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International journal of technology assessment in health care, Vol. 24, No. 2. (2008), pp. 166-169, doi:10.1017/s0266462308080239 Key: citeulike:9334682
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The aim of this study was to examine potential associations between the professional background and experience of expert clinicians and their opinions about the clinical utility of interventional procedures. A retrospective survey of expert clinician characteristics and their opinions was conducted. Information was collected on expert clinical adviser self-declared "operator," "researcher," and conflict of interest status. Associations were sought between expert clinical adviser characteristics and their opinions on whether procedures were "established," "efficacious," and "safe." The setting was the Interventional Procedures Programme of the UK's National Institute for Health and Clinical Excellence (NICE). A total of 598 expert clinician questionnaires relating to 182 different interventional procedures were analyzed. Expert clinical advisers with operative experience of procedures were significantly more likely to consider them as established (odds ratio [OR] 3.93; 95 percent confidence interval [CI], 2.43 to 6.36; p < .001), efficacious (OR 1.76; 95 percent CI, 1.00 to 3.08; p = .049), and safe (OR 2.28; 95 percent CI, 1.43 to 3.65; p = .001). Once adjusted for other characteristics, there was no association between either researcher or conflict of interest status and opinions about the clinical utility of procedures. Expert clinical advisers are an important source of information for decision makers producing guidance about the use of procedures, especially when published evidence is sparse or of poor quality. This study suggests that those who are operators, but not those who are researchers or declare a conflict of interest, are more likely to have a favorable opinion of a procedure's clinical utility. Use of expert clinical advisers with a variety of experience and backgrounds seems a reasonable approach to obtaining authoritative opinions about interventional procedures, to supplement and help interpret evidence from published data.
Interesting methods: Categorization of opinions about
clinical utility was post hoc, and based on a posteriori judgment
by the researchers. Nevertheless, in most instances the
advice providedwas “categorical” in itself, and interpretation
of opinions was only required in a minority of questionnaires
(less than 15 percent). Misclassification of “true opinions”
about a procedure’s clinical utility is unlikely to have been
systematic (i.e., consistently in favor of either a “positive” or
a “negative” opinion).
Interesting findings: The findings suggest
that operative experience for a given procedure is a strong
and independent predictor of a favorable clinical opinion
about whether that procedure can be considered established,
efficacious, and safe.
Conversely, research experience and self-declared conflict
of interest status relating to a procedure were not independently
associated with a favorable opinion of a procedure’s
clinical utility, despite the univariate analysis being
indicative of some such associations
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