

Most studies were retrospective analyses of chart reviews or medical registries, and all studies were published between 2017 and 2022 (Table S3 ). Nearly half of the RWE studies (8 out of 18 studies) were conducted in the US [ 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ], while the remaining studies included sites in Canada, China, Germany, Italy, Japan, and the United Kingdom [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. Sample sizes ranged from as few as 4 to as many as 839 patients across included studies, with patient age ranging from 26 to 86 years old.

Although treatment characteristics in the 1 L setting were not the focus of the present review, these details are captured in Table S3 . Briefly, several RWE studies reported 1 L CDK4/6i use in combination with ET (8 out of 18 studies) or as monotherapy (2 out of 18 studies) (Table S3 ). Treatments used in combination with 1 L CDK4/6i included letrozole, fulvestrant, exemestane, and anastrozole. Where reported (4 out of 18 studies), palbociclib was the most common 1 L CDK4/6i treatment. Many studies (8 out of 18 studies) did not report which specific CDK4/6i treatment(s) were used in 1 L or if its administration was in combination or monotherapy.

Characteristics of treatments after 1 L CDK4/6i therapy

Across all studies included in this review, effectiveness and safety data were only available for treatments administered in the 2 L setting after 1 L CDK4/6i treatment. No studies were identified that reported outcomes for patients treated in the third-line setting or beyond after 1 L CDK4/6i treatment. All 18 studies reported effectiveness outcomes in 2 L, with only two of these studies also describing 2 L safety outcomes. The distribution of outcomes reported in these studies is provided in Table S4 . Studies varied in their reporting of outcomes for 2 L treatments; some studies reported outcomes for a group of 2 L treatments while others described independent outcomes for specific 2 L treatments (i.e., everolimus, fulvestrant, or chemotherapy agents such as eribulin mesylate) [ 42 , 45 , 50 , 54 , 55 ]. Due to the heterogeneity in treatment classes reported in these studies, this data was categorized (as described below) to align with the guidelines provided by NCCN and ESMO [ 15 , 16 ]. The treatment class categorizations for the purpose of this review are: single-agent ET (patients who exclusively received a single-agent ET after 1 L CDK4/6i treatment), mTORi ± ET (patients who exclusively received an mTORi with or without ET after 1 L CDK4/6i treatment), mix of ET and/or mTORi (patients who may have received only ET, only mTORi, and/or both treatments but the studies in this group lacked sufficient information to categorize these patients in the “single-agent ET” or “mTOR ± ET” categories), and chemotherapy (patients who exclusively received chemotherapy after 1 L CDK4/6i treatment). Despite ESMO and NCCN guidelines indicating that limited evidence exists to support rechallenge with CDK4/6i after 1 L CDK4/6i treatment [ 15 , 16 ], two studies reported outcomes for this treatment approach. Data for such patients were categorized as “ CDK4/6i ± ET ” as it was unclear how many patients receiving CDK4/6i rechallenge received concurrent ET. All other patient groups that lacked sufficient information or did not report outcome/safety data independently (i.e., grouped patients with mixed treatments) to categorize as one of the treatment classes described above were grouped as “ other ”.

The majority of studies reported effectiveness outcomes for endocrine-based therapy after 1 L CDK4/6i treatment; five studies for single-agent ET, six studies for mTORi ± ET, and three studies for a mix of ET and/or mTORi (Fig.  2 ). Eleven studies reported effectiveness outcomes for chemotherapy after 1 L CDK4/6i treatment, and only two studies reported effectiveness outcomes for CDK4/6i rechallenge ± ET. Eight studies that described effectiveness outcomes were grouped into the “other” category. Safety data was only reported in two studies: one study evaluating the chemotherapy agent eribulin mesylate and one evaluating the mTORi everolimus.

Effectiveness outcomes

Real-world progression-free survival

Median rwPFS was described in 13 studies (Tables  2 and Table S5 ). Across the 13 studies, the median rwPFS ranged from 2.5 months [ 49 ] to 17.3 months [ 39 ]. Out of the 13 studies reporting median rwPFS, 10 studies reported median rwPFS for a 2 L treatment recommended by ESMO and NCCN guidelines, which ranged from 2.5 months [ 49 ] to 9.7 months [ 45 ].

