Barriers to Australian physicians' and paediatricians' involvement in randomised controlled trials

Objective: To compare attitudes of Australian physicians and paediatricians about treatment and randomised controlled trial (RCT) participation. Design and participants: A cross-sectional survey using the validated "Physician Orientation Profile" (POP), with 250 physicians and 250 paediatricians surveyed. Outcome measures: Five indices - primary allegiance, decision making under uncertainty, professional activities, perceived rewards, and peer-group influence with scores for each participant ranging along a continuum from clinician-oriented to research-oriented and expressed as a number between 0 and 1. Results: Overall response rate was 60%, with 135 physicians (54%) and 165 paediatricians (66%) responding. Paediatricians and physicians were similar in their attitudes to RCT participation, being generally clinician-oriented rather than research-oriented and less inclined to participate in RCTs when there is uncertainty about the best treatment. Most assign limited time to research, with 26.9% not currently involved in research and 31.5% having no experience of RCT participation. Doctors perceive few rewards and little peer-group influence regarding trial participation. Independent predictors of favourable attitudes to trial participation (based on POP scores) were the presence of allocated research time (0.37 for no allocated research time v 0.61 for >70% research time; P<0.0001), previous experience enrolling a patient in an RCT (0.40 for no experience v 0.46 for experience; P<0.0001), and articles published in the past 12 months (0.40 for no publications v 0.55 for >3 publications; P<0.0001). Conclusions: This study highlights the minor importance of research for most Australian physicians. Research plays only a small role in their professional activities, and the importance of research participation is not recognised. They are clinician-oriented in their attitudes to RCT participation. To encourage greater involvement in trials among physicians in Australia, clinical research needs to be restructured in a primarily clinically oriented setting with dedicated research time.