Carpenter James, Hutchings Andrew, Raine Rosalind, Sanderson Colin
Department of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK.
Int J Technol Assess Health Care. 2007 Winter;23(1):108-15. doi: 10.1017/S0266462307051641.
The aim of this study was to examine the influence of participants' characteristics on the results produced by formal consensus methods.
The approach was an experimental study of 346 participants in 20 groups rating the appropriateness of four mental health interventions for the treatment of chronic fatigue syndrome, irritable bowel syndrome, and chronic back pain. There were four factors in the design: systematic literature review provided or not, decisions made under realistic or "ideal" resource assumptions, clinically mixed (general practitioners and mental health professionals) or homogenous group (general practitioners only), convened or mail-only group. A group's rating was defined as the median of participants' ratings. The influence of participants' characteristics (age, sex, and specialty) was examined using multilevel models.
The largest differences were between the GPs and mental health professionals, both in their initial ratings of the different interventions, and in how much they altered their ratings between rounds. There were smaller but statistically significant (p<.05) differences between specialty and age groups in initial ratings for the treatment (by whatever means) of different conditions, and for certain conditions women increased their ratings more than men. Women rated intervention more favorably when assuming "ideal" rather than realistic levels of resources, but men did not.
Our findings support the practice of treating professional specialty as an important determinant of the results in consensus panels.
本研究旨在探讨参与者特征对正式共识方法所产生结果的影响。
该研究采用实验性研究,让20个小组中的346名参与者对用于治疗慢性疲劳综合征、肠易激综合征和慢性背痛的四种心理健康干预措施的适宜性进行评分。研究设计中有四个因素:是否提供系统文献综述、在现实或“理想”资源假设下做出决策、临床混合组(全科医生和心理健康专业人员)或同质组(仅全科医生)、召集组或仅邮件组。一个小组的评分被定义为参与者评分的中位数。使用多层次模型研究参与者特征(年龄、性别和专业)的影响。
全科医生和心理健康专业人员之间的差异最大,无论是在他们对不同干预措施的初始评分上,还是在各轮之间他们改变评分的程度上。不同专业和年龄组在对不同病症(无论采用何种方法)治疗的初始评分上存在较小但具有统计学意义(p<0.05)的差异,对于某些病症,女性比男性提高评分的幅度更大。在假设“理想”而非现实资源水平时,女性对干预措施的评分更有利,但男性并非如此。
我们的研究结果支持将专业作为共识小组结果的重要决定因素的做法。