Weighted average median rwPFS was calculated for 2 L treatments recommended by both ESMO and NCCN guidelines (Fig.  3 ). The weighted average median rwPFS for single-agent ET was 3.9 months ( n  = 92 total patients) and was derived using data from two studies reporting median rwPFS values of 3.3 months ( n  = 70) [ 38 ] and 6.0 months ( n  = 22) [ 40 ]. For one study ( n  = 7) that reported outcomes for single agent ET, median rwPFS was not reached during the follow-up period; as such, this study was excluded from the weighted average median rwPFS calculation [ 49 ].

The weighted average median rwPFS for mTORi ± ET was 3.6 months ( n  = 128 total patients) and was derived based on data from 3 studies with median rwPFS ranging from 2.5 months ( n  = 4) [ 49 ] to 4.9 months ( n  = 25) [ 54 ] (Fig.  3 ). For patients who received a mix of ET and/or mTORi but could not be classified into the single-agent ET or mTORi ± ET treatment classes, the weighted average median rwPFS was calculated to be 3.7 months ( n  = 17 total patients). This was calculated based on data from two studies reporting median rwPFS values of 3.0 months ( n  = 5) [ 46 ] and 4.0 months ( n  = 12) [ 49 ]. Notably, one study of patients receiving ET and/or everolimus reported a median rwPFS duration of 3.0 months; however, this study was excluded from the weighted average median rwPFS calculation for the ET and/or mTORi class as the sample size was not reported [ 53 ].

The weighted average median rwPFS for chemotherapy was 6.1 months ( n  = 499 total patients), calculated using data from 7 studies reporting median rwPFS values ranging from 3.7 months ( n  = 249) [ 38 ] to 9.7 months ( n  = 121) [ 45 ] (Fig.  3 ). One study with a median rwPFS duration of 5.6 months was not included in the weighted average median rwPFS calculation as the study did not report the sample size [ 53 ]. A second study was excluded from the calculation since the reported median rwPFS was not reached during the study period ( n  = 7) [ 41 ].

Although 2 L CDK4/6i ± ET rechallenge lacks sufficient information to support recommendation by ESMO and NCCN guidelines, the limited data currently available for this treatment have shown promising results. Briefly, two studies reported median rwPFS for CDK4/6i ± ET with values of 8.3 months ( n  = 302) [ 38 ] and 17.3 months ( n  = 165) (Table  2 ) [ 39 ]. The remaining median rwPFS studies reported data for patients classified as “Other” (Table S5 ). The “Other” category included median rwPFS outcomes from seven studies, and included a myriad of treatments (e.g., ET, mTOR + ET, chemotherapy, CDK4/6i + ET, alpelisib + fulvestrant, chidamide + ET) for which disaggregated median rwPFS values were not reported.

Overall survival

Median OS for 2 L treatment was reported in only three studies (Table  2 ) [ 38 , 42 , 43 ]. Across the three studies, the 2 L median OS ranged from 5.2 months ( n  = 3) [ 43 ] to 35.7 months ( n  = 302) [ 38 ]. Due to the lack of OS data in most of the studies, weighted averages could not be calculated. No median OS data was reported for the single-agent ET treatment class whereas two studies reported median OS for the mTORi ± ET treatment class, ranging from 5.2 months ( n  = 3) [ 43 ] to 21.8 months ( n  = 54) [ 42 ]. One study reported 2 L median OS of 24.8 months for a single patient treated with chemotherapy [ 43 ]. The median OS data in the CDK4/6i ± ET rechallenge group was 35.7 months ( n  = 302) [ 38 ].

Patient mortality was reported in three studies [ 43 , 44 , 45 ]. No studies reported mortality for the single-agent ET treatment class and only one study reported this outcome for the mTORi ± ET treatment class, where 100% of patients died ( n  = 3) as a result of rapid disease progression [ 43 ]. For the chemotherapy class, one study reported mortality for one patient receiving 2 L capecitabine [ 43 ]. An additional study reported eight deaths (21.7%) following 1 L CDK4/6i treatment; however, this study did not disclose the 2 L treatments administered to these patients [ 44 ].

