Scantlebury, Arabella Louise orcid.org/0000-0003-3518-2740, McDaid, Catriona Maria orcid.org/0000-0002-3751-7260, Cook, Liz orcid.org/0000-0001-6902-0235 et al. (1 more author) (2022) Evidence based spinal surgery or the “journal of anecdotal medicine?” Using qualitative interviews with spinal surgeons to understand how the drivers of orthopaedic decision making can influence the creation and adoption of surgical trial evidence. SSM - Qualitative Research in Health. ISSN 2667-3215
Abstract
Background: There is uncertainty regarding the best available treatment for stable thoracolumbar fractures without spinal cord injury. We explore what influences surgical decision making for the treatment of stable thoracolumbar fractures in the UK and discuss the implications of variation in spinal surgical work on the creation and adoption of future evidence. Methods: Qualitative semi-structured interviews with 19 spinal surgeons from 13 UK hospitals. Data were collected as part of a mixed methods randomised pilot study (PRESTO). A conceptual framework of drivers of variation in orthopaedic surgical work informed how we analysed and reported our findings. Results: We identified various patient, surgeon, organisational and cultural factors to influence surgical decision making and variation in the treatment of stable thoracolumbar fractures. We then use our findings to present the ‘cycle of uncertainty,’ to illustrate how a lack of evidence is a justification for a Randomised Controlled Trial (RCT) and the reason why a trial is not deemed feasible. Conclusion: Surgical decision-making is complex, particularly in the absence of robust evidence. The reliance on informal sources to inform decision making and the limited role of evidence, have implications for the likelihood that RCT evidence will be created and/or adopted. To break this cycle of uncertainty we suggest focussing earlier in the research cycle to develop context-specific strategies, designed to avoid equipoise from deeming future surgical trials unfeasible and encourage evidence based surgical decision-making. This could include targeted qualitative research conducted prior to RCTs to explore drivers of surgical decision making.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2022 The Authors. |
Dates: |
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Institution: | The University of York |
Academic Units: | The University of York > Faculty of Sciences (York) > Health Sciences (York) |
Funding Information: | Funder Grant number NETSCC 15/145/07 |
Depositing User: | Pure (York) |
Date Deposited: | 06 May 2022 11:50 |
Last Modified: | 25 Feb 2025 00:08 |
Published Version: | https://doi.org/10.1016/j.ssmqr.2022.100092 |
Status: | Published |
Refereed: | Yes |
Identification Number: | 10.1016/j.ssmqr.2022.100092 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:186484 |
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