Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework
Abstract Background The perception and use of scientific evidence in orthopaedic surgical decision-making is variable, and there is considerable variation in practice. A previous conceptual framework described eight different drivers of orthopaedic surgical decision-making: formal codified and manag...
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BMC
2025-07-01
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| Series: | BMC Medical Informatics and Decision Making |
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| Online Access: | https://doi.org/10.1186/s12911-025-03032-5 |
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| author | Arabella Scantlebury Katherine Jones Joy Adamson Melissa Harden Catriona McDaid Amy Grove |
| author_facet | Arabella Scantlebury Katherine Jones Joy Adamson Melissa Harden Catriona McDaid Amy Grove |
| author_sort | Arabella Scantlebury |
| collection | DOAJ |
| description | Abstract Background The perception and use of scientific evidence in orthopaedic surgical decision-making is variable, and there is considerable variation in practice. A previous conceptual framework described eight different drivers of orthopaedic surgical decision-making: formal codified and managerial knowledge, medical socialisation, cultural, normative and political influence, training and formal education, experiential factors, and individual patient and surgeon factors. This Qualitative Evidence Synthesis (QES) aims to refine the conceptual framework to understand how these drivers of decision-making are applied to orthopaedic surgical work in a dynamic and fluid way. Methods A QES explored how different types of knowledge and evidence inform decision-making to explore why there is so much variation in orthopaedic surgical work. Nine databases were systematically searched from 2014 to 2023. Screening was undertaken independently by two researchers. Data extraction and quality assessment were undertaken by one researcher and accuracy checked by another. Findings were mapped to the conceptual framework and expanded through thematic synthesis. Results Twenty-five studies were included. Our re-conceptualised framework of evidence-based orthopaedics portrays how surgeons undergo a constant process of medical brokering to make decisions. Routinely standardising, implementing and regulating surgical decision making presents a challenge when the decision-making process is in a constant state of flux. We found that surgeons constantly prioritise drivers of decision-making in a flexible and context-specific manner. We introduce the concept of socialisation in decision making, which describes “the socialisation of factors affecting decision-making. Socialisation is additive to surgeon identity and organisational capacity, which as explanatory linchpins act to mediate our understanding of how and why surgical decision-making varies. Our conceptual framework allows us to rationalise why formal codified knowledge, typically endorsed through clinical guidelines, consistently plays a limited role in orthopaedic decision-making. Conclusions We present a re-conceptualised framework for understanding what drives real world decision-making in orthopaedics. This framework highlights the dynamic and fluid way these drivers of decision-making are applied in orthopaedic surgical work. A shift in orthopaedics is required away from prioritising informal, experiential knowledge first to incorporating evidence-based sources of evidence as essential for decision-making. This paradigm shift, views decision-making as a complex intervention, that requires alternative approaches underpinned by multi-faceted, evidence-based implementation strategies to encourage evidence-based practice. Registration PROSPERO CRD42022311442 Clinical Trial Number Not applicable. |
| format | Article |
| id | doaj-art-a9bfea5d15ad47cd8e6c27c8a2d34f5e |
| institution | Kabale University |
| issn | 1472-6947 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj-art-a9bfea5d15ad47cd8e6c27c8a2d34f5e2025-08-20T04:01:36ZengBMCBMC Medical Informatics and Decision Making1472-69472025-07-0125111510.1186/s12911-025-03032-5Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual frameworkArabella Scantlebury0Katherine Jones1Joy Adamson2Melissa Harden3Catriona McDaid4Amy Grove5Centre for Evidence and Implementation Science, College of Social Sciences, University of BirminghamWarwick Medical School, University of WarwickYork Trials Unit, Department of Health Sciences, University of YorkCentre for Reviews and Dissemination, University of YorkYork Trials Unit, Department of Health Sciences, University of YorkCentre for Evidence and Implementation Science, College of Social Sciences, University of BirminghamAbstract Background The perception and use of scientific evidence in orthopaedic surgical decision-making is variable, and there is considerable variation in practice. A previous conceptual framework described eight different drivers of orthopaedic surgical decision-making: formal codified and managerial knowledge, medical socialisation, cultural, normative and political influence, training and formal education, experiential factors, and individual patient and surgeon factors. This Qualitative Evidence Synthesis (QES) aims to refine the conceptual framework to understand how these drivers of decision-making are applied to orthopaedic surgical work in a dynamic and fluid way. Methods A QES explored how different types of knowledge and evidence inform decision-making to explore why there is so much variation in orthopaedic surgical work. Nine databases were systematically searched from 2014 to 2023. Screening was undertaken independently by two researchers. Data extraction and quality assessment were undertaken by one researcher and accuracy checked by another. Findings were mapped to the conceptual framework and expanded through thematic synthesis. Results Twenty-five studies were included. Our re-conceptualised framework of evidence-based orthopaedics portrays how surgeons undergo a constant process of medical brokering to make decisions. Routinely standardising, implementing and regulating surgical decision making presents a challenge when the decision-making process is in a constant state of flux. We found that surgeons constantly prioritise drivers of decision-making in a flexible and context-specific manner. We introduce the concept of socialisation in decision making, which describes “the socialisation of factors affecting decision-making. Socialisation is additive to surgeon identity and organisational capacity, which as explanatory linchpins act to mediate our understanding of how and why surgical decision-making varies. Our conceptual framework allows us to rationalise why formal codified knowledge, typically endorsed through clinical guidelines, consistently plays a limited role in orthopaedic decision-making. Conclusions We present a re-conceptualised framework for understanding what drives real world decision-making in orthopaedics. This framework highlights the dynamic and fluid way these drivers of decision-making are applied in orthopaedic surgical work. A shift in orthopaedics is required away from prioritising informal, experiential knowledge first to incorporating evidence-based sources of evidence as essential for decision-making. This paradigm shift, views decision-making as a complex intervention, that requires alternative approaches underpinned by multi-faceted, evidence-based implementation strategies to encourage evidence-based practice. Registration PROSPERO CRD42022311442 Clinical Trial Number Not applicable.https://doi.org/10.1186/s12911-025-03032-5SurgeryEvidence-based practiceImplementationDecision-makingOrthopaedicsEvidence-based medicine |
| spellingShingle | Arabella Scantlebury Katherine Jones Joy Adamson Melissa Harden Catriona McDaid Amy Grove Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework BMC Medical Informatics and Decision Making Surgery Evidence-based practice Implementation Decision-making Orthopaedics Evidence-based medicine |
| title | Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework |
| title_full | Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework |
| title_fullStr | Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework |
| title_full_unstemmed | Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework |
| title_short | Can we ever have evidence-based decision making in orthopaedics? A qualitative evidence synthesis and conceptual framework |
| title_sort | can we ever have evidence based decision making in orthopaedics a qualitative evidence synthesis and conceptual framework |
| topic | Surgery Evidence-based practice Implementation Decision-making Orthopaedics Evidence-based medicine |
| url | https://doi.org/10.1186/s12911-025-03032-5 |
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