Recommendations for optimising pilot and feasibility work in surgery

Background:
Surgical trials are recognised as inherently challenging. Pilot and feasibility studies (PAFS) are increasingly acknowledged as a key method to optimise the design and conduct of randomised trials but remain limited in surgery. We used a mixed methods approach to develop recommendations for how surgical PAFS could be optimised.

Methods:
The findings from a quantitative analysis of funded surgical PAFS over a 10-year period and in-depth qualitative interviews with surgeons, methodologists and funders were triangulated and synthesised with available methodological guidance on PAFS.

Results:
The synthesis informed development of an explanatory model describing root causes and compounding challenges that contribute to how and why surgical PAFS are not currently optimised. The four root causes identified include issues relating to i) understanding the full scope of PAFS; ii) design and conduct of PAFS; iii) reporting of PAFS; and iv) lack of appreciation of the value of PAFS by all stakeholder groups. Compounding challenges relate to both cultural issues and access to and interpretation of available methodological PAFS guidance. The study findings and explanatory model were used to inform development of a practical guidance tool for surgeons and study teams to improve research practice.

Conclusions:
Optimisation of PAFS in surgery requires a cultural shift in research practice amongst funders, academic institutions, regulatory bodies and journal editors, as well as amongst surgeons. Our ‘Top Tips’ guidance tool offers an accessible framework for surgeons designing PAFS. Adoption and utilisation of these recommendations will optimise surgical PAFS, facilitating successful and efficient future surgical trials.