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A mixed methods case study investigating how randomised controlled trials (RCTs) are reported, understood and interpreted in practice.

Abstract：

BACKGROUND:While randomised controlled trials (RCTs) provide high-quality evidence to guide practice, much routine care is not based upon available RCTs. This disconnect between evidence and practice is not sufficiently well understood. This case study explores this relationship using a novel approach. Better understanding may improve trial design, conduct, reporting and implementation, helping patients benefit from the best available evidence. METHODS:We employed a case-study approach, comprising mixed methods to examine the case of interest: the primary outcome paper of a surgical RCT (the TIME trial). Letters and editorials citing the TIME trial's primary report underwent qualitative thematic analysis, and the RCT was critically appraised using validated tools. These analyses were compared to provide insight into how the TIME trial findings were interpreted and appraised by the clinical community. RESULTS:23 letters and editorials were studied. Most authorship included at least one academic (20/23) and one surgeon (21/23). Authors identified wide-ranging issues including confounding variables or outcome selection. Clear descriptions of bias or generalisability were lacking. Structured appraisal identified risks of bias. Non-RCT evidence was less critically appraised. Authors reached varying conclusions about the trial without consistent justification. Authors discussed aspects of internal and external validity covered by appraisal tools but did not use these methodological terms in their articles. CONCLUSIONS:This novel method for examining interpretation of an RCT in the clinical community showed that published responses identified limited issues with trial design. Responses did not provide coherent rationales for accepting (or not) trial results. Findings may suggest that authors lacked skills in appraisal of RCT design and conduct. Multiple case studies with cross-case analysis of other trials are needed.

journal_name

BMC Med Res Methodol

journal_title

BMC medical research methodology

authors

Byrne BE,Rooshenas L,Lambert HS,Blazeby JM

doi

10.1186/s12874-020-01009-8

subject

Has Abstract

pub_date

2020-05-12 00:00:00

pages

112

issue

issn

1471-2288

pii

10.1186/s12874-020-01009-8

journal_volume

pub_type

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A mixed methods case study investigating how randomised controlled trials (RCTs) are reported, understood and interpreted in practice.