Evidence gaps in ENT surgery - a qualitative survey

Abstract

Introduction: As in other disciplines, the burgeoning knowledge in ENT medicine long ago surpassed our ability to adequately absorb it and maintain a proper overview. This can give rise to actual or assumed evidence gaps that can impede the progress of the discipline and evidence-based treatment of patients. Clinics and medical practices also hold to traditional doctrines that shape day-to-day medicine, without these schools being challenged based on evidence. Methods: Between February and June 2015, 160 ENT clinics, including 34 university hospitals, and 2,670 ENT practices took part in a two-arm online survey on existing or perceived evidentiary gaps in ENT medicine using a previously developed questionnaire. The survey used for half of the participants was open in form; the other half were given a closed survey with systematics of the field for orientation. The survey was augmented with additional data such as the number of publications and focus areas in the clinics and the age and type of practice of the established physicians. Results: The return rate from the clinics was 39.7%; the return rate of the closed surveys was 29.3%. Of the physicians in medical practice, 14.6% responded to the closed and 18.6% to the open survey. There were no major differences between the two forms of survey. Otological and oncological issues comprised approximately 30% of the list of answers from clinics. Corresponding questions were formulated regarding the current diagnostic and therapeutic problems, such as with stage-related tumor treatment or implantable hearing aids. Diagnostic procedures, e.g., special new procedures in audiology and vestibulogy, dominated the surveys from the practices. However clinics and practices alike cited marginal areas of the discipline that are of daily relevance. Discussion: The cited evidence gaps then needed to be verified or refuted and clarified based on research of the literature as to whether the existing evidence actually reached healthcare providers in the form of guidelines, publications, conferences, or continuing training for application in daily practice. Other steps would include prioritizing future research, evidence mapping, deciding on further systematic reviews, and targeted studies in conjunction with procuring third-party funding and in cooperation with patient associations. The knowledge thus gained should ultimately be transferred in improved form for application in daily clinical practice. Ten questions of key importance each needed to be formulated for the hospitals and practices.

Keywords: ENT medicine; evidence gaps; evidence-based medicine; healthcare research; survey.

Table 1. ENT-specific system for the closed survey (explanations can be found in the text)

Table 2. Process of the survey

Table 3. Coding scheme based on the example of question 1 of the closed survey of hospitals (explanations are found in the text)

Table 4. Response rate of hospitals

Table 5. Basic data of practices

Table 6. Age distribution of practices

Table 7. Results of question 1 (hospitals); fields with particular need of research

Table 8. Results of question 2 (hospitals); currently relevant evidence gaps

Table 9. Responses of question 3 (hospitals); issues that require urgent answers

Table 10. Research focus of hospitals

Table 11. Number of publications (hospitals) from 2013 to 2014

Table 12. Results of question 1 (practices) regarding uncertainties of diagnostic procedures

Table 13. Results of question 2 (practices)

Table 14. Results of question 3 (practices)

Figure 1. Time accumulation of the returned questionnaires (Table 2). Hospitals: right ordinate axis; practices: left ordinate axis.