Randomized, controlled trials in surgery - Perceived barriers and attitudes of Australian colorectal surgeons

PURPOSE: Although the randomized, controlled trial has gained preeminence a s the criterion standard for evaluating pharmaceutical treatments, randomiz ed controlled trials in surgery have been perceived as difficult to surmoun t. Furthermore, attitudes of surgeons toward randomized, controlled trials are not well understood. We determined the views of Australian surgeons abo ut feasibility of and barriers to surgical randomized trials. METHODS: All members of the Section of Colon and Rectal Surgery of the Royal Australasia n College of Surgeons (n = 147) and all Australian colorectal subspecialist surgeons (n = 72) were mailed a questionnaire that included questions abou t surgical randomized, controlled trials. RESULTS: A total of 195 surgeons responded (89 percent). Two-thirds (66.7 percent; 95 percent confidence int erval 59.5-73.1) of respondents agreed that "Randomized controlled trials s hould be the study design of choice" to evaluate new surgical procedures. O nly 19 percent (95 percent confidence interval 13.9-25.3) endorsed the stat ement that "too much emphasis is placed on results of randomized controlled trials." Barriers to conducting surgical randomized, controlled trials ide ntified by the majority included insufficient funding (74.4 percent; 95 per cent confidence interval 67.5-80.2), a lack of support from the wider surgi cal community (55.9 percent; 95 percent confidence interval 48.6-62.9), and difficulties in convincing patients to accept random allocation to treatme nt (62.6 percent; 95 percent confidence interval 55.3-69.3). CONCLUSION: Th ese results reveal positive attitudes among Australian surgeons toward rand omized, controlled trials, although concerns about the feasibility of rando mized, controlled trials have been reinforced.