INTRODUCTION
When embarking on a research project, it is well known that conducting a literature review is essential for framing the study and effectively identifying gaps in knowledge to guide the next stages of a research project. This process can be particularly challenging for early career researchers, who may have a research question or concern about a concept or phenomenon but struggle to decide where to start. Given the vast amount of research available, methods of evidence synthesis have evolved to consolidate findings and make knowledge from multiple studies more accessible to the research community. The development of numerous classification systems and terminologies to help clarify and categorise different types of review makes this selection more difficult, evidenced by the work of Grant and Booth, who developed a typology of 14 different types of review (Booth et al., 2016; Grant & Booth, 2009), and a more recent publication that identified 48 types of review (Sutton et al., 2019).
Scoping reviews are a type of evidence synthesis that is increasingly favoured for research in the health sciences, and particularly in nursing, because they provide a flexible approach to synthesising diverse evidence and are a good starting point for addressing a research problem (Wang et al., 2024; Woo et al., 2023). Although there are many guidelines for conducting a scoping review, they often lack the detailed information and experiential insights that can only be gained by applying them.
The paper draws from our knowledge as two doctoral candidates (TO, NL) undertaking a scoping review as part of our healthcare research. In the first case, TO’s overall research topic concerned how the multidimensional construct of ‘career growth’ could be applied to nurses in healthcare organisations. In the second case, NL’s research explored psychological interventions that can reduce the fear of cancer recurrence in cancer patients. Although our research questions were very different, there were similarities in the challenges faced. We each did a preliminary search and found that there was a lot of research related to the construct and interventions of interest. The information in the articles led us in many different directions, and instead of the knowledge gap related to each of our research topics becoming clearer, it became less clear. The information available was rich, complex and varied, with different viewpoints and contradictions. In summary, our initial search was not helpful in further defining the research gaps we each wanted to explore.
In this paper, we aim to share our learnings to guide early career health researchers on choosing and using scoping reviews through four main sections: 1) when to choose a scoping review; 2) what are scoping reviews; 3) guidelines for conducting scoping reviews; and, 4) steps for conducting a scoping review. We draw on and summarise the most recent guidelines for conducting scoping reviews and the sequential steps involved. We also provide practical advice on how to apply the evidence synthesis methodology of scoping reviews.
WHEN TO CHOOSE A SCOPING REVIEW
When we began, our initial searches related to the concepts related to our particular focus of study. The first temptation was to propose a systematic review, thinking that this might bring more clarity to all that was known about our topics. However, a scoping review was more versatile than we thought for providing this clarity. In fact, a scoping review serves a number of purposes, including as a precursor to a systematic review (Pollock et al., 2021); to identify the types of evidence available in a particular area and to identify and analyse knowledge gaps (Peters et al., 2015); to clarify key concepts/definitions in the literature (Peters et al., 2021); to examine how research is conducted on a particular topic or field (Mak & Thomas, 2022; Peters et al., 2015); and to identify key characteristics or factors associated with a concept (Halabi et al., 2020).
But why not a systematic review? We began to explore the differences between a systematic review and a scoping review in more detail to determine what we needed to do to inform the next stages of our PhD programme. We reviewed key resources to understand the similarities and differences between the two types of reviews. Table 1 outlines our key findings. Overall, we found that a scoping review, with its broader inclusion criteria and iterative nature, allowed for a more comprehensive and exploratory search of the literature on a particular topic. In contrast, a systematic review is highly rigorous and answers a specific research question, often using the population-intervention-comparison-outcome (PICO) format (Aromataris et al., 2024). As a result, scoping reviews are often used to provide general guidance on the size and scope of the available literature and to support recommendations for future research, whereas systematic reviews are typically used to inform policy and practice (Pollock et al., 2021, 2024) and are the preferred method for determining the effectiveness of healthcare interventions or the accuracy of diagnostic tests (Campbell et al., 2015; Hoffmann et al., 2017).
