Consensus development for healthcare professionals

Abstract

Consensus development sprang from a desire to synthesize clinician and expert opinions on clinical practice and research agendas in the 1950s. And since the American Institute of Medicine formally defined “guidelines” in 1990, there has been a proliferation of clinical practice guidelines (CPG) both formally and informally. This modern decision making tool used by both physicians and patients, requires extensive planning to meet the challenges of consensus development while reaping its rewards. Consensus allows for a group approach with multiple experts sharing ideas to form consensus on topics ranging from appropriateness of procedures to research agenda development. Disagreements can shed light on areas of controversy and launch further discussions. It has five main components: three inputs (defining the task, participant identification and recruitment, and information synthesis), the approach (consensus development by explicit or implicit means), and the output (dissemination of results). Each aspect requires extensive planning a priori as they influence the entire process, from how information will be interpreted, the interaction of participants, the resulting judgment, to whether there will be uptake of results. Implicit approaches utilize qualitative methods and/or a simple voting structure of majority wins, and are used in informal consensus development methods and consensus development conferences. Explicit approaches aggregate results or judgments using explicit rules set a priori with definitions of “agreement” or consensus. Because the implicit process can be more opaque, unforeseen challenges can emerge such as the undue influence of a minority. And yet, the logistics of explicit approaches may be more time consuming and not appropriate when speed is a priority. In determining which method to use, it is important to understand the pros and cons of the different approaches and how it will affect the overall input, approach, and outcome.

Consensus modeling to develop the farmers’ market readiness assessment and decision instrument

“…However, given the purposive method for recruiting diverse participants representing different rural and urban contexts, it is anticipated that the results of this research may be relevant to other contexts. Third, unlike other consensus techniques such as the Delphi method, we allowed expert panelists to interact and synthesize their expertise through a face-to-face consensus conference, which could result in potential bias introduced by interpersonal dynamics such as influence of dominant participants [14][15][16][17]. Fourth, regardless of level of experience, we applied equal weighting of all expert panelists' opinions.…”

“…Due to this complex nature of community, there is a need for techniques, such as consensus modeling, that promote collaboration among key stakeholders to inform decision-making processes for implementing community-based interventions [12,13]. The primary goals of consensus modeling methods are to determine the extent to which various stakeholders agree about causes and solutions to targeted issues through iterative discussion and reflection used to develop the best strategies for implementation [14][15][16][17].…”

“…Panelists were recruited purposively because of their expertise in farmers' market development and management, experience in community nutrition and public health practice, and/or experience working with low-income populations. The primary purpose of this process was to generate ideas, uncover controversial issues, and synthesize stakeholder opinions to ascertain legitimacy of the indicators for farmers' market implementation [15][16][17].…”

Is there expert consensus on expert consensus?

“…However, the use for medical problems of the consensus methodology suitable for the social sciences does not guarantee validity. Whether these complex structures add value to the consensus-based recommendations is unproved (reviewed in reference [8]). However, there are reasonably high levels of internal and external validation for these complex processes.…”

A Nationwide Survey of UK cardiac surgeons’ view on clinical decision making during the COVID-19 pandemic

“…practice and for patients [3]. We aimed to collect and quantitatively appraise nationwide UK senior surgeons' opinion on clinical decision making for patients requiring cardiac surgery during the COVID-19 pandemic.…”