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Abstract
OBJECTIVE: To explore the prior beliefs regarding the effectiveness of percutaneous vesico-amniotic shunting in congenital lower urinary tract obstruction among different clinical specialist groups involved in caring for this condition. STUDY DESIGN: Questionnaire survey of experts in the field based on principles of Bayesian elicitation of prior beliefs. The sample was 59 consultants in three specialties. Of these, 37 (63%) were subspecialty trained fetal medicine practitioners, 16 (27%) were paediatric nephrologists and 6 (10%) were paediatric urologists. The questionnaire elicited experts' opinions as to: control arm perinatal mortality, effect of vesico-amniotic shunting on perinatal mortality, current clinical practice and the level of evidence required to change current practice. RESULTS: The response rates were 28% for fetal medicine specialists, 29% for paediatric nephrolgists and 10% for paediatric urologists. The median belief for fetal medicine specialists was a 10% (inter-quartile range, IQR 0-20%) reduction in perinatal mortality with shunting and a mean control arm perinatal mortality of 61%. For paediatric nephrologists the results were 5% (IQR -10 to 15%) and 18% and for paediatric urologists 10% (IQR 0-15%) and 17%. Fetal medicine specialists had the most optimistic beliefs regarding effect of shunting on perinatal mortality. Thirty-eight experts (68%) indicated that vesico-amniotic shunting would most likely reduce morbidity associated with renal dysfunction. CONCLUSION: The prior beliefs show a divergence of opinion among specialists. This establishes clinical equipoise, which should be resolved with a randomised trial.
Original language | English |
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Pages (from-to) | 25-9 |
Number of pages | 5 |
Journal | European Journal of Obstetrics & Gynecology and Reproductive Biology |
Volume | 152 |
Issue number | 1 |
DOIs | |
Publication status | Published - 21 May 2010 |
Keywords
- VAS shunting
- Bayesian prior beliefs
- PLUTO trial
- Congenital lower urinary tract obstruction
- Effectiveness
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- 1 Finished
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The PLUTO Trial: Percutaneous Shunting in Lower Urinary Tract Obstruction
Kilby, M. (Principal Investigator), Morris, K. (Co-Investigator), Daniels, J. (Co-Investigator), Khan, K. (Co-Investigator), Middleton, L. (Co-Investigator), Bryan, S. (Co-Investigator), Roberts, T. (Co-Investigator), Taylor, C. (Co-Investigator), Gray, R. (Co-Investigator), Lilford, R. (Co-Investigator) & Quinlan-Jones, E. (Co-Investigator)
THE NHS HEALTH TECHNOLOGY ASSESMENT PROGRAMME (HTA)
1/09/08 → 30/06/12
Project: Research