Choosing the best research design for each question

BMJ 1997; 315 doi: http://dx.doi.org/10.1136/bmj.315.7123.1636 (Published 20 December 1997) Cite this as: BMJ 1997;315:1636

It's time to stop squabbling over the “best” methods

  1. David L Sackett, Directora,
  2. John E Wennberg, Directorb
  1. a NHS Research and Development Centre for Evidence-Based Medicine, Oxford OX3 9DU
  2. b Center for the Evaluative Clinical Sciences, Hanover, New Hampshire, USA

Lots of intellectual and emotional energy, ink, paper, and readers' precious time have been expended comparing, contrasting, attacking, and defending randomised control trials, outcomes research, qualitative research, and related research methods. This has mostly been a waste of time and effort, and most of the disputants, by focusing on methods rather than questions, have been arguing about the wrong things.

Our thesis is short: the question being asked determines the appropriate research architecture, strategy, and tactics to be used—not tradition, authority, experts, paradigms, or schools of thought.

If the question is, “What is the importance of patient preferences in the choice of treatment for benign prostatic hyperplasia?” the appropriate study architecture, strategy, and tactics are those that identify and characterise the reactions of individual patients to their disease and their assessments of the risks and benefits of alternative treatments through open ended, in depth interviews (to the point of redundancy or saturation), with emphasis on variations in preferences among individuals. The fact that this …

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