Abstract
BackgroundRecommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. However, there are potential biases in group decision making, and formal consensus methods may help reduce these.MethodsWe conducted a case study using formal consensus, to develop one set of recommendations within the Neonatal Parenteral Nutrition guideline being produced for the National Institute for Health and Care Excellence. Statements were generated through identification of published guidelines on several topics relating to neonatal parenteral nutrition. Ten high quality guidelines were included, and 28 statements were generated; these statements were rated by the committee via two rounds of voting. The statements which resulted in agreement were then used to develop the recommendations.ResultsThe approach was systematic and provided transparency. Additionally, a number of lessons were learnt; including the value of selecting the appropriate topic, giving adequate time to the process, and ensuring methodologies are understood by the committee for their value and relevance.ConclusionFormal consensus is a valuable option for use within guideline development when specific criteria are met. The approach provides transparent methodology, ensuring clarity on how recommendations are developed.
Highlights
Recommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus
Guidelines are developed by the National Institute for Health and Care Excellence (NICE) to improve health and social care
During the initial phase of the guideline, stakeholders, who included a range of public and private parties with an interest in neonatal parenteral nutrition (NPN), identified certain topics that were considered vital for inclusion [1]
Summary
Recommendations within guidelines are developed by synthesising the best available evidence; when limited evidence is identified recommendations are generally based on informal consensus. There are potential biases in group decision making, and formal consensus methods may help reduce these. The effectiveness of group decision making using informal consensus may be open to bias [2]. Despite the NICE guideline processes emphasising that all committee members have equal status, evidence suggests in some situations some individuals may not be as confident in giving their views as openly as others. Formal consensus methods were developed to overcome these potential biases, giving equal participation to all members of the group, and to provide a transparent and systematic approach to group decision making [8]. Understanding the practicalities of conducting a formal consensus exercise should be explored, and importantly the methods should be documented and discussed
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