After considering all these issues, we each decided to undertake a scoping review, but for different reasons. TO’s review question was related to nurses’ career growth, which is not a new topic. However, the extent to which the concept had been explored in nursing was unclear, so her scoping review was driven by the need to organise and update understanding and practice in relation to nursing. This knowledge was expected to be useful in identifying the actual career growth opportunities for nurses and their needs, as well as the extent of current research and relevant gaps. All this information would be used to inform the study of career pathways in a country where career progression has not been studied.
The aim of NL’s review was to examine the effectiveness of existing psychological interventions in reducing the fear of cancer recurrence in cancer survivors. NL conducted a scoping review to gain insight into the current landscape of interventions, their effectiveness and the characteristics of the interventions themselves. This approach intended to identify opportunities for the development and testing of psychological interventions in colorectal cancer patients and provide evidence of the research gap to inform the subsequent research.
In addition, we both found it useful to conduct a scoping review to clarify key concepts and definitions in the literature before embarking on our research projects. It was important to understand the basis of the concepts being explored, including the extent to which our definitions were being applied. This better prepared us to identify our research population and whether important perspectives were being overlooked, in terms of how the concepts were operationalised for practice and research.
WHAT ARE SCOPING REVIEWS?
When we decided to undertake a scoping review, we needed to be clear about what it was. Confusingly, some publications initially referred to scoping reviews as ‘systematic scoping reviews’ (Peters et al., 2015). However, it has since been argued that all reviews should adhere to systematic principles (Booth et al., 2016) and the term ‘systematic’ has subsequently been dropped. Scoping reviews had also been referred to as ‘mapping reviews’ or ‘scoping studies’ (Campbell et al., 2023; Khalil & Tricco, 2022). A scoping review is a type of evidence synthesis that aims to systematically identify and map the breadth of evidence available on a particular topic, area, concept or issue (Munn et al., 2022; Pollock et al., 2024). Scoping reviews can include broad types of sources, such as primary research, reviews and non-empirical evidence (Peters et al., 2021).
To help clarify the meaning of scoping reviews, we developed a fruit analogy to describe our understanding of the nature of scoping reviews at the time and to illustrate to others how they can be useful (Figure 1). Figure 1a shows many fruits, but it is not possible to say exactly what kind or colour they are. In Figure 1b, however, it is possible to see the type and colour of the fruits. Applying this thinking to the literature illustrates the ‘magic’ of a scoping review in revealing the nature, size and characteristics of the resources it identifies. To illustrate, Figure 1a shows how we felt when setting the direction for our respective research programmes, with the fruit representing all the literature available on our topic. However, we needed a systematic approach to mapping the range of literature on our topics; to stay with the fruit analogy, to systematically identify the exact nature, colour and type of fruit.
GUIDELINES FOR CONDUCTING SCOPING REVIEWS
We also found that guidelines for conducting scoping reviews had continued to evolve (Figure 2). The first framework for conducting a scoping review was proposed by Arksey and O’Malley (2005). However, this approach was criticised for lacking methodological clarity, particularly in relation to data analysis. Subsequently, in 2015, the Joanna Briggs Institute (JBI) developed guidance for scoping reviews through an expert working group (Peters et al., 2015), and in 2018, the Preferred Reporting Items for Systematic Reviews (PRISMA) statement was extended to include scoping reviews - the PRISMA-ScR (Tricco et al., 2018). The latest available edition of the JBI Evidence Synthesis Manual was published in March 2024 (Aromataris et al., 2024). We used the 2024 JBI guidelines to guide the process and PRISMA-ScR to guide writing the research report, as these were the most rigorous methodological resources available to date.
STEPS FOR CONDUCTING A SCOPING REVIEW
This section summarises the systematic steps involved in conducting a scoping review based on the JBI guidelines (Aromataris et al., 2024).
First step: Identifying the research question
This step involves defining the broad topic or issue of interest, specifying the aim to be achieved by the review, and formulating a clear, focused question or questions that outline the scope of the review (Mak & Thomas, 2022). In this step, we each identified a primary review question and several secondary research questions to guide the review (Table 2). Each question served a different purpose.
