The challenge of equipoise in trials with a surgical and non-surgical comparison : a qualitative synthesis using meta-ethnography

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The challenge of equipoise in trials with a surgical and non-surgical comparison : a qualitative synthesis using meta-ethnography

Davies, Loretta (författare): University of Oxford

Beard, David (författare): University of Oxford

Cook, Jonathan A. (författare): University of Oxford

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Price, Andrew (författare): University of Oxford

Osbeck, Ida (författare): Lund University,Lunds universitet,Ortopedi, Lund,Sektion III,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Orthopaedics (Lund),Section III,Department of Clinical Sciences, Lund,Faculty of Medicine

Toye, Francine (författare): Nuffield Orthopaedic Centre

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2021-10-07
2021
Engelska.
Ingår i: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 22:1

Relaterad länk:: http://dx.doi.org/10... (free); visa fler...; https://trialsjourna...; https://lup.lub.lu.s...; https://doi.org/10.1...; visa färre...

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Background: Randomised controlled trials in surgery can be a challenge to design and conduct, especially when including a non-surgical comparison. As few as half of initiated surgical trials reach their recruitment target, and failure to recruit is cited as the most frequent reason for premature closure of surgical RCTs. The aim of this qualitative evidence synthesis was to identify and synthesise findings from qualitative studies exploring the challenges in the design and conduct of trials directly comparing surgical and non-surgical interventions. Methods: A qualitative evidence synthesis using meta-ethnography was conducted. Six electronic bibliographic databases (Medline, Central, Cinahl, Embase and PsycInfo) were searched up to the end of February 2018. Studies that explored patients’ and health care professionals’ experiences regarding participating in RCTs with a surgical and non-surgical comparison were included. The GRADE-CERQual framework was used to assess confidence in review findings. Results: In total, 3697 abstracts and 49 full texts were screened and 26 published studies reporting experiences of patients and healthcare professionals were included. The focus of the studies (24/26) was primarily related to the challenge of recruitment. Two studies explored reasons for non-compliance to treatment allocation following randomisation. Five themes related to the challenges to these types of trials were identified: (1) radical choice between treatments; (2) patients’ discomfort with randomisation: I want the best treatment for me as an individual; (3) challenge of equipoise: patients’ a priori preferences for treatment; (4) challenge of equipoise: clinicians’ a priori preferences for treatment and (5) imbalanced presentation of interventions. Conclusion: The marked dichotomy between the surgical and non-surgical interventions was highlighted in this review as making recruitment to these types of trials particularly challenging. This review identified factors that increase our understanding of why patients and clinicians may find equipoise more challenging in these types of trials compared to other trial comparisons. Trialists may wish to consider exploring the balance of potential factors influencing patient and clinician preferences towards treatments before they start recruitment, to enable issues specific to a particular trial to be identified and addressed. This may enable trial teams to make more efficient considered design choices and benefit the delivery of such trials.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Ortopedi (hsv//swe)
MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Orthopaedics (hsv//eng)

Nyckelord

Non-surgical interventions
Qualitative evidence synthesis
Recruitment challenges
Surgical interventions

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Av författaren/redakt...: Davies, Loretta; Beard, David; Cook, Jonathan A ...; Price, Andrew; Osbeck, Ida; Toye, Francine

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MEDICIN OCH HÄLSOVETENSKAP: MEDICIN OCH HÄLS ...; och Klinisk medicin; och Ortopedi

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Av lärosätet: Lunds universitet

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