Consensus Methodology to Inform the Development of Consensus-based Standards: A Narrative Review and Their Application in Epilepsy
Abstract number :
2.066
Submission category :
15. Practice Resources
Year :
2024
Submission ID :
1102
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Rowan Haffner, BSc (2022-present) – Duke University
Brian Mathew, BS – Rowan University School of Osteopathic Medicine
Francesco Brigo, MD – Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy
Anila Qasim, HBSc, MSc – Alimentiv Inc., London, ON, Canada
Victoria San Antonio-Arce, MD, PhD – University Hospital Freiburg
Houda Ben Ayed, MD – Department of preventive medicine and hospital Hygiene, Hedi Chaker University Hospital, Faculty of Medicine of Sfax, Tunisia.
Edoardo Ferlazzo, MD, PhD – Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
Churl-Su Kwon, MD, MPH – Columbia University
Kheng Seang Lim, MD – Division of Neurology, Department of Medicine, Universiti Malaya
James Mitchell, MBChB, MRCP(UK) – University of Liverpool, UK
Muhammad Salisu, MBBS, MPH, MSc, FMCPaed, Cert (Electroencephalography). – Lagos State University College of Medicine, Ikeja.
Kette Valente, MD, PhD – University of Sao Paulo (USP)
Kollencheri Puthenveettil Vinayan, MD – Department of Pediatric Neurology, Amrita Institute of Medical Sciences Cochin, Kerala, India
Colin Josephson, MD – University of Calgary
Nathalie Jette, MD, MSc – Cumming School of Medicine at the University of Calgary
Rationale: Clinical practice guidelines (CPGs) are essential for healthcare decision-making, but challenges arise when evidence is limited or conflicting. For instance, clinical evidence concerning rare epilepsy syndromes can be sparse, but informed patient care is still needed. Consensus-based standards (CBS) using methodologies such as the Delphi technique, nominal group technique (NGT), and the RAND/UCLA appropriateness method (RAM) can inform CBS. This narrative review explores the advantages and disadvantages of these methods and their applications in epilepsy care.
Methods: A narrative review in PubMed (Nov 22, 2022) was undertaken examining peer-reviewed publications detailing the Delphi technique, the NGT, and RAM, and their application in epilepsy research. The frequency of use of each consensus method and their applications in epilepsy research were also reviewed (search: Oct 31, 2023).
Results: Sixteen articles about these consensus-based methods were identified to describe the advantages and disadvantages of each. In addition, sixty-four epilepsy research studies that used consensus methods were identified, with fifty-eight of these studies utilizing the Delphi technique. The Delphi technique is the most widely used across both general and epilepsy research, as it is inexpensive, and can be applied to many raters internationally due to its suitability for remote collaboration. The Delphi technique effectively guided consensus on managing epilepsy during pregnancy, defining quality of life outcomes, and addressing rare conditions like myoclonic atonic seizures. The NGT was utilized in two studies, successfully guiding expert consensus on the use of cannabidiol for Dravet and Lennox-Gastaut syndromes and was used to facilitate decision-making among pharmacy students addressing ethical issues related to epilepsy patients who drive. The RAM was applied in four studies for its combined individual and group evaluative approach. It was used in epilepsy research to develop guidelines for imaging, create quality-of-care indicators for infantile spasms, and establish a web-based tool for assessing surgical candidates.
Conclusions: The Delphi technique, the most widely used method, emerged as particularly adaptable for areas with limited evidence or impracticality of face-to-face interactions. While NGT favors prompt consensus in single-session formats, the RAM offers a balanced approach with its hybrid structure. The application of these consensus methods is crucial for advancing epilepsy care, particularly in formulating CBS where direct evidence is lacking to inform the development of CPGs. The best method depends on the goal of the study and available resources. This review highlights their distinct roles and collective significance in shaping CBS in epilepsy that are both scientifically sound and practically applicable in varied clinical contexts.
Funding: N/A.
Practice Resources