A comparison of formal consensus methods used for developing clinical guidelines.
A comparison of formal consensus methods used for developing clinical guidelines.
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DOI：
10.1258/135581906778476553
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发表时间：
2006-10-01
影响因子：
2.4
通讯作者：
Black, Nick
中科院分区：
文献类型：
--
作者：
Hutchings, Andrew;Raine, Rosalind;Black, Nick
目标：比较两种共识的发展方法，通常用于制定临床指南的判断产生的，接近的共识，轮之间的变化量，与研究证据和reliability.METHODS的一致性：在所有，213全科医生和心理健康专业人士从英格兰参加了四个德尔菲和四个名义组。他们评估了四种治疗方法（认知行为疗法[CBT]，行为疗法[BT]，简短的心理动力学人际治疗[BPIT]和抗抑郁药）对三种疾病的适当性。首先，参与者使用邮寄问卷独立评估干预措施的适当性。对于名义组，评分被反馈并在会议上讨论，然后组成员再次私下完成问卷。对于德尔菲组，有反馈，但没有讨论，整个过程是通过邮寄questionnaire.RESULTS进行的：最终评级的共识方法的效果不同的治疗干预，与名义组CBT和抗抑郁药的评级更有利的德尔菲组。在这两轮中，名义上的共识比德尔菲小组更接近。在与研究证据的一致性方面，两组之间没有总体差异（比值比1.13，95%置信区间0.79-1.61）。在这项研究中，德尔菲法是更可靠的（kappa系数0.88和0.89相比，0.41和0.65的名义groups.CONCLUSIONS：名义组的优势（更多的共识，更好地理解分歧的原因）可以结合更大的可靠性的德尔菲方法开发一种混合方法。
OBJECTIVES: To compare two consensus development methods commonly used for developing clinical guidelines in terms of the judgments produced, closeness of consensus, amount of change between rounds, concordance with research evidence and reliability.METHODS: In all, 213 general practitioners and mental health professionals from England participated in four Delphi and four nominal groups. They rated the appropriateness of four treatments (cognitive behavioural therapy [CBT], behavioural therapy [BT], brief psychodynamic interpersonal therapy [BPIT] and antidepressants) for three conditions. First, participants rated the appropriateness of interventions independently, using a postal questionnaire. For nominal groups, the ratings were fed back and discussed at a meeting, and then group members privately completed the questionnaire again. For Delphi groups, there was feedback but no discussion, and the entire process was conducted by postal questionnaire.RESULTS: The effect of consensus method on final ratings varied with therapeutic intervention, with nominal groups rating CBT and antidepressants more favourably than Delphi groups. Consensus was closer in the nominal than in the Delphi groups in both rounds. There was no overall difference between groups in their concordance with research evidence (odds ratio 1.13, 95% confidence interval 0.79-1.61). In this study, the Delphi method was more reliable (kappa coefficients 0.88 and 0.89 compared with 0.41 and 0.65 for nominal groups).CONCLUSIONS: The advantages of nominal groups (more consensus; greater understanding of reasons for disagreement) could be combined with the greater reliability of the Delphi approach by developing a hybrid method.