Shifting the focus away from binary thinking of statistical significance and towards education for key stakeholders: revisiting the debate on whether it's time to de-emphasize or get rid of statistical significance

There has been a long-standing controversy among scientists regarding the appropriate use of P-values and statistical significance in clinical research. This debate has resurfaced through recent calls to modify the threshold of P-value required to declare significance, or to retire statistical significance entirely. In this article, we revisit the issue by discussing: i) the connection between statistical thinking and evidence-based practice; ii) some history of statistical significance and P-values; iii) some practical challenges with statistical significance or P-value thresholds in clinical research; iv) the on-going debate on what to do with statistical significance; v) suggestions to shift the focus away from binary thinking of statistical significance and towards education for key stakeholders on research essentials including statistical thinking, critical thinking, good reporting, basic clinical research concepts and methods, and more. We then conclude with remarks and illustrations of the potential deleterious public health consequences of poor methods including selective choice of analysis approach and misguided reliance on binary use of P-values to report and interpret scientific findings.