SHORT COMMUNICATION Measurement of beliefs about effectiveness of laparoscopic uterosacral nerve ablation Pallavi M. Latthe, a David A. Braunholtz, b Robert K. Hills, c Khalid S. Khan, d Richard Lilford b To explore gynaecologists’ ‘prior’ beliefs on effectiveness of laparoscopic uterosacral nerve ablation (LUNA), a structured survey was used to gather information on the distribution of their prior beliefs regarding the effects of LUNA on pelvic pain, both numerically [on a 10-point visual analogue scale] and by responses to a questionnaire. None of the 25 gynaecologists responding to the questionnaire stated that LUNA would increase pain, while two of the 25 gave numerical answers suggesting they believed that the intervention would worsen the pain. The most widely held ‘prior belief’, reflected in both questionnaire and numerical responses, was that LUNA would have a small beneficial effect on pain. Introduction It is ethical to initiate a clinical trial when there is collective clinical equipoise about the effectiveness of the available treatments. 1 Prior beliefs are formed from indirect evidence (laboratory studies, epidemiology, extrapolation from similar treatments) and direct evidence (clinical trials, perhaps of an inconclusive nature). Surveys eliciting di- chotomous ‘yes’ and ‘no’ responses to a question about effectiveness are limited because clinicians’ beliefs about a treatment usually amount to rather more than just ‘I believe it is effective’ (or the converse). They may believe the treatment to be greatly or marginally beneficial (or harmful). Different clinicians will admit varying degrees of uncertainty. Some may be rather more certain than the evidence apparently warrants, others may be uncer- tain to a degree that they believe the treatment may, in the due course, turn out to be either greatly beneficial or harmful. Observing differences in practice or, as explored here, formal measurement of beliefs about effectiveness can provide a clearer picture than the dichotomous responses. Formal measurements of ‘prior belief’ provide respondents with an opportunity to signal the magnitude of the expected effects and the relative probabilities of effects of different sizes. However, the published examples of collecting such information are sparse in both obstetrics and gynaecology and in medicine generally. 2,3 A recent survey has indicated that there is wide varia- tion in the practice and use of laparoscopic uterosacral nerve ablation (LUNA) for treatment of chronic pelvic pain among clinicians, suggesting that collective clinical equipoise is present. The technique has been introduced without definite evidence, but opinion regarding its use has not yet solidified, as 81% of gynaecologists performing LUNA stated their willingness to recruit patients in a trial to assess effectiveness of LUNA. 4 However, this survey does not provide information on distribution of beliefs concerning effectiveness of LUNA in alleviating pelvic pain. We therefore undertook a structured survey to formally document the range of beliefs on effectiveness of this surgical treatment. A double blind, randomised, controlled trial to assess effectiveness of LUNA is currently recruit- ing women with pelvic pain in the UK. 5 We will be able to update these beliefs when the LUNA trial results are available and see whether clinicians’ beliefs change in line with Bayesian formulae. Design and methods We designed a survey that was administered with oral explanation to a ‘captive’ group of participants in a Collaborators’ meeting of the LUNA trial 5 in November 2002. The aim was to obtain distribution of their beliefs about the likely effectiveness of LUNA in alleviating pelvic BJOG: an International Journal of Obstetrics and Gynaecology February 2005, Vol. 112, pp. 243–246 D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog a Academic Department of Obstetrics and Gynaecology, University of Birmingham, UK b Department of Public Health and Epidemiology, University of Birmingham, UK c University of Birmingham Clinical Trials Unit, UK d Birmingham Women’s Healthcare NHS Trust, Birmingham, UK Correspondence: Dr P. Latthe, Academic Department of Obstetrics and Gynaecology, Birmingham Women’s Healthcare NHS Trust, B15 2TG UK. DOI:10.1111/j.1471-0528.2004.00304.x