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Clinicians with medical training work in an environment where randomised controlled trials (RCTs) overshadow other forms of medical evidence in informing clinical practice, policy and guidance. It is no surprise that clinical researchers tend towards RCTs, since they are considered the ‘gold standard’ of research, placed firmly at the top of traditional hierarchies of evidence. RCTs are grounded in a positivist paradigm, seeking to answer the question ‘does this intervention work?’ by generating and testing a hypothesis in order to propose or dispute a particular truth. This approach may work well for research about specific medical treatments or technologies, including drug treatments such as a new pain medication. However, it is limited when it comes to research that examines less well-circumscribed, complex interventions, such as pain management through a new clinic or play therapy. Furthermore, in the ‘real world’ of clinical practice, it is rarely possible to control the environment in which a healthcare intervention is delivered. In paediatrics, the nature of a child’s illness or ability to comply with medical treatments is multifactorial, depending on their medical condition and on other factors including their family dynamics, access to education, housing and mental health. Clinicians must take these into account when making skilled decisions about evidence-based medical treatments …
Contributors This article was conceptualised by SM, ZA, JD, A-MS and JC. SM drafted the article. ZA, JD, A-MS and JC reviewed the article for intellectual content and edited the final version. All authors have reviewed and approved this version.
Funding This article was conceptualised and written as part of SM's National Institute for Health Research Doctoral Research Fellowship funded by the Research Trainees Coordinating Centre (DRF-2014-07-065).
Disclaimer The views expressed in this article are those of the authors and not necessarily those of the NHS, the National Institute of Health Research (NIHR) or the Department of Health.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.