Second step: Scoping review protocol
The scoping review protocol is the plan or blueprint for how the scoping review will be conducted. It must be completed before the review begins, as this step lays the foundation for the entire review process by determining what literature will be examined and how it will be analysed (Mak & Thomas, 2022). Peters et al. (2022) provided the most up-to-date guidance on how to develop a detailed protocol. Sections include: a) introduction, review objective and review questions; b) eligibility criteria, which must be presented in the population-concept-context framework and resources sought; and c) method, which details the search strategy, study selection, data extraction and data presentation.
We recommend allowing sufficient time for the process of drafting the protocol. Based on our experience, it took us over six weeks to complete the final versions. It is important to pay particular attention to detail when defining eligibility criteria and the search strategy. The eligibility criteria for resources need to align with the population-concept-context framework. This framework is recommended by JBI as a guide to constructing clear and meaningful eligibility criteria for a scoping review (Pollock et al., 2023). On the other hand, it is also necessary to ensure that the search strategy is as effective as possible. To give an example of how long it takes to develop a search strategy, we spent at least two weeks developing and testing our strategies, but this could be more or less depending on expertise, topic and extent of evidence. At this stage, working with an experienced librarian proved invaluable in refining our search strategies.
Protocol registration
It is highly recommended to register the protocol as it increases the transparency of the research methods. We chose to register our protocols in the Open Science Framework (OSF), available at https://osf.io, an online platform designed to facilitate collaboration and teamwork in scientific research. OSF has many valuable tools for managing research projects. However, we did not use all of them; each of us used the platform as a place to register our PhD projects and our respective scoping review protocols. Another option for registering protocols is Figshare (https://figshare.com/), an online repository where researchers can store, share and manage their research outputs, including datasets, figures, images, videos and other types of research-related content. In addition, scoping reviews are increasingly being published in peer-reviewed journals such as JBI Evidence Synthesis, BMJ Open, and the Journal of Research in Nursing. As well as promoting transparency, publication also promotes reproducibility, avoidance of duplication of research and stakeholder engagement through peer review prior to the start of a project. External peer review as part of the publication process is also an opportunity to improve the quality of research. Links to our protocols are provided as examples of a registered scoping review protocol: https://doi.org/10.17605/OSF.IO/NKUJB (TO) and https://doi.org/10.17605/OSF.IO/R5C43 (NL).
It is worth noting that it is possible for the protocol to be satisfactory at the start of the review process but may need to be modified later in the process. The process of conducting scoping reviews is iterative, and therefore, the protocol is not an infallible document. For example, when NL was developing the scoping review protocol, she initially intended to focus solely on participants with colorectal cancer. However, after conducting a preliminary search and discussing with her supervisory team, she expanded the participant criteria to include studies involving all adult cancer patients, including those with colorectal cancer. This decision was made due to the limited number of studies focusing exclusively on colorectal cancer and the opportunity to gain a broader understanding of effective interventions and potential options for managing fear of cancer recurrence—some of which have been found to be effective in other types of cancer. As we progress through our research, we will undoubtedly gain further insight into our related topics. This should prompt us to reconsider aspects of our approach, such as determining which evidence sources are most appropriate from both methodological and theoretical perspectives, and which sources will provide the information needed to develop and support the next stage of our research programme.
Third step: Identifying relevant studies and literature
As highlighted earlier, the search strategy, which details the process for identifying relevant studies, needs to be specified in the scoping review protocol. The first decision is to identify where to find information relevant to the topic, and the appropriate electronic databases, websites and repositories for grey literature (conference papers, reports, theses and dissertations) (Marsolek et al., 2018) and other relevant sources must be identified. We recommend considering: a) whether the information sources or databases are appropriate for the researcher’s area of study; b) selecting information sources that cover the topic in sufficient depth; and c) prioritising information sources with precise search functions to facilitate more accurate searches. According to these criteria, Embase, Medline and the Cochrane Central Register of Controlled Trials (CENTRAL) are commonly used high-quality databases. An additional consideration is that some databases overlap. For example, Medline and PubMed are known for their overlapping resources, so it is recommended to use only one of them.
