Attitudes towards, and patterns of use, of published research evidence in clinical decision making amongst intensive care clinicians.

Abstract

An evidence-practice gap is defined as the difference between what we know from the best available research evidence and what actually happens in current practice. The highly respected ARDSNet low-tidal-volume ventilation trial was published in 2000, however, in 2016 an observational study conducted in over 50 countries documented that up to one third of eligible patients failed to receive the ARDSNet low-tidal-volume ventilation strategy. In this thesis, we undertook a sequence of studies to better understand research evidence use in intensive care, with the intention of developing a tool that may help close evidence-practice gaps. To better understand research evidence use, we conducted a self-administered mail-out survey of intensive care specialists in Australia and New Zealand, and a self-administered online survey of a multinational group of intensive care clinicians. Based on knowledge gained from these surveys, we developed a concise evidence summary tool designed to overcome 27 explicit barriers to the use of research evidence. To evaluate the evidence summary tool, we developed a clinical case-based scenario. Ninety-three multinational intensive care clinicians were invited to review the casebased scenario and then read the evidence summary tool. Reading the evidence summary tool led to a significant increase in the belief that the intervention described in the tool would benefit the realistic patient in our case-based scenario (mean score change 0.32, 95% CI 0.19 to 0.46, P<0.001). Interestingly, the group most influenced by the evidence summary tool were those who appeared to be less up to date. Whilst it is not known whether this success in increasing intensive care clinicians’ belief in the benefit of a treatment would translate into a change in clinical practice behaviours, these promising results clearly indicate a need for further investigation into the use of evidence summary tools as an intervention to help close evidence-practice gaps.