57: INTENSIVIST PHYSICIANS’ KNOWLEDGE AND ATTITUDES ABOUT BAYESIAN ADAPTIVE CLINICAL TRIALS

Abstract

Introduction: Randomized clinical trials are critical to evidence-based medicine but have drawbacks including time and cost. Bayesian adaptive designs attempt to address some of these limitations and are increasingly common in critical care. However, the complexity of such trials raises concerns that clinicians may not adequately understand their methods or act on their results. There has been no systematic investigation of clinician understanding or acceptance of Bayesian trials. We sought to determine intensivist physicians’ understanding and acceptance of Bayesian trials compared to more traditional frequentist trials. Methods: We surveyed US intensivists as part of a longitudinal survey of how physicians develop and update treatment preferences in response to new evidence. We randomized participants to review an abstract reporting a hypothetical new drug trial that used a) Bayesian adaptive methods (“Bayesian group”) or b) traditional frequentist methods (“frequentist group”). The same simulated trial data were used for each abstract. Participants were asked eight Likert style questions to evaluate acceptance, self-perceived understanding, and measured understanding of the trial. Groups were compared using proportional odds logistic regression with an odds ratio >1 indicating lower Bayesian group acceptance or understanding. Results: The response rate was 273 of 592 surveys sent (46.1%). For the two questions related to general acceptance there were no significant differences between groups (OR=1.19 p=0.464 and OR=1.46 p=0.099). However, for the two questions related to self-perceived understanding the frequentist group scored significantly higher (OR=2.6 p< 0.001 and OR=3.21 p< 0.001). For the four questions related to measured understanding, the frequentist group scored significantly higher on three of four (OR=2.06 p=0.001, OR=1.49 p=0.077, OR=2.94 p< 0.001, and OR=1.60 p=0.041). Conclusions: We found no difference in Bayesian adaptive and frequentist trial acceptance among intensivists, but they had lower understanding of Bayesian trials. While efforts are needed to promote understanding of complex Bayesian trial designs, researchers and sponsors should confidently utilize these methods as clinicians are similarly accepting of results compared to traditional trials.