Lomas J, Anderson G, Enkin M, Vayda E, Roberts R, MacKinnon B
Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada.
JAMA. 1988 May 27;259(20):3001-5.
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.
作为剖宫产共识会议的一部分，由十名成员组成的共识小组对224种临床情况进行了剖宫产适宜性评估。评估在共识会议之前和之后立即进行。针对有充分研究证据的情况（有证据情况）和证据相互矛盾、证据不足或无证据的情况（无证据情况），分别评估了小组成员之间的一致程度（共识）。对于每种情况，小组成员之间的共识以对剖宫产适宜性的完全一致、部分一致或不一致来衡量。会议前，与无证据情况相比，有证据情况中存在完全或部分一致的比例更高（85%对30%），而不一致的模式则相反（15%对70%）。会议后，71%的有证据情况的共识水平实际出现了可能的提高，而无证据情况中只有24%出现了这种情况。因此，这里构建的共识过程对充分证据的可获得性很敏感，表明专家和公众过程的各个方面可以成功结合。然而，通过根据严格研究证据的可获得性对最终建议进行分级，可以对该过程进行改进。
