1 Flinders Medical Centre, Bedford Park, SA, Australia.
2 Marie Curie Hospice, Belfast, UK.
Palliat Med. 2018 Sep;32(8):1363-1368. doi: 10.1177/0269216318778460. Epub 2018 Jun 1.
Translating research evidence into clinical practice often has a long lag time.
To determine the impact of a phase III randomised controlled trial on palliative care clinicians' self-reported practice change.
Online survey about use of octreotide in managing inoperable malignant bowel obstruction due to cancer or its treatments distributed in November 2016, 2 years after the first publication of the study in a peer-reviewed journal. Demographic, self-reported practice and the reasons underpinning this were collected. Responses were aggregated to 'practice modified' or 'practice not modified'. A multinomial regression model explored predictors of practice change.
Members of the Australian New Zealand Society of Palliative Medicine.
Response rate was 20.8% (106/509): 55.6% were aged >50 years, 56.5% were female and 77% had previously prescribed octreotide for this clinical indication. Out of 106 respondents, 52 (49.1%) indicated modified practice (60.9% of those who had previously prescribed octreotide in this setting). In those who reported practice change, most frequently octreotide was now used when other therapies failed; for not changing practice, 'more confirmatory evidence was needed' was most often cited. In the regression model, older age (clinician age = 50-59 years; relative risk = 0.147; 95% confidence interval = 0.024-0.918; p = 0.04) and having practices with lower proportions of people treated with octreotide (0%-20%; relative risk = 0.039; 95% confidence interval = 0.002-0.768; p = 0.033) predicted greater self-reported practice change.
Clinician-reported change in practice in the survey is seen in the majority of respondents. This suggests that there is a cohort of 'early adopters' within palliative care practice as new evidence becomes available.
将研究证据转化为临床实践通常需要很长的时间。
确定一项 III 期随机对照试验对姑息治疗临床医生自我报告的实践改变的影响。
2016 年 11 月，在同行评议期刊首次发表该研究后 2 年，在线调查了奥曲肽在治疗因癌症或其治疗而导致的不可手术性恶性肠梗阻方面的应用。收集了人口统计学、自我报告的实践以及支持这一实践的原因。将回答汇总为“实践改变”或“实践未改变”。使用多项回归模型探讨实践改变的预测因素。
澳大利亚和新西兰姑息治疗学会的成员。
应答率为 20.8%（106/509）：55.6%的人年龄>50 岁，56.5%为女性，77%曾在此临床适应证下开具奥曲肽。在 106 名应答者中，有 52 名（49.1%）表示实践有所改变（在该环境下曾开具奥曲肽的人群中，有 60.9%改变了实践）。在报告实践改变的人群中，最常见的是当其他治疗方法失败时，现在使用奥曲肽；而对于没有改变实践的人群，最常引用的原因是“需要更多的确认性证据”。在回归模型中，年龄较大（医生年龄为 50-59 岁；相对风险=0.147；95%置信区间=0.024-0.918；p=0.04）和治疗人群中使用奥曲肽的比例较低（0%-20%；相对风险=0.039；95%置信区间=0.002-0.768；p=0.033）预测自我报告的实践改变更大。
调查中，大多数应答者报告了实践的改变。这表明，在新证据出现时，姑息治疗实践中有一部分“早期采用者”。
