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Results From a Canadian Consensus Exercise

Jonathan Lomas, MA; Geoffrey Anderson, MD; Murray Enkin, MD, FRCS(C); Eugene Vayda, MD, FRCP(C); Robin Roberts, MT; Betsy MacKinnon, MSc

JAMA. 1988;259(20):3001-3005.

Abstract
As part of a consensus conference on cesarean birth, the ten-member consensus panel rated 224 clinical scenarios on their appropriateness for a cesarean section. Ratings were obtained before and immediately after the consensus conference. The level of agreement (consensus) among panelists was assessed separately for scenarios with good research evidence (evidence scenarios) and for those with conflicting, poor, or no evidence (nonevidence scenarios). For each scenario, consensus between panelists was measured as total agreement, partial agreement, or disagreement on the appropriateness of a cesarean section. Before the conference, total or partial agreement existed for a larger percentage of evidence than nonevidence scenarios (85% vs 30%), with the pattern reversed for disagreements (15% vs 70%). After the conference, possible improvement in the level of consensus actually occurred for 71% of the evidence and only 24% of the nonevidence scenarios. Thus, the consensus process, as structured here, was sensitive to the availability of good evidence and suggests that aspects of both expert and public processes can successfully be combined. However, an improvement could be made in the process by grading final recommendations according to the availability of rigorous research evidence.

(JAMA 1988;259:3001-3005)

Author Affiliations
From the Departments of Clinical Epidemiology and Biostatistics (Mr Lomas, Dr Enkin, Mr Roberts, and Ms MacKinnon) and Obstetrics and Gynaecology (Dr Enkin), McMaster University, Hamilton, Ontario; the Department of Community Medicine and Epidemiology, University of Ottawa (Dr Anderson); and the Department of Health Administration, Division of Community Health, University of Toronto (Dr Vayda).

Footnotes
Reprint requests to Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, Health Sciences Centre, McMaster University, Hamilton, Ontario, Canada L8N 3Z5 (Mr Lomas).

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