Search engines use the words chosen by us in our search strategy as a filter, but there are as many articles, translations of terms, connotations and interpretations as there are authors. Therefore, researchers need to ensure that their search strategy includes synonyms, alternative words and spellings for key search terms. The use of MeSH (Medical Subject Headings) terms is a good way of overarching the relevant topics related to the subject, as they provide descriptors in a standardised hierarchical structure that allows searching at different levels of specificity. While MeSH headings are useful for navigating biomedical literature, they have limitations when exploring social science or Indigenous topics. They often reflect Western biomedical frameworks, may lack appropriate terms for culturally specific or emerging concepts, and may misclassify or underrepresent Indigenous perspectives.
Fourth step: Selecting studies to be included in the review
Applying the search strategy is only the tip of the iceberg. It is then necessary to continue with a systematic and transparent approach to the selection of studies for review. Typically, there are no less than two reviewers who carry out the screening independently. Therefore, before conducting title and abstract screening to identify relevant studies, it is important to ensure that researchers have an accurate and consistent understanding of the criteria, in addition to developing the protocol. For example, NL and TO created flowcharts with the inclusion and exclusion criteria for title and abstract screening and definitions. Figure 4 is an example of a flowchart (for NL’s research) created to standardise article selection decisions between screeners.
This fourth step starts with finding and eliminating duplicates. While this can be done in a Word document, an Excel spreadsheet, or a reference manager such as EndNote, it is a challenging task and can be aided by the use of technology. There are now web-based applications designed for conducting systematic reviews, such as Rayyan <https://rayyan.ai/ and Covidence <https://www.covidence.org/. We strongly recommend the systematic approach that these applications provide for conducting scoping reviews, particularly in the third and fourth steps. Although these technologies facilitate the process, the rationale for the inclusion or exclusion of articles should still be documented in detail as this will assist in the subsequent resolution of disagreements. We have used both platforms and have therefore had the opportunity to evaluate both tools and identify their advantages and disadvantages, which are summarised in the following section and in Table 3.
Step 4a. Import the sources found
Both Rayyan and Covidence are very useful for importing and exporting results after the search is completed in universal formats such as EndNote XML format, PubMed format and Research Information System (RIS). At this stage, NL started using Covidence and TO started using Rayann.
Step 4b. Identify and remove duplicates
For this purpose, Rayyan was the most user-friendly platform as it displayed the articles and details for possible duplicates to help the user to manually decide whether the articles are duplicates or not. It also has an automatic duplicate removal feature and it is possible to select the percentage of similarity between articles that are considered the same. In Covidence, duplicates are detected automatically, which can be inconvenient in cases where resources are part of the same study or have very similar titles.
Step 4c. Screening titles and abstracts
This step was similar on both platforms, as both allow the user to label articles, leave notes and highlight keywords. These features made it easier to visualise important information from each abstract in order to choose one source over another.
Step 4d. Resolving disagreements
Covidence was found to be a more useful tool for this step because it allowed the user to identify the reasons for exclusion and then to visualise the reasons for disagreement with other authors. NL was able to successfully complete the disagreement resolution on this platform and then proceed to the next step. Although TO started the review process in Rayyan, at this stage she needed to export her data to Covidence to more easily visualise the rest of the team’s decisions and access the reasons for exclusion. Using Covidence, TO’s team were able to complete the full-text review and data extraction process using the free trial of Covidence, which allows the import of less than 500 articles.
Step 4e. Full text review
As previously mentioned, we carried out this step in Covidence, which was straightforward because it allowed full-text import and subsequent visualisation to extract the useful data. A systematic and detailed approach to selecting relevant articles is essential, as the extracted data needs to be aligned with the population-concept-context framework developed in the protocol (Pollock et al., 2023).
Fifth step: Data extraction, synthesis and results presentation
The final step is to extract the data from the selected articles. To do this, an extraction form is needed. The protocol should include a draft data extraction form and a data dictionary (which defines the exact meaning of each element in the extraction form). It may be necessary to revise the data extraction form during the review process. It should first be piloted on the first five eligible studies, with modifications made based on this pilot to ensure that all relevant information is captured (Peters et al., 2015). The revised data extraction form will be applied to all studies, including repeating the process for the first five eligible studies.
