Consensus Development at the NIH Improving the Program (1990) / Chapter Skim
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3. Recommendations for Program Function
3. Recommendations for Program Function
Pages 18-33
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From page 18... ...
The process of selecting topics should be formalized! and include participation by the aforementioned OMAR advisory council, OMAR stay, and BID directors.
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From page 19... ...
The active solicitation of topic suggestions on a regular basis will assist OMAR in identifying the concerns of the health care system. Examples of agencies and organizations that might provide topic suggestions include, but are not limited to, the Agency for Health Care Policy and Research, American Academy of Family Practitioners, American College of Physicians, American College of Surgeons, American Hospital Association, American Medical Association, American Nursing Association, Blue Cross and Blue Shield Association, Centers for Disease Control, Council of Medical Specialty Societies and its member organizations, Department of Veterans Affairs, Food and Drug Administration, Health Care Financing Administration, Health Industry Manufacturers Association, Health Insurance Association of America, National Institutes of Health, and Pharmaceutical Manufacturers Association.
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From page 20... ...
Even when evidence is not adequate to support firm conclusions about safety and efficacy, NTH consensus development conferences on management of important clinical problems may be useful. For example, a consensus development conference might evaluate an important, frequently used technology for which evidence of safety and efficacy is inadequate for developing recommendations about its appropriate use.
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From page 21... ...
The planning committee for each conference greatly influences the outcome of a consensus development conference by drafting the questions that define the scope and substance of the conference, by nominating panelists who will respond to those questions, and by nominating the speakers who will present the information on which, in large part, the panelists win base their findings. Accordingly, the membership of the planning committee should reflect a balance of the parties interested in the selected topic in its entirety and possess a comprehensive understanding of the conference topic (as broadly defined above)
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From page 22... ...
The planning committee chair should be selected in consultation with OMAR staff, relevant BID directors, and the OMAR advisory council recommended above. As noted above, the planning committee shapes the consensus development conference and can greatly influence its outcome.
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From page 23... ...
There is a risk that a pane} chair may become too influential, particularly in light of the pane} chair's participation in the planning committee. Panel chair participation in the planning committee provides continuity of the planning and implementation of conferences, enhances the pane} chair's understanding of the process and the specific conference objectives, and develops a stronger relationship between the chair
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From page 24... ...
The breadth of panel expertise should be commensurate with the issues being addressed by a conference. When assembling the conference panel, the planning committee should carefully identify and distinguish among the various disciplines required to address conference questions.
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From page 25... ...
IMPLEMENTATION Preparation of Speakers, Data Synthesis, and Data Presentation Speakers should submit, in advance of the conference, brief statements that outline their positions, reasoning, or findings on each specific question they have been asked to address; the full text of the key referenced articles on which they base their positions; and, preferably, the full text of their presentations. Panelists must deal with a large amount of evidence during the consensus conference.
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From page 26... ...
Other issues to be considered in reviewing the evidence include the precision of definition of the outcome being measured, the adequacy of the study methodology and the degree to which it has been described, the adequacy of sample size, the degree to which the characteristics of the population studied and the activity being evaluated have been described, and We degree to which results can be generalized (Public Health Service, 1989~. Given the subject matter and types of questions posed for a particular topic, more than one meta-analysis may be prepared for a particular consensus development conference.
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From page 27... ...
Although there are potential disadvantages as well as advantages3 associated with grading evidence, it can be an excellent means of improving the process of evaluating evidence and deriving welIfounded recommendations. For example, a system of grades of evidence similar to the one used by the Canadian Task Force on the Periodic Health Examination and the U.S.
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From page 28... ...
Certainly, peer-reviewed evidence has been subject to a measure of expert examination for quality that most panelists otherwise would be unable to perform in the context of a consensus conference session. Expert presentations made at the conferences of peer-reviewed studies that have been examined by panelists prior to me conference can focus on key issues of direct relevance to the conference, and panelists will be better prepared to make useful inquiries.
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From page 29... ...
Further, as final consensus statements should reflect the evidentiary basis of their findings, readers win be better prepared to consider whether the findings of evidence peer reviewed after the conference might alter the consensus statements' findings and whether a reevaluation of the topic is in order. OMAR's guideline that "speakers should be asked to confine their presentations to the scientific topic that they have agreed to address" should be strictly enforced by the pane!
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From page 30... ...
Such a mode} provides language for representing conflicting data and conflicting objectives and can be explored under a variety of alternative assumptions to determine whether or not the choice of an optimal strategy is dependent on variations in the data base (Pauker, 1986~. Quantitative decision aids and their use of explicit processes to assist in evaluating evidence and deriving recommendations may be of value to panels in achieving consensus.
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From page 31... ...
Specifically, the facilitator might assist the pane} chair in ensuring participation by all panelists, preventing domination by strong pervenalities on the panel, monitoring and allocating panel discussion time, and keeping the pane} focused on the questions to be answered. The limited time available to consensus panels may raise conce~ns about the quality of the resulting consensus statements by creating pressure for the panels to produce statements before they have an adequate opportunity to review the available evidence and reach well-founded conclusions.
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From page 32... ...
It is inappropriate to have a draft consensus statement before a conference begins,6 as this may imply prejudgment of an issue mat 6A previous report to NIH recommended that "panelists should be assigned to questions and write first drafts of answers prior to the conference" or that the panel should meet before the conference and "write an advanced draft of the consensus statement" (Wortman and Vinokur, 1982~. The recommendations in that report were intended to reduce the burden on the panel during its executive session, when the consensus statement is written, and to provide the panel with additional time to produce an improved final consensus statement.
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From page 33... ...
The executive session during which the pane} writes the consensus statement has been described as '~grueling" (Mullen and Jacoby, 1985~. Given the existing time constraint and the potential difficulty of drafting consensus statements, the pane} should be provided with appropriate tools to lessen the burden of Weir work and reduce concern that a deadline forces panels into inadequately considered judgments.
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