IT

A proof of concept that experience-based management of endometriosis can complement evidence-based guidelines

09/10/2023

A proof of concept that experience-based management of endometriosis can complement evidence-based guidelines
Facts Views Vis Obgyn. 2023 Sep;15(3):197-214. doi: 10.52054/FVVO.15.3.094. PMID: 37742197
Background:
Management of endometriosis should be based on the best available evidence.
The pyramid of evidence reflects unbiased observations analysed with traditional statistics.
Evidence-based medicine (EBM) is the clinical interpretation of these data by experts.
Unfortunately, traditional statistical inference can refute but cannot confirm a hypothesis and clinical experience is considered a personal opinion.
Objectives:
A proof of concept to document clinical experience by considering each diagnosis and treatment as an experiment with an outcome, which is used to update subsequent management.
Materials and methods:
Experience and knowledge-based questions were answered on a 0 to 10 visual analogue scale (VAS) by surgery-oriented clinicians with experience of > 50 surgeries for endometriosis.
Results:
The answers reflect the collective clinical experience of managing >10.000 women with endometriosis.
Experience-based management was overall comparable as approved by >75% of answers rated ≥ 8/10 VAS. Knowledge-based management was more variable, reflecting debated issues and differences between experts and non-experts.
Conclusions:
The collective experience-based management of those with endometriosis is similar for surgery-oriented clinicians.
Results do not conflict with EBM and are a Bayesian prior, to be confirmed, refuted or updated by further observations.
What is new?
Collective experience-based management can be measured and is more than a personal opinion.
This might extend EBM trial results to the entire population and add data difficult to obtain in RCTs, such as many aspects of surgery.