Attitudes to evidence-based practice in urology: Results of a survey

Background: The advantages of promoting evidence-based care through impleme ntation of clinical guidelines are well established. Clinical practice guid elines have been developed for lower urinary tract symptoms (LUTS) and pros tate cancer screening. Aspects of the delivery of care by urologists or spe cialist registrars relevant to the guidelines were assessed. Methods: A questionnaire was distributed at the 1999 meeting of the Urologi cal Society of Australasia, which was attended by 187 Australasian and 33 f oreign delegates. Questions addressed access to resources for evidence-base d medicine; perceived need; preferred sources of information; and then pres ented four clinical scenarios. These were: (i) treatment recommendations in early stage prostate cancer; (ii) the same scenario if the respondent was the patient; (iii) treatment recommendations after radical prostatectomy wh en there was a positive resection margin; and (iv) clinical investigations for mild to moderate LUTS. Results: Of 220 possible responses, 132 were received, a response rate of 6 0%. Urologists overwhelmingly (100%) endorsed the need for access to eviden ce-based reviews, although 28% claimed such access was non-existent to poor . Clinical guidelines were the preferred source of evidence-based informati on. For early stage prostate cancer in a 55-year-old man, radical prostatec tomy was recommended by 93.2% of respondents, but this dropped to 83% when the respondent was the patient (P < 0.05), and a wider range of treatments was recommended. Pelvic radiotherapy and hormone therapy were equally recom mended for biochemical progression following radical prostatectomy where th ere was a positive surgical margin. Investigations for LUTS included serum prostate-specific antigen (PSA) testing (78.0%) and voided flow studies (77 .3%). Conclusions: Urologists express a need for evidence-based practice resource s, in particular clinical guidelines. Nevertheless their clinical approach is not necessarily consistent with existing guidelines, particularly for LU TS. An alteration in the recommendation when the respondent is the patient of interest and endorses the recommendation that patients with prostate can cer should be involved in treatment decisions.