Developing measures of surgeons' equipoise to assess the feasibility of randomized controlled trials in vascular surgery.

BACKGROUND

Equipoise is defined medically as a state of genuine uncertainty about the relative benefits of alternative treatment options. This study investigated individual and collective equipoise among vascular surgeons for controversial clinical questions to assess the feasibility of conducting randomized controlled trials.

METHODS

Vascular surgeons throughout Australia and New Zealand received a survey by mail.

RESULTS

Vascular surgeons (n=146, 77% response fraction) were able to quantify the strength of their treatment preferences and did so differentially between clinical scenarios using a simple scale. Almost one quarter (24%; 95% CI, 18%-32%) were completely undecided about whether carotid endarterectomy or carotid stenting was preferable to treat carotid stenosis in high-risk patients, indicating individual equipoise. In contrast, the vast majority of respondents (89%; 95% CI, 82%-93%) favored carotid endarterectomy over carotid stenting for average-risk patients, suggesting lack of community equipoise for this patient group. Similarly, there was lack of community equipoise for treatments for abdominal aortic aneurysm in high-risk patients with 88% (95% CI, 81%-92%) favoring a minimally invasive approach. Older respondents were consistently less willing to take part in randomized trials, with strength of treatment preference also independently predicting willingness to participate in 4 of 6 trials.

CONCLUSIONS

Individual and community equipoise can be measured in a representative sample of surgeons as part of the feasibility assessment for future randomized controlled trials.