Interpretation of subgroup results in clinical trial publications: insights from a survey of medical specialists in Ontario, Canada

American Heart Journal
Andrea B Parker, C David Naylor

Abstract

Clinicians routinely apply randomized trial evidence to their patients who meet study selection criteria. However, little is known about how clinicians interpret conflicting subgroup data. We mailed a self-administered survey to all practicing cardiologists (n = 309) and 695 randomly chosen other specialists in Ontario, Canada. The survey presented 6 hypothetical trials where a subgroup result deviated from the overall result. We also elicited responses to some general statements about clinical evidence and subgroups. Completed surveys were received from 435 physicians (44%). Faced with overall benefit but no apparent treatment effect in a subgroup, almost 44% would exclude subgroup-type patients, notwithstanding the hazard of beta error. Given overall harm but significant benefit for a subgroup, responses were split approximately 60:40 between continuing conventional therapy for all and treating subgroup-type patients with the new drug. For an overall null result with a positive treatment-subgroup interaction term, 25% of respondents would continue conventional therapy, whereas 69% would adopt the new drug for subgroup-type patients. Physicians with an academic appointment, devoting more time to research, or with formal traini...Continue Reading

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Citations

Nov 26, 2009·Health Services Research·Erik Fernandez Y GarciaRichard L Kravitz
Jun 1, 2017·The Journal of Continuing Education in the Health Professions·Leila KahwatiJessica DeFrank

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