Physicians' Knowledge, Attitudes and Beliefs about a Hospital Wide Cluster Cross Over Pragmatic Fluid Administration Trial: An Electronic Survey
CCCF ePoster library. Gershkovich B. 11/11/19; 283424; EP49
Dr. Benjamin Gershkovich
Dr. Benjamin Gershkovich
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Topic: Survey or Interview (quantitative or qualitative)

Gershkovich, Benjamin1,2; Weijer, Charles10; Taljaard, Monica1,3; Brehault, Jamie1; McArdle, Tracy1; Schweitzer, Irwin1; Cook, Deborah J9; English, Shane W1,2; Fergusson, Dean1,3; Forster, Alan1; Fox-Robichaud, Alison4; Graham, Ian D1; Hawken, Steven1,3; Iyengar, Akshai11 ; Martin, Claudio5; Marshall, John6; Maybee, Alies12; McDonald, Ellen15; Menon, Kusum7; McCartney, Colin14; Muscedere, John8; Saginur, Raphael11; Seely, Andrew1,14; Thavorn, Kednapa1,3; McIntyre, Lauralyn1,2,3

1. Department of Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
2. Department of Medicine, Division of Criticial Care, University of Ottawa, Ottawa, Ontario, Canada
3. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
4. Department of Medicine, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
5. Division of Critical Care Medicine, London Health Sciences Centre, Western University, London Ontario, Canada
6. Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
7. Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
8. Department of Criticial Care Medicine, Kingston General Hospital, Queen's University, Kingston, Ontario, Canada
9. Department of Medicine, Clinical Epidemiology and Biostatistics, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, Ontario, Canada
10. Rotman Institute of Philosophy, Western University, London, Ontario, Canada
11. Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
12. Patient Engagement Advisory Board, Bruyere Research Institute, Ottawa, Ontario, Canada
13. Department of Anesthesiology, The Ottawa, Hospital, Ottawa, Ontario, Canada
14. Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
15. McMaster University, Hamilton, Ontario, Canada

Introduction: FLUID is a hospital wide pragmatic cluster cross over randomized controlled trial developed to test whether Ringers Lactate reduces death and readmission to hospital when compared to Normal Saline. The recently completed four-centre FLUID pilot trial demonstrated feasibility for the conduct of the large FLUID trial.

Objectives: Due to FLUID's pragmatic and novel design (hospital wide intervention, waiver of consent, requirement to implement an automatic fluid substitution), we aimed to survey physicians at FLUID pilot participating centres to understand the effectiveness of FLUID communication strategies, as well as their knowledge, attitudes, and beliefs about FLUID's pragmatic trial design.
Methods: A web-based survey was developed targeting physicians at all participating FLUID pilot centres using mass email distribution lists upon completion of the pilot trial. The survey was developed through consensus with the FLUID scientific team. The survey was designed to take no more than 5 minutes to complete to maximize response rate. Survey domains included physician demographics, FLUID communication strategies, and knowledge, attitudes and beliefs about FLUID's pragmatic design. Completion was voluntary. Data were anonymized and collected through the use of a web-based survey platform. Communication effectiveness and knowledge, attitudes and belief questions about FLUID were answered using a 5-point Likert scale response. Responses were described with numbers and proportions for dichotomous and categorical variables, with mean and standard deviations or medians and interquartile ranges for continuous variables as appropriate. Post-hoc, likert scale responses were collapsed into 3 categories to enhance clarity in the presentation of results.
Results: A total of 254 physicians from four pilot centres responded to the survey, of whom 206 (81.1%) worked at academic centres. Thirty-six percent (92/254) of respondents had been in practice for greater than ten years. The most common area of practice was internal medicine (26%, 65/254). The top four reported communication strategies were email, posters, word of mouth, and study coordinator (very effective/effective: 87% (220/254), 63% (161/254), 62% (158/254), and 31% (80/254), respectively). Eighty-four percent (214/254) of physicians reported feeling comfortable (agreed or strongly agreed) having their patients participate in the study, while 5% (13/254) did not (disagreed or strongly disagreed). Most physicians (76%, 194/254) agreed or strongly agreed that waiver of informed consent was appropriate; 5% (12/254) disagreed or strongly disagreed with the appropriateness of waiver of consent. Thirty-three percent (85/254, agreed/strongly agreed) of physicians reported a strong fluid preference between the two resuscitation fluids under evaluation. However, only 10% (25/254) of physicians reported that they agreed or strongly agreed that FLUID would demonstrate a significant mortality difference between the two study fluids.
Conclusions: Among responding physicians working in tertiary care centres and one community hospital, a large degree of comfort was reported with respect to the aims, purpose, and execution of the FLUID pilot study. Most physicians agreed that waiver of consent was appropriate in FLUID.

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