Formal Measurement of Clinical Uncertainty: Prelude to a Trial in Perinatal Medicine
BMJ (British Medical Journal). 1994 Jan 8; 308(6921): 111-112.
...During the planning of a trial to compare early with delayed delivery under different circumstances 10 specialists in fetomaternal medicine were interviewed about their beliefs. These results show that experts do not agree about the benefit of delivery for preterm fetuses that are failing to thrive but are not thought to be near to death. For babies such as those described there is a collective and reasonably balanced uncertainty -- the main requirement for a randomised trial. It is fortunate that clinicians given the same inconclusive information form different views because these differences provide the impetus for clinical trials. Our results also show, however, that some clinicians are in two minds when others have strong expectations of either benefit or harm. This makes agreement on fixed entry criteria unlikely and suggests that individual balanced uncertainty should be the entry criterion, a method already adopted in some major trials. The measurement of experts' previous belief and their confidence in this previous belief is also suitable for bayesian analysis of clinical trials, which takes account of opinions based on information external to the trial.
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