Equipoise in clinical nursing research.

Equipoise, a state of uncertainty about the relative merits of 2 or more treatments or therapeutic approaches, is fundamental to the ethical conduct of clinical research. The degree of uncertainty necessary for ethical conduct of a clinical trial is the subject of ongoing debate. The concept of equipoise has not received sufficient attention from nurse authors. This paper examines the concept of equipoise by drawing on the author's experience with 3 trials of psychosocial interventions in mental health. Arguments for and against using equipoise in the evaluation of ethics of clinical research are summarized. Equipoise may be impossible to achieve in trials of psychosocial treatments with multiple outcomes for patients and relatives. In addition, the need to achieve equipoise may put nurses who provide psychosocial treatments in clinical trials in conflict. In order to provide the best treatment possible, they must believe that what they are doing is in the best interests of their client. Yet, in order to accept randomization, they must, to some extent, relinquish that belief. Case examples are used to examine how discrepancies with respect to the "equipoise status" of researchers, clinicians, and research participants may be problematic in achieving methodologically sound, ethical clinical nursing research.