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Coming to a consensus

September 6, 2018
 - Tim Hardman

Clinical consensus statements are agreed opinions formulated by a group of experts on specific clinical challenges. In contrast to clinical practice guidelines, which are based primarily on high-level evidence, clinical consensus statements are more applicable to situations where evidence is limited or lacking, but where there are opportunities to reduce uncertainty and improve quality of care for patients. The secret of developing practical and applicable consensus statements quickly is down to the team itself. A good team member is eager to contribute and yet willing to compromise. They should respond to requests to contribute to and/or review materials promptly to keep the project on schedule.

In our latest Insider's Insight you will learn that developing practical, effective, and applicable medical consensus statements is a structured process that relies on expert collaboration and evidence-based decision-making [1]. These statements are crucial for guiding clinical practice, so they need to be both scientifically robust and practical for real-world use. Here are key secrets to achieving this:

Involve a Multidisciplinary Team of Experts

  • Diverse Representation: Ensure that the consensus panel includes experts from various fields relevant to the topic, including clinicians, researchers, policy makers, and patient advocates if applicable. This brings in different perspectives, ensuring the statement is comprehensive and widely accepted.
  • Inclusivity in Expertise: Balance senior thought leaders with early-career professionals to capture innovation while maintaining credibility.

Use a Rigorous, Evidence-Based Approach

  • Systematic Review of Literature: Begin with a thorough review of the most recent and high-quality evidence to ensure the recommendations are based on solid data. This should include meta-analyses, randomized controlled trials, and observational studies when applicable.
  • Grading Evidence: Implement systems like GRADE (Grading of Recommendations Assessment, Development, and Evaluation) to assess the strength of the evidence. This ensures transparency in how recommendations are developed and categorized based on evidence strength .

Structured Consensus Process

  • Formal Consensus Methods: Use structured methods like the Delphi process or the Nominal Group Technique. These methods involve multiple rounds of anonymous feedback from panel members, which minimizes bias and promotes objectivity in forming the final consensus.
  • Transparent Voting: Employ clear, objective criteria for voting on different recommendations, ensuring that there is alignment among experts. Thresholds for agreement should be defined upfront (e.g., 70-80% consensus for a strong recommendation).

Focus on Practicality and Applicability

  • Clarity and Simplicity: Ensure that the language of the consensus statement is clear and concise so that it is easily understood by healthcare practitioners. Avoid jargon, and provide practical recommendations that can be implemented across diverse healthcare settings.
  • Real-World Feasibility: Recommendations should consider resource constraints, such as availability of technology or medications, especially in low-resource settings. This makes the guidelines more universally applicable and useful.

Continuous Review and Flexibility

  • Updating Process: Build in mechanisms for regular updates to the consensus statements as new evidence emerges. Medicine evolves quickly, so ensuring the guidelines stay relevant and updated is critical for their long-term applicability.
  • Feedback Mechanisms: Incorporate feedback from the healthcare community after the consensus statement is published to assess real-world challenges and adapt future versions accordingly.

It is important to note that developing a consensus statement is not a one-off affair.  By following these best practices—engaging diverse experts, grounding recommendations in strong evidence, using structured consensus methods, emphasising practical relevance, and ensuring the flexibility to adapt over time—consensus statements can become effective tools in clinical practice, helping healthcare providers offer the best care based on the latest and most relevant knowledge. Arrangements should be in place for regular review and feedback on the clinical consensus statement, its performance in the clinical setting and its future. In the end, avoiding mediocrity through compromise may become your greatest challenge. Take care not to engineer the teeth out of your position in an attempt avoid contention. You can see our process in action in recent publication detailing consensus on the treatment of constipation in older people [2].

Reference

  1. Coming to a consensus: An Insider’s Insight. Niche Science & Technology Ltd., 2018 
  2. Emmanuel A, et al. Constipation in older people: A consensus statement. Int J Clin Pract. 2017 Jan;71(1). doi: 10.1111/ijcp.12920.

About the author

Tim Hardman
Managing Director
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Dr Tim Hardman is Managing Director of Niche Science & Technology Ltd., a bespoke services CRO based in the UK. He also serves as Managing Director at Thromboserin Ltd., an early-stage biotechnology company. Dr Hardman is a keen scientist and an occasional commentator on all aspects of medicine, business and the process of drug development.

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