Effect of Different Financial Competing Interest Statements on Readers' Perceptions of Clinical Educational Articles: A Randomized Controlled Trial

Sara Schroter,1 Julia Pakpoor,2 Julie Morris,3 Mabel Chew,4 Fiona Godlee5

Objective Declaration of conflicts of interest (COIs) is now the norm for research published in medical journals, with awareness that such interests may influence findings and reader perceptions. Less attention has been focused on the role of COIs in education articles intended to guide clinical practice. We investigated how different COI statements affect clinical readers’ perceptions of education articles.

Design We invited UK physicians in the British Medical Association membership database, by email, to participate in a research project in January 2016. One-third were general practitioners, one-third junior physicians, and one-third consultants. Volunteers were blinded and randomized to receive a shortened version of 1 of 2 clinical reviews (on gout or dyspepsia) previously published by The BMJ and considered to be of interest to a wide clinical audience. Each review was assigned 1 of 4 possible COI statements, and each review was identical except for permutations of the COI statement. After reading the review, participants completed an online questionnaire rating their confidence in the article’s conclusions (primary outcome), its importance, their level of interest in the article, and their likeliness to change practice after reading it. Blinded factorial analyses of variance and analyses of covariance were carried out to assess the influence of each review and type of COI on outcomes.

Results Of 10,889 physicians invited to participate, 1065 (9.8%) volunteered. Of these volunteers, 749 (70.3%) completed the survey. Analysis of covariance adjusting for age, sex, job type, and years since qualification showed no significant difference between the groups in participants’ confidence in the article (gout: P = .32, dyspepsia: P = .78) or their rating of its importance (gout: P = .09, dyspepsia: P = .79) (Table). For the gout review, participants rated articles with advisory board COI as significantly less interesting than those with no COI (P = .02 with Bonferroni correction). Among participants indicating that they treat the condition and that the article’s recommendations differed from their own practice, there was no significant difference in likelihood to change practice between groups (gout: P = .59, n = 59; dyspepsia: P = .56, n = 80).

Conclusions Physicians’ confidence in educational articles was not influenced by the COI statements. Our study was limited by a low response rate and by only using 2 articles that may not have been of interest to all participants. Further work is required to determine if physicians do not perceive these COIs as important in educational articles or if they do not pay attention to these statements.

1The BMJ, London, UK, sschroter@bmj.com; 2Oxford University Clinical Academic Graduate School, Oxford, UK; 3University of Manchester, Manchester, UK; 4The BMJ, London, UK; 5The BMJ, London, UK

Conflict of Interest Disclosures: Sara Schroter, Fiona Godlee, and Mabel Chew are employed by The BMJ; Julia Pakpoor was a Clegg Scholar at The BMJ; and Julie Morris is a statistics editor for The BMJ. Fiona Godlee is a member of the Peer Review Congress Advisory Board but was not involved in the review of or decision for this abstract.

Funding/Support: We received no external funding for this study.

Additional Contributions: We thank the editors in The BMJ education team (Cath Brizzell, Tony Delamothe, Giselle Jones, Navjoyt Ladher, Emma Parish, Alison Tonks, Sophie Cook) and Theo Bloom for their help in designing the study; the authors of the original Clinical Reviews for giving us permission to use their work; Emma Parish for editing these articles for use in the study; and Keith Bates, Data Analyst at the British Medical Association, for providing data about association members and help with sampling.

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