23rd Jun 2022

Equipoise - when opinions interfere with research

The constant and vital factor in answering any anaesthetic research question is 'equipoise'. Equipoise is the assumption that there is not one definitive 'better' intervention present during the design of an RCT.

But perhaps more important is the concept of personal equipoise, where the clinician has no personal preconceived preferences toward the ability of one or more of the interventions to have a better outcome. Lack of personal equipoise, when the treating clinician already has a preference despite inadequate scientific evidence, has shown itself to be a significant barrier to allowing our specialty to answer key questions through research. One recent study showed that participation in a randomised trial comparing two acceptable treatments is almost always a less popular option than choosing one of the treatments based on pre-existing knowledge and belief.

The question is what do we think about this as a community? Do clinicians with preferences have grounds to justify their decisions as care providers? Is this acceptable in the context of a patient who has a right to enroll in an appropriately governed research trial?

The answer is no doubt complex and relies on a delicate balance between ethics, patient-specific clinical decision-making, evaluation of the evidence, and personal experience. What we do know is that we have a duty to provide safe care, but also to improve care for future patients while respecting our patients' right to participate in research. The National Institute of Academic Anaesthesia founding partners have recognised the significance of this issue and released a position statement on clinician equipoise to our community. Over the coming months we are hoping to unpick this complex issue within anaesthesia research, and better understand how our clinical equipoise impacts on the decisions we make for patients within research trials.

  • Interested in the upcoming national equipoise in perioperative research that is planned?
    Contact Dr Mandeep Phull or Dr Katie Samuel via email or Twitter - all are welcome to get involved.

  • Have you seen our equipoise article in the RCoA Bulletin? Page 29.

  • Download the NIAA equipoise position statement  niaa position statement.pdf (136 KB)

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