Other clinical endpoints

The studies included limited information on additional clinical endpoints; two studies reported on time-to-discontinuation (TTD), two reported on duration of response (DOR), and one each on time-to-next-treatment (TTNT), time-to-progression (TTP), objective response rate (ORR), clinical benefit rate (CBR), and stable disease (Tables  2 and Table S5 ).

Safety, tolerability, and patient-reported outcomes

Safety and tolerability data were reported in two studies [ 40 , 45 ]. One study investigating 2 L administration of the chemotherapy agent eribulin mesylate reported 27 patients (22.3%) with neutropenia, 3 patients (2.5%) with febrile neutropenia, 10 patients (8.3%) with peripheral neuropathy, and 14 patients (11.6%) with diarrhea [ 45 ]. Of these, neutropenia of grade 3–4 severity occurred in 9 patients (33.3%) [ 45 ]. A total of 55 patients (45.5%) discontinued eribulin mesylate treatment; 1 patient (0.83%) discontinued treatment due to adverse events [ 45 ]. Another study reported that 5 out of the 22 patients receiving the mTORi everolimus combined with ET in 2 L (22.7%) discontinued treatment due to toxicity [ 40 ]. PROs were not reported in any of the studies included in the SLR.

The objective of this study was to summarize the existing RWE on the effectiveness and safety of therapies for patients with HR+/HER2- LABC/mBC after 1 L CDK4/6i treatment. We identified 18 unique studies reporting specifically on 2 L treatment regimens after 1 L CDK4/6i treatment. The weighted average median rwPFS for NCCN- and ESMO- guideline recommended 2 L treatments ranged from 3.6 to 3.9 months for ET-based treatments and was 6.1 months when including chemotherapy-based regimens. Treatment selection following 1 L CDK4/6i therapy remains challenging primarily due to the suboptimal effectiveness or significant toxicities (e.g., chemotherapy) associated with currently available options [ 56 ]. These results highlight that currently available 2 L treatments for patients with HR+/HER2- LABC/mBC who have received 1 L CDK4/6i are suboptimal, as evidenced by the brief median rwPFS duration associated with ET-based treatments, or notable side effects and toxicity linked to chemotherapy. This conclusion is aligned with a recent review highlighting the limited effectiveness of treatment options for HR+/HER2- LABC/mBC patients post-CDK4/6i treatment [ 56 , 57 ]. Registrational trials which have also shed light on the short median PFS of 2–3 months achieved by ET (i.e., fulvestrant) after 1 L CDK4/6i therapy emphasize the need to develop improved treatment strategies aimed at prolonging the duration of effective ET-based treatment [ 56 ].

The results of this review reveal a paucity of additional real-world effectiveness and safety evidence after 1 L CDK4/6i treatment in HR+/HER2- LABC/mBC. OS and DOR were only reported in two studies while other clinical endpoints (i.e., TTD, TTNT, TTP, ORR, CBR, and stable disease) were only reported in one study each. Similarly, safety and tolerability data were only reported in two studies each, and PROs were not reported in any study. This hindered our ability to provide a comprehensive assessment of real-world treatment effectiveness and safety following 1 L CDK4/6i treatment. The limited evidence may be due to the relatively short period of time that has elapsed since CDK4/6i first received US FDA approval for 1 L treatment of HR+/HER2- LABC/mBC (2015) [ 35 ]. As such, almost half of our evidence was informed by conference abstracts. Similarly, no real-world studies were identified in our review that reported outcomes for treatments in the third- or later-lines of therapy after 1 L CDK4/6i treatment. The lack of data in this patient population highlights a significant gap which limits our understanding of the effectiveness and safety for patients receiving later lines of therapy. As more patients receive CDK4/6i therapy in the 1 L setting, the number of patients requiring subsequent lines of therapy will continue to grow. Addressing this data gap over time will be critical to improve outcomes for patients with HR+/HER2- LABC/mBC following 1 L CDK4/6i therapy.

