Survey of the impact of randomised clinical trials on surgical practice inFrance

Objective: To evaluate the impact of randomised clinical trials (RCT) on de cision-making and therapeutic policies among general and gastrointestinal s urgeons in France. Design: Telephone questionnaire. Setting Multicentre study, France. Subjects: A random sample of 152 surgeons, mean (SD) age 50 (8) years. Interventions and Main outcome measure: Surgeons were asked 12 questions ab out their knowledge of RCT and how trials were conducted; influence of RCT on their treatment policies; means of obtaining information about treatment s; how they evaluated their own results; whether they were willing to take part in RCT; and personal details including age, speciality, and type of pr actice. Surgeons were stratified according to age and type of practice. Results: 148 questionnaires were suitable for analysis. 83 surgeons (56%) w ere under 50 years old, 38 (26%) were exclusively gastrointestinal surgeons , 82 (56%) worked in private practice, and 36 (24%) worked in teaching and university hospitals. The rest undertook mixed duties. When asked to say wh ere they obtained their knowledge about antibiotics, 91 (61%) referred to R CT; these were mainly hospital-based, gastrointestinal, and younger surgeon s. Asked to name a RCT-based policy, 81 (55%) gave medical rather than oper ative examples. 80 (54%) had already participated in a RCT; 79 (53%) said t hat they were willing to participate in a RCT that included random allocati on of patients (there were no statistically significant differences in answ ers according to speciality or type of practice, although younger surgeons answered "yes" to both questions). Specialised journals were the main sourc e of information for 115 (78%), and surgeons read a mean of 40 issues/year. 142 (96%) read journals in French and 66 (45%) in English, but this number fell to 10 (15%) of the 65 surgeons aged 50 or more. Personal experience w as considered a more important source of therapeutic knowledge by older and specialist surgeons. 109 surgeons (74%) recalled patients during the first month postoperatively to evaluate their results. Conclusions: French surgeons, particularly those aged 50 or over, are not w ell informed about the nature, conduct, and value of RCT. Most of their inf ormation is acquired through reading and attending scientific meetings and congresses. Surgeons tended to attach more importance to the fame of the au thor than to the conduct of the study. The overall impact of RCT was weak a mong the surgeons questioned.