Consensus Papers: Why They Matter

Posted by Cindy Clare Ivy, M.ED, OTD, CHT on 06/29/2020

“Medical consensus” is a public statement of medical knowledge on a particular topic that is generally agreed upon as evidence-based and state-of-the-art knowledge by a representative group of experts. [1] While consensus statements synthesize current information, they do not typically provide specific algorithms for practice as treatment guidelines do. Rather, the consensus takes into consideration cost, available expertise, technology and unique practice conditions. Consensus statements may be used to assist in developing treatment guidelines.

Consensus may be achieved through the convening of experts at a physical meeting, online questionnaires and communication or both. Consensus panels may convene after presenting research at a scientific conference. The Delphi process involves gathering anonymous feedback and sharing this within the group through a number of cycles without physically meeting in person. [2] In this method, respondents may change their answers over the various rounds; the anonymity may facilitate exchanges amongst experts and reduce individual bias.

Regardless of approach, it is useful to follow the Institute of Medicine standards for trustworthy guidelines-adapted from Cooke et al. when developing a consensus. These guidelines suggest disclosing conflicts, having a multidisciplinary panel, following standards for evidence synthesis including trustworthy systematic reviews, using a standard format, keeping review notes confidential while making a draft available for public comment, among other standards. [3, 4]

Consensus papers allow a greater breadth of information to guide intervention planning than literature reviews alone can offer. An example of a case of lack of clinical trials or strong evidence in the realm of hand therapy where a consensus statement would be appreciated is in rehabilitation of adolescents with Osteogenesis imperfecta (OI). In a consensus paper on this subject experts developed 17 statements regarding physical training to improve motor function in adolescents with OI. [5] Through synthesis of available evidence and dialogue and participation from content experts, consensus statements may provide valuable information in determining evaluation techniques, interventions and outcome measures in hand therapy.

References

1. Council of Europe. Developing a methodology for drawing up guidelines on best medical practice Recommendation Rec(2001)13 and explanatory memorandum, Council of Europe Publishing, Strasbourg (2002)

2. K.M. Cam, P.E. McKnight, J.N. Doctor. Delphi method online: medical expert consensus via the internet

Proc AMIA Symp (2002), p. 990

3. Cooke CR, Gould MK. Advancing clinical practice and policy through guidelines: the role of the American Thoracic Society. Am J Respir Crit Care Med. 2013;187(9):910-914. doi:10.1164/rccm.201301-0009PP

4. Gould MK, Cooke CR. A guide to guidelines for pulmonary, sleep, and critical care medicine clinicians. Proc Am Thorac Soc. 2012;9(5):211-214. doi:10.1513/pats.201211-103ED

5. Mueller, B., Engelbert, R., Baratta-Ziska, F. et al. Consensus statement on physical rehabilitation in children and adolescents with osteogenesis imperfecta. Orphanet J Rare Dis 13, 158 (2018). https://doi.org/10.1186/s13023-018-0905-4