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Published on: September 20, 2019
Barriers to Australian physicians' and paediatricians' involvement in randomised controlled trials
Patrina H Y Caldwell1, Jonathan C Craig, Phyllis N Butow
1Centre for Kidney Research, NHMRC Centre for Clinical Research Excellence in Renal Medicine, The Children's Hospital at Westmead, Locked bag 4001, Westmead, NSW 2145, Australia. Patrinac@chw.edu.au
Objective:
To compare attitudes of Australian physicians and paediatricians about treatment and randomised controlled trial (RCT) participation.
Design And Participants:
A cross-sectional survey using the validated "Physician Orientation Profile" (POP), with 250 physicians and 250 paediatricians surveyed.
Outcome Measures:
Five indices - primary allegiance, decision making under uncertainty, professional activities, perceived rewards, and peer-group influence - with scores for each participant ranging along a continuum from clinician-oriented to research-oriented and expressed as a number between 0 and 1.
Results:
Overall response rate was 60%, with 135 physicians (54%) and 165 paediatricians (66%) responding. Paediatricians and physicians were similar in their attitudes to RCT participation, being generally clinician-oriented rather than research-oriented and less inclined to participate in RCTs when there is uncertainty about the best treatment. Most assign limited time to research, with 26.9% not currently involved in research and 31.5% having no experience of RCT participation. Doctors perceive few rewards and little peer-group influence regarding trial participation. Independent predictors of favourable attitudes to trial participation (based on POP scores) were the presence of allocated research time (0.37 for no allocated research time v 0.61 for > 70% research time; P < 0.0001), previous experience enrolling a patient in an RCT (0.40 for no experience v 0.46 for experience; P < 0.0001), and articles published in the past 12 months (0.40 for no publications v 0.55 for > 3 publications; P < 0.0001).
Conclusions:
This study highlights the minor importance of research for most Australian physicians. Research plays only a small role in their professional activities, and the importance of research participation is not recognised. They are clinician-oriented in their attitudes to RCT participation. To encourage greater involvement in trials among physicians in Australia, clinical research needs to be restructured in a primarily clinically oriented setting with dedicated research time.
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