EQUIPOISE AS A MEANS OF MANAGING UNCERTAINTY - PERSONAL, COMMUNAL ANDPROXY

Equipoise is advocated as a means of achieving high scientific and eth ical standards in randomised trials. As used in the context of researc h the word describes a state of uncertainty uncertainty characterised by the belief that ill a tr-idl no arm is known to offer greater harm or benefit than any other arm. Clinicians who lack personal equipoise are advised to accept clinical or communal equipoise, based on current unresolved disagreement among the medical profession. Equipoise is ma inly discussed in the literature as an issue for senior doctors and re search directors. Limitations of professional equipoise are reviewed, and data on the neglected topic of patients' equipoise are reported us ing the example of breast cancer trials. In theory, a patient who give s informed and voluntary consent to enter a randomised trial has achie ved the equilibrium of equipoise. In practice, equipoise among patient s ranges from personal to proxy acceptance.