‘Thinking that somebody's going to delay [a tonsillectomy] for one to two years is quite horrifying really’: a qualitative feasibility study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 2)

McSweeney, Lorraine; O’Hara, James; Rousseau, Nikki; Stocken, Deborah; Sullivan, Frank; Vale, Luke; Wilkes, Scott; Wilson, Janet A.; Haighton, Catherine

doi:10.1111/coa.12781

Cited by 6 publications

(15 citation statements)

References 20 publications

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“… Pre-trial (Feasibility) Participants ( n = 48), ear, nose and throat (ENT) consultants, 1 ET trainee (registrar), research nurses ( n = 6), nurse practitioners ( n = 4), trial manager ( n = 2) Tonsillectomy/deferred surgery as conservative management option In-depth interviews Framework analysis 5. McSweeney (2017) [ 69 ]. (United Kingdom) To determine the impact of recurrent sore throats and tonsillitis in adults and stakeholder views of treatment pathways.…”

Section: Resultsmentioning

confidence: 99%

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The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography

Davies

Beard

Cook

et al. 2021

Trials

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Background Randomised controlled trials in surgery can be a challenge to design and conduct, especially when including a non-surgical comparison. As few as half of initiated surgical trials reach their recruitment target, and failure to recruit is cited as the most frequent reason for premature closure of surgical RCTs. The aim of this qualitative evidence synthesis was to identify and synthesise findings from qualitative studies exploring the challenges in the design and conduct of trials directly comparing surgical and non-surgical interventions. Methods A qualitative evidence synthesis using meta-ethnography was conducted. Six electronic bibliographic databases (Medline, Central, Cinahl, Embase and PsycInfo) were searched up to the end of February 2018. Studies that explored patients’ and health care professionals’ experiences regarding participating in RCTs with a surgical and non-surgical comparison were included. The GRADE-CERQual framework was used to assess confidence in review findings. Results In total, 3697 abstracts and 49 full texts were screened and 26 published studies reporting experiences of patients and healthcare professionals were included. The focus of the studies (24/26) was primarily related to the challenge of recruitment. Two studies explored reasons for non-compliance to treatment allocation following randomisation. Five themes related to the challenges to these types of trials were identified: (1) radical choice between treatments; (2) patients’ discomfort with randomisation: I want the best treatment for me as an individual; (3) challenge of equipoise: patients’ a priori preferences for treatment; (4) challenge of equipoise: clinicians’ a priori preferences for treatment and (5) imbalanced presentation of interventions. Conclusion The marked dichotomy between the surgical and non-surgical interventions was highlighted in this review as making recruitment to these types of trials particularly challenging. This review identified factors that increase our understanding of why patients and clinicians may find equipoise more challenging in these types of trials compared to other trial comparisons. Trialists may wish to consider exploring the balance of potential factors influencing patient and clinician preferences towards treatments before they start recruitment, to enable issues specific to a particular trial to be identified and addressed. This may enable trial teams to make more efficient considered design choices and benefit the delivery of such trials.

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Section: Resultsmentioning

confidence: 99%

“…Patients’ views of the potential risk of undergoing surgery and implications of the risks varied depending on the condition or injury being evaluated. Greater duration or severity of symptoms influenced patients towards more invasive treatments, affecting their willingness to participate in a randomsied trial [ 69 , 70 , 74 , 80 ].…”

Section: Resultsmentioning

confidence: 99%

The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography

Davies

Beard

Cook

et al. 2021

Trials

View full text Add to dashboard Cite

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“…Otolaryngologists surveyed in Scotland in 2004 agree with our GPs that thresholds for referral had become more stringent 28 . It would seem that patients are having to face many barriers and years of suffering severe symptoms in the process 18 .…”

Section: Discussionmentioning

confidence: 99%

“…As part of the NAtional Trial of Tonsillectomy IN Adults (NATTINA) feasibility study 2,18 and the main NATTINA trial process evaluation 19 , GPs were interviewed on their views of the sore throat patient pathway process and treatment as well as of the NATTINA trial.…”

Section: Criteriamentioning

confidence: 99%

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Is Scottish Intercollegiate Guidelines Network guidance for GP management of tonsillitis suitable? A qualitative study

et al. 2018

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The introduction of the guidelines appears to coincide with what some may have hoped to be a desired effect of reducing adult sore throat referrals and subsequent tonsillectomies by increasing the number of episodes a patient must suffer before the referral threshold is met. GPs may find equipoise for tonsillectomy referral challenging as many patients express a strong preference for surgery. We believe this paper reinforces GP professionalism and patient-centred consultations, and challenges the role of clinical guidelines.

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Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis: Analyzing the Lesser of Two Evils

Jacob,

Leshno,

Carmel‐Neidermann

et al. 2023

The Laryngoscope

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ObjectiveTo determine the best timing for surgical intervention for adults with recurrent tonsillitis (RT).MethodsA Markov model was constructed using variables and ranges based upon a literature review. A 1‐way sensitivity analysis was performed to evaluate the number of yearly bouts at which each algorithm (antibiotics or tonsillectomy) would be favored. A Monte‐Carlo probabilistic sensitivity analysis was calculated for gains and cost. Model outcomes were measured with quality‐adjusted life‐years (QALYs) and incremental cost‐effectiveness ratios (ICER) for tonsillectomy versus repeat antibiotic treatment.ResultsPatients expected to sustain a single annual tonsillitis event will have a negative QALY of 0.02 if treated with surgery and those with 2 annual events will have a QALY gain from undergoing tonsillectomy of 0.01, 3 events = 0.03, 4 events = 0.05, 5 events = 0.07, 6 events = 0.09, 7 events = 0.1, and 8 events = 0.11. These gains became meaningful only after 2 years of recurrent bouts. The average cost of tonsillectomy was 3,238 USD, and the overall average cost of RT was 7,069 USD (an incremental cost of 3,831 USD). The ICER of tonsillectomy over antibiotic treatment for 1 QALY gain was 44,741 USD.ConclusionAdult patients who sustain more than 3 annual bouts of tonsillitis over a period of at least 2 years will gain QALY after tonsillectomy. These gains increase proportionally to the number of yearly events and perennial episodes. The incremental costs of tonsillectomy fail to meet the NICE guidelines but are within other acceptable reference ranges.Level of EvidenceN/A Laryngoscope, 2023

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‘Thinking that somebody's going to delay [a tonsillectomy] for one to two years is quite horrifying really’: a qualitative feasibility study for the NAtional Trial of Tonsillectomy IN Adults (NATTINA Part 2)

Cited by 6 publications

References 20 publications

The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography

The challenge of equipoise in trials with a surgical and non-surgical comparison: a qualitative synthesis using meta-ethnography

Is Scottish Intercollegiate Guidelines Network guidance for GP management of tonsillitis suitable? A qualitative study

Antibiotics or Tonsillectomy for Adult Recurrent Tonsillitis: Analyzing the Lesser of Two Evils

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