Elsevier

Critical Care Clinics

Volume 13, Issue 2, 1 April 1997, Pages 417-440
Critical Care Clinics

CONSENSUS CONFERENCES IN CRITICAL CARE MEDICINE: Methodologies and Impact

https://doi.org/10.1016/S0749-0704(05)70319-5Get rights and content

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THE PURPOSES OF BIOMEDICAL CONSENSUS CONFERENCES

Consensus development conferences have the general purpose of developing standards for the appropriate use of biomedical technologies, especially in areas that pose significant patient risk and contain significant clinical uncertainty due to a lack of adequate experimental data. The consensus development process begins with the perception of a need to bridge the gap between what may be occurring in practice, and what may be justified scientifically. This need may in part be caused by a

THE NEED FOR CONSENSUS CONFERENCES

The perceived need for consensus conferences has arisen from the explosive growth of biomedical technologies, including medications, medical and surgical procedures, and devices, that has occurred over the past quarter century. In particular instances this growth has caused concern that definitive evidence about a technology's appropriate application has not always kept pace with the technology's dissemination. Commenting on this issue in 1978, Dr. Fredrickson, then director of the National

OVERVIEW OF THREE COMMON CONSENSUS CONFERENCE ARCHETYPES

Three models for conducting a consensus conference were extensively used to guide the design of the conferences presented in Table 1. These models are first described, and then the strengths and weaknesses of their applications are discussed.

CONSENSUS CONFERENCE METHODS

This section examines the specific methods, activities, and processes that the consensus conferences use to develop their recommendations. The methods used to conduct a consensus conference affect the content, accuracy, usefulness, and impact of the recommendations. It is thus important to assess the strengths and weaknesses of these methods. For this examination the consensus development process is divided into three stages: (1) preconference activities, (2) conference activities, and (3)

Literature Evaluation

Few conferences use systematic or formal analysis methodologies to synthesize and evaluate the available evidence and expert opinion.There are several methodologies that could be used as part of a comprehensive assessment of the evidence that would help to highlight gaps, strengths, weaknesses, undervalued and overvalued data in the state-of-the-science, and would provide theoretically sound frameworks for developing recommendations. These methodologies include meta-analysis18; statistical

THEORETICALLY SOUND ALTERNATIVE CONSENSUS CONFERENCE METHODS

Numerous methods exist for the elicitation, synthesis, and evaluation of knowledge from expert panels. All methods have strengths and weaknesses, and no one method is best suited to all situations. In this section we briefly present a sample of alternative methods for developing an expert consensus (Table 3). By and large, because of their attention to group requirements for particular tasks, these can serve as models for the construction of consensus panel methods for the organizers of

FOUNDATIONS OF EXPERT PANEL CONSENSUS DEVELOPMENT METHODS

There are three functional stages that are necessary for a successful consensus development process, to which virtually all valid methodsshould adhere. The first stage is knowledge elicitation. This is the stage where knowledge is solicited from the experts. This stage may start by providing the panelists with a synthesis of the literature, such as a literature review, a meta-analysis, or a "levels of evidence" evaluation of published studies. An important feature of processes used to elicit

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      Conference participants were selected because of expertise in clinical healthcare practice or patient safety, or because they represented a governmental healthcare agency or an organization with a stake in the conference findings. Pre- and intra-conference activities were based on established consensus procedures.12,18,19 The published literature for each topic was synthesized, with additional knowledge being contributed by participants via discussions, debate and critique in a series of workshops.

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    Address reprint requests to Armando J. Rotondi, PhD Room 646 Scaife Hall, CCM University of Pittsburgh 200 Lothrop Street Pittsburgh, PA 15213

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