There are several strengths of this study, including adherence to the guidelines outlined in the Cochrane Handbook to ensure a standardized and reliable approach to the SLR [ 58 ] and reporting of the SLR following PRISMA guidelines to ensure transparency and reproducibility [ 59 ]. Furthermore, the inclusion of only RWE studies allowed us to assess the effectiveness of current standard of care treatments outside of a controlled environment and enabled us to identify an unmet need in this patient population.

This study had some notable limitations, including the lack of safety and additional effectiveness outcomes reported. In addition, the dearth of studies reporting PROs is a limitation, as PROs provide valuable insight into the patient experience and are an important aspect of assessing the impact of 2 L treatments on patients’ quality of life. The studies included in this review also lacked consistent reporting of clinical characteristics (e.g., menopausal status, sites of metastasis, prior surgery) making it challenging to draw comprehensive conclusions or comparisons based on these factors across the studies. Taken together, there exists an important gap in our understanding of the long-term management of patients with HR+/HER2- LABC/mBC. Additionally, the effectiveness results reported in our evidence base were informed by small sample sizes; many of the included studies reported median rwPFS based on less than 30 patients [ 39 , 40 , 41 , 46 , 49 , 51 , 60 ], with two studies not reporting the sample size at all [ 47 , 53 ]. This may impact the generalizability and robustness of the results. Relatedly, the SLR database search was conducted in December 2022; as such, novel agents (e.g., elacestrant and capivasertib + fulvestrant) that have since received FDA approval for the treatment of HR+/HER2- LABC/mBC may impact current 2 L rwPFS outcomes [ 61 , 62 ]. Finally, relative to the number of peer-reviewed full-text articles, this SLR identified eight abstracts and one poster presentation, comprising half (50%) of the included unique studies. As conference abstracts are inherently limited by how much content that can be described due to word limit constraints, this likely had implications on the present synthesis whereby we identified a dearth of real-world effectiveness outcomes in patients with HR+/HER2- LABC/mBC treated with 1 L CDK4/6i therapy.

Future research in this area should aim to address the limitations of the current literature and provide a more comprehensive understanding of optimal sequencing of effective and safe treatment for patients following 1 L CDK4/6i therapy. Specifically, future studies should strive to report robust data related to effectiveness, safety, and PROs for patients receiving 2 L treatment after 1 L CDK4/6i therapy. Future studies should also aim to understand the mechanism underlying CDK4/6i resistance. Addressing these gaps in knowledge may improve the long-term real-world management of patients with HR+/HER2- LABC/mBC. A future update of this synthesis may serve to capture a wider breadth of full-text, peer-reviewed articles to gain a more robust understanding of the safety, effectiveness, and real-world treatment patterns for patients with HR+/HER2- LABC/mBC. This SLR underscores the necessity for ongoing investigation and the development of innovative therapeutic approaches to address these gaps and improve patient outcomes.

This SLR qualitatively summarized the existing real-world effectiveness data for patients with HR+/HER2- LABC/mBC after 1 L CDK4/6i treatment. Results of this study highlight the limited available data and the suboptimal effectiveness of treatments employed in the 2 L setting and underscore the unmet need in this patient population. Additional studies reporting effectiveness and safety outcomes, in addition to PROs, for this patient population are necessary and should be the focus of future research.

PRISMA flow diagram. *Two included conference abstracts reported the same information as already included full-text reports, hence both conference abstracts were not identified as unique. Abbreviations: 1 L = first-line; AACR = American Association of Cancer Research; ASCO = American Society of Clinical Oncology; CDK4/6i = cyclin-dependent kinase 4/6 inhibitor; ESMO = European Society for Medical Oncology; ISPOR = Professional Society for Health Economics and Outcomes Research; n = number of studies; NMA = network meta-analysis; pts = participants; SABCS = San Antonio Breast Cancer Symposium; SLR = systematic literature review.