In our case, to create a personalised data extraction form, we both used our respective scoping review questions to create overarching themes. In addition, many columns were included to collect and summarise the details of the available sources of evidence, in a concise description, such as type of study, journal, year, country and information about the authors of the paper. Although the data extraction step can be completed in Covidence, it can also be completed using other methods, for example, in a Word or Excel document. However, when using Covidence, it is helpful to know that all the extracted data can be downloaded as an Excel document to get the full information sheet as a large table. We extracted the information using a personalised grid created in Covidence and then exported the data to an Excel file.
Once the data had been extracted, each question was established as an overarching theme, and the data were then analysed deductively to answer each review question. There are a variety of ways in which these data can be presented (Pollock et al., 2023), and we chose to follow the JBI recommendations and PRISMA-ScR checklist for writing the final report of scoping reviews (Aromataris et al., 2024). Therefore, the first part of the results section of our papers includes graphical and tabular information on the number of articles found, their characteristics and the search decision process, accompanied by a flowchart of the identification of sources of evidence and the inclusion decision. This information is accompanied by a narrative description of the results of the review questions and objectives to provide context and clarity for the data presented. This narrative highlights key themes and gaps identified in the literature to ensure that the reader understands the significance of the findings in relation to the review objectives. In addition, any limitations in the data collection process or potential biases were addressed to enhance the transparency and rigour of the review process.
FINAL REFLECTION
This was our first experience of conducting scoping reviews, and we felt like travellers in unexplored lands. This metaphor resonates with our experience as international students (NL & TO) who had to travel far to come to Aotearoa New Zealand and be brave, embracing the challenges that a PhD entails. Through the process of conducting a scoping review, we gained a clearer understanding of its essential purpose: to capture a broad picture of the knowledge available on a specific topic. At the beginning of a PhD, this is particularly valuable because it helps orient the student, clarify the path ahead, and identify potential pitfalls along the way.
NL reflections: For me, the scoping review facilitated my pathway into the PhD because I wanted to design an effective intervention for colorectal cancer survivors experiencing fear of cancer recurrence. To do that, I needed to know which interventions had already been tested and what limitations existed. Having completed a scoping review, I realised that other types of literature reviews wouldn’t have been suitable to support me in this endeavour.
TO reflections: For me, the scoping review was my map, drawn just before beginning my journey across unfamiliar terrain. I knew I wanted to address the issue of career growth for nurses in Chile. Although many articles claimed to address this topic, the terminology and concepts used were often inconsistent or unclear. My scoping review helped me summarise the efforts made by different healthcare organisations, allowing me to begin to understand what might work for Chile, and what might not.
CONCLUSION
Through this paper, we have intended to provide comprehensive insight into the process and challenges of conducting a scoping review through the experiences of us as PhD students (TO & NL). While the paper outlines standard practices, such as applying the most up-to-date guidelines, it also highlights the specific challenges that early career researchers may face. By incorporating personal experiences, the article adds a valuable practical dimension to the theoretical framework, providing readers with actionable insights in a real-world setting.
We hope that this resource can serve as a valuable supplement to official guidelines for early career researchers, particularly in nursing. By providing a deeper understanding of the scoping review process, it not only facilitates the conduct of such reviews, but also strengthens the foundation for transitioning to other types of literature syntheses or research projects.
Funding
None
Conflicts of interest
CW is an editor of Nursing Praxis. Peer review was conducted independently, in accordance with the COPE guidelines.
Author Contributions
The conception and design of this manuscript from which illustrative examples were drawn (NL, TO, CW, LR, SJ); writing - conception of the article, drafting the initial manuscript and integrating feedback (NL,TO), critical revision of the initial (CW) and final manuscript (CW, LR, SJ); final approval of the version submitted (NL, TO, CW, LR, SJ).
Acknowledgements
NL & TO would like to express our heartfelt gratitude to our doctoral supervisory teams and to Professor Andrew Jull and Dr Wal Baraza for their support and encouragement in our journey toward improvement and excellence.