Does randomised evidence alter clinical practise? The react qualitative study

In 2015, the results of the 'Small bites versus large bites for closure of abdominal midline incisions (STITCH) Trial' were published in The Lancet. This demonstrated the superiority of small bite laparotomy closure over mass closure for the reduction of incisional hernias; despite this most surgeons have not changed their practice. Previous research has shown the time taken for the implementation of evidenced based practise within medicine takes an average of 17 years. This study aims to understand the reasons why surgeons have and have not changed their practice with regards to closure of midline laparotomy.

Semi-structured interviews were completed with surgical consultants and registrars at a single institution in South West England. The interview topic guide was informed by a review of the published literature, which identified barriers to adopting evidence into surgical practice. Interview transcripts underwent thematic analysis with themes identified following discussions within the research team, exploring views on published data and clinical practise.

Nine interviews with general surgical and urological consultants as well as registrars in training were performed. Three themes were identified; 'Trusting the Evidence & Critical Appraisal', 'Surgical Attitude to Risk' and 'Adopting Evidence in Practise', that reflected barriers to the introduction of evidenced based practise to clinical work.

Identification of the themes highlights possible areas for intervention to decrease the adoption time for evidence, for example from randomised controlled trials. The continued updating of clinical practise allows clinicians to provide best evidenced based care for patients and improve their outcomes.