{
  "abstract": "Background The perception and use of scientific evidence in orthopaedic surgical decision-making is variable, and there is considerable, variation in practice. Orthopaedic surgery is becoming increasingly research active and surgeons and surgical teams are obtaining multi-million pound, publicly funded research investment to support orthopaedic research. Unfortunately, history shows us that the production of high quality research evidence and guideline recommendations are not enough to change practice; particularly in specialties such as orthopaedics which are renowned for resisting standardisation. To demonstrate a return on this growing research investment, avoid research waste and reduce clinical uncertainty, we need to understand why the perception and application of evidence in orthopaedics remain uncertain and variable.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 2014–2023. 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 conceptual 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 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.Conclusion 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 which underpins multi-faceted, evidence-based implementation strategies to encourage evidence-based practice.",
  "authors": [
    {
      "affiliations": [
        "College of Social Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Arabella Scantlebury"
    },
    {
      "affiliations": [
        "Warwick Medical School, University of Warwick, Warwick, UK"
      ],
      "name": "Katherine Jones"
    },
    {
      "affiliations": [
        "College of Social Science, University of Birmingham, Birmingham, UK"
      ],
      "name": "Amy Grove"
    },
    {
      "affiliations": [
        "Centre for Reviews and Dissemination, University of York, York, UK"
      ],
      "name": "Melissa Harden"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Catriona McDaid"
    },
    {
      "affiliations": [
        "Department of Health Sciences, University of York, York, UK"
      ],
      "name": "Joy Adamson"
    }
  ],
  "title": "OP15 Can we ever have evidence-based decision making in orthopaedics?: a qualitative evidence synthesis and conceptual framework",
  "uid": "6ff721e0-6391-5586-bb7b-caed899023f9"
}