An experimental study of determinants of the extent of disagreement within clinical guideline development groups.
OBJECTIVE
To assess the effect of design features and clinical and social cues on the extent of disagreement among participants in a formal consensus development process.


METHODS
Factorial design involving 16 groups consisting of 135 general practitioners (GPs) and 42 mental health professionals from England. The groups rated the appropriateness of four mental health interventions for three conditions (chronic back pain, irritable bowel syndrome, and chronic fatigue syndrome) in the context of various clinical and social cues. The groups differed in three design features: provision of a systematic literature review (versus not provided), group composition (mixed versus GP only), and assumptions about the healthcare resources available (realistic versus idealistic). Disagreement was measured using the mean absolute deviation from a group's median rating for a scenario.


RESULTS
None of the design features significantly affected the extent of disagreement within groups (all p>0.3). Disagreement did differ between treatments (closer consensus for cognitive behavioural therapy and behavioural therapy than for brief psychodynamic intervention therapy and antidepressants) and cues (closer consensus for depressed patients and patients willing to try any treatment).


CONCLUSIONS
In terms of the extent of disagreement in the groups in this study, formal consensus development was a robust technique in that the results were not dependent on the way it was conducted.
Hutchings
A
A
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK. andrew.hutchings@lshtm.ac.uk
Raine
R
R
Sanderson
C
C
Black
N
N
D000328:Adult; D000704:Analysis of Variance; D000928:Antidepressive Agents / Q000627:therapeutic use; D001416:Back Pain / Q000188:drug therapy / Q000628:therapy; D002908:Chronic Disease; D032921:Consensus; D004739:England; D005194:Family Practice; D015673:Fatigue Syndrome, Chronic / Q000188:drug therapy / Q000628:therapy; D005260:Female; D006126:Group Processes; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000188:drug therapy / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D017410:Practice Guidelines as Topic
D000928:Antidepressive Agents