Awareness, attitudes, and practices concerning the use of indirect evidence in pediatrics: a cross-sectional survey of healthcare professionals in China.

Abstract

The "evidence gap" in pediatrics often requires healthcare professionals to use evidence that is not fully direct for the target population, intervention, or context. Despite its critical clinical relevance, the conceptual understanding and practice patterns surrounding indirect evidence among healthcare professionals remain poorly characterized. This study aimed to evaluate the awareness, attitudes, practice patterns, and unmet needs regarding the use of indirect evidence among pediatric healthcare professionals in China. A cross-sectional survey was conducted among clinicians, pharmacists, technicians, researchers, and other professionals working in the field of pediatrics in China. This survey assessed four domains: self-reported awareness, attitudes, practice behaviors, and perceived barriers or support needs. Multivariable proportional-odds ordinal logistic regression was the main analysis of four single-item ordinal outcomes; linear regression was a sensitivity analysis. Multi-item matrix sections were examined using internal-consistency coefficients and exploratory factor analysis. A total of 571 valid responses were included in the final analysis. After reading a brief definition of indirect evidence, 57 participants (10.0%) rated themselves as extremely familiar with the concept. Respondents reported greater confidence in evidence from similar diseases (41.0% reporting high or extremely high confidence) than in adult data (25.0%) or animal studies (20.0%). In a separate item, 295 participants (51.7%) reported being required to base decisions on indirect evidence in their professional routine at least several times per week, and 55.7% reported often or always consulting peers or experts when assessing applicability. In adjusted ordinal models, tertiary-hospital affiliation was associated with a higher category of reported frequency of needing to base decisions on indirect evidence (adjusted OR 1.95, 95% CI 1.25 to 3.03), whereas master's or doctoral education was associated with a lower category than bachelor's degree or below (adjusted OR 0.58, 95% CI 0.38 to 0.89). The most frequently reported barrier was the absence of unified, standardized evaluation processes or tools.

Conclusion:  Our findings suggest a substantial perceived need for structured guidance and tools to support the appraisal and application of indirect evidence in pediatric practice. Pediatric healthcare professionals in China reported awareness of the evidence gap and willingness to consider indirect evidence, but also reported low confidence, limited use of standardized methods, and substantial reliance on informal, experience-based approaches. These findings identify perceived needs that may inform the development and evaluation of user-friendly frameworks, targeted training programs, and supportive institutional policies.

What is known: • Pediatric evidence gaps often require professionals to consider indirect evidence, yet limited data exist on how they perceive such evidence or how often they report encountering decisions that require it.

What is new: • After reading a brief definition of indirect evidence, 10.0% of respondents rated themselves as extremely familiar with the concept. In a separate item, 51.7% reported being required to base professional decisions on indirect evidence at least several times per week; 55.7% often or always consulted peers or experts, while frequent use of formal assessment methods was uncommon.