Surgeon perceptions and utilization of evidence-based medicine.

Objective: Knowledge translation approaches for augmenting the use of evidence in medical practice require identifying potential barriers to implementation. Important but poorly understood determinants of the uptake of knowledge translation tools are the intrinsic characteristics of health professionals themselves. In this study, the authors explored how surgeons' perceptions of evidence-based medicine (EBM) and their behavior in response to new evidence affect their awareness and use of evidence-based summaries designed for application at the point of care.

Methods: Faculty surgeons in two North American pediatric Hydrocephalus Clinical Research Networks, who had shunt infection prevention protocol compliance data for more than 10 shunt procedures in their respective clinical registries during the study period (September 2021-March 2023), participated in a cross-sectional survey regarding their attitudes, knowledge, and behaviors related to EBM and evidence-based practice. Univariable associations between these surgeon characteristics and two dependent variables were sought: 1) compliance with the steps of a perioperative protocol designed to minimize the incidence of shunt infection and 2) knowledge of evidence-based guidelines and recommendations relevant to the care of children with hydrocephalus.

Results: Ninety-two of 212 eligible surgeons responded to the survey. Most were inclined to implement new evidence in surgical practice. Compliance with the shunt infection prevention protocol was higher for those whose responses about their behavior in response to new information on the effectiveness of clinical strategies suggested that they value evidence over experience (i.e., those who actively seek or are receptive to new evidence) compared to those whose practice is driven by practical and pragmatic considerations (OR 5.27, 95% CI 1.08-25.74 for seekers and OR 4.32, 95% CI 1.48-12.58 for receptives vs pragmatists, p = 0.01). Overall knowledge of pediatric hydrocephalus-related guidelines was modest. Surgeons with a more favorable attitude toward the construct of EBM tended to correctly identify most of the published guideline statements presented to them (OR 1.07, 95% CI 1.00-1.16 for every 10-point increment on a 100-point visual analog scale, p = 0.05).

Conclusions: The authors demonstrate that surgeons have variable knowledge of, and behave differently to, evidence that should influence care. Measurable surgeon characteristics are associated with the application of evidence in surgical practice. Thus, to improve the use of evidence-based summaries at the point of care, surgeon attitudes and behaviors should be assessed when designing knowledge translation interventions.