Number of studies reporting effectiveness outcomes exclusively for each treatment class. *Studies that lack sufficient information on effectiveness outcomes to classify based on the treatment classes outlined in the legend above. Abbreviations: CDK4/6i = cyclin-dependent kinase 4/6 inhibitor; ET = endocrine therapy; mTORi = mammalian target of rapamycin inhibitor.

Weighted average median rwPFS for 2 L treatments (recommended in ESMO/NCCN guidelines) after 1 L CDK4/6i treatment. Circular dot represents weighted average median across studies. Horizontal bars represent the range of values reported in these studies. Abbreviations: CDK4/6i = cyclin-dependent kinase 4/6 inhibitor; ESMO = European Society for Medical Oncology; ET = endocrine therapy, mTORi = mammalian target of rapamycin inhibitor; n = number of patients; NCCN = National Comprehensive Cancer Network; rwPFS = real-world progression-free survival.

Data availability

All data generated or analyzed during this study are included in this published article [and its supplementary information files]. This study is registered with PROSPERO (CRD42023383914).

Abbreviations

Second-line

Second-line treatment setting and beyond

American Association of Cancer Research

Aromatase inhibitor

American Society of Clinical Oncology

• Breast cancer

breast cancer gene/partner and localizer of BRCA2 positive

Clinical benefit rate

Cyclin-dependent kinase 4/6 inhibitor

Complete response

Duration of response

European Society for Medical Oncology

Food and Drug Administration

Human epidermal growth factor receptor 2

Human epidermal growth factor receptor 2 negative

Hormone receptor

Hormone receptor positive

Professional Society for Health Economics and Outcomes Research

Locally advanced breast cancer

Metastatic breast cancer

Medical Literature Analysis and Retrieval System Online

Medical subject headings

Mammalian target of rapamycin inhibitor

National Comprehensive Cancer Network

Newcastle Ottawa Scale

Objective response rate

Poly-ADP ribose polymerase inhibitor

Progression-free survival

Population, Intervention, Comparator, Outcome, Study Design

Partial response

Preferred Reporting Items for Systematic Literature Reviews and Meta-Analyses

Patient-reported outcomes

• Real-world evidence

San Antonio Breast Cancer Symposium

• Systematic literature review

Time-to-discontinuation

Time-to-next-treatment

Time-to-progression

United States

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Acknowledgements

The authors would like to acknowledge Joanna Bielecki who developed, conducted, and documented the database searches.

This study was funded by Pfizer Inc. (New York, NY, USA) and Arvinas (New Haven, CT, USA).

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Sarah Kane, Belal Howidi, Bao-Ngoc Nguyen and Imtiaz A. Samjoo contributed equally to this work.

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Veronique Lambert & Yan Wu

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Sarah Kane, Belal Howidi, Bao-Ngoc Nguyen & Imtiaz A. Samjoo

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VL, IAS, SK, BH, BN, DC, YW, and ME participated in the conception and design of the study. IAS, SK, BH and BN contributed to the literature review, data collection, analysis, and interpretation of the data. VL, IAS, SK, BH, BN, DC, YW, and ME contributed to the interpretation of the data and critically reviewed for the importance of intellectual content for the work. VL, IAS, SK, BH, BN, DC, YW, and ME were responsible for drafting or reviewing the manuscript and for providing final approval. VL, IAS, SK, BH, BN, DC, YW, and ME meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work, and have given their approval for this version to be published.

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The authors of this manuscript declare that the research presented was funded by Pfizer Inc. and Arvinas. While the support from Pfizer Inc. and Arvinas was instrumental in facilitating this research, the authors affirm that their interpretation of the data and the content of this manuscript were conducted independently and without bias to maintain the transparency and integrity of the research. IAS, SK, BH, and BN are employees of EVERSANA, Canada, which was a paid consultant to Pfizer in connection with the development of this manuscript.

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Lambert, V., Kane, S., Howidi, B. et al. Systematic literature review of real-world evidence for treatments in HR+/HER2- second-line LABC/mBC after first-line treatment with CDK4/6i. BMC Cancer 24 , 631 (2024). https://doi.org/10.1186/s12885-024-12269-8

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DOI : https://doi.org/10.1186/s12885-024-12269-8

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