Rapid Responses to:

RESEARCH:
Preference Collaborative Review Group
Patients’ preferences within randomised trials: systematic review and patient level meta-analysis
BMJ 2008; 337: a1864 [Abstract] [Full text]
*Rapid Responses: Submit a response to this article

Rapid Responses published:

[Read Rapid Response] Null Seeking Trials
Patrick Mitchell   (13 January 2009)

Null Seeking Trials 13 January 2009
Top
Patrick Mitchell,
Consultant Neurosurgeon
Newcastle General Hospital NE4 6BE

Send response to journal:
Re: Null Seeking Trials

Re BMJ 2008;337:a2554, 2747 & 1864

These articles on patient preference trials detail a significant step in the conduct of randomised trials in surgery. Over the past four years we have been developing a randomised trial methodology that shares many of the advantages of patient preference trials: the Null Seeking Trial. In this scheme the spectrum of indication for an operation ranging from clear indication through equipoise to clear contraindication is enumerated as an index of indication. The index for specific patients presenting with the condition of interest is calculated and they are asked to participate. If they agree, they and their clinicians view the result of patients who have previously participated in the Null Seeking Trial plotted against those patients' indices of indication. After consulting the data patients and clinicians are asked to decide whether to have one treatment, the alternative, or to be randomised. They then undergo the treatment they have selected or been randomised to and when their outcome is known it is added immediately to the results of the trial and placed in the public domain. This scheme allows a negative feedback loop to operate where the position of equipoise in the spectrum of indication is guided by previous results of the trial. This negative feedback loop causes the zone of equipoise to converge on the true point of no difference between the treatments being studied. A preliminary report was published in 2006. A full account is pending.

1) Mitchell, P; Gregson, B. A.; Mendelow, A. D.; Null Seeking Trials; Proceedings of the Scottish and Newcastle Neurosurgery Research Group: GNAMED Meeting May 2006 Pages 8-15; Newcastle University; ISBN: 0701702109

Competing interests: None declared