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Does randomised evidence alter clinical practise? The react qualitative study
Samuel Lawday1,2,3,4, Karen Mattick2, Rob Bethune5,6
1HeSRU, Royal Devon & Exeter Hospital, Exeter, UK.
BMC Health Services Research
|July 29, 2024
Summary
Surgeons face barriers adopting evidence-based practices like small bite laparotomy closure, despite proven benefits for reducing incisional hernias. Understanding these challenges is key to improving patient care.
Area of Science:
- Surgical Practice and Evidence-Based Medicine
- Hernia Prevention Research
Background:
- The STITCH Trial demonstrated small bite closure superiority for reducing incisional hernias.
- Despite evidence, most surgeons have not adopted this practice.
- Medical evidence implementation averages 17 years.
Purpose of the Study:
- Investigate surgeon barriers to adopting evidence-based midline laparotomy closure.
- Understand reasons for practice change or stagnation.
Main Methods:
- Conducted semi-structured interviews with surgeons (consultants and registrars).
- Utilized a topic guide based on literature review of adoption barriers.
- Performed thematic analysis on interview transcripts.
Main Results:
- Interviewed nine surgeons across general surgery and urology.
- Identified three key themes: 'Trusting the Evidence & Critical Appraisal', 'Surgical Attitude to Risk', and 'Adopting Evidence in Practice'.
- These themes highlight barriers to implementing evidence-based practices.
Conclusions:
- Identified themes offer potential intervention points to accelerate evidence adoption.
- Updating clinical practice ensures patients receive the best evidence-based care.
- Faster adoption of evidence improves patient outcomes.
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