Hutchings A, Raine R, Sanderson C, Black N
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK.
Qual Saf Health Care. 2005 Aug;14(4):240-5. doi: 10.1136/qshc.2004.013227.
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.
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.
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).
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.
评估设计特征、临床及社会线索对正式共识达成过程中参与者之间分歧程度的影响。
采用析因设计，涉及16个小组，由来自英国的135名全科医生（GP）和42名心理健康专业人员组成。这些小组在各种临床和社会线索背景下，对三种病症（慢性背痛、肠易激综合征和慢性疲劳综合征）的四种心理健康干预措施的适宜性进行评分。各小组在三个设计特征方面存在差异：是否提供系统的文献综述、小组构成（混合组与仅全科医生组）以及对可用医疗资源的假设（现实型与理想型）。使用各小组针对某一情景的中位数评分的平均绝对偏差来衡量分歧程度。
没有任何设计特征对小组内分歧程度产生显著影响（所有p>0.3）。不同治疗方法之间的分歧确实存在差异（认知行为疗法和行为疗法的共识比简短心理动力干预疗法和抗抑郁药的共识更接近），线索之间也存在差异（抑郁症患者和愿意尝试任何治疗方法的患者的共识更接近）。
就本研究中各小组的分歧程度而言，正式的共识达成是一种稳健的技术，因为结果并不依赖于其实施方式。
