Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative
Abstract Background Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspi...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2022-07-01
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| Series: | BMC Medical Research Methodology |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12874-022-01667-w |
| _version_ | 1818474000615997440 |
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| author | John C. Hardman Kevin Harrington Tom Roques Sanjai Sood Jemy Jose Shane Lester Paul Pracy Ricard Simo Costa Repanos Frank Stafford Chris Jennings Stuart C. Winter Hugh Wheatly Jarrod Homer B. Nirmal Kumar Vinidh Paleri |
| author_facet | John C. Hardman Kevin Harrington Tom Roques Sanjai Sood Jemy Jose Shane Lester Paul Pracy Ricard Simo Costa Repanos Frank Stafford Chris Jennings Stuart C. Winter Hugh Wheatly Jarrod Homer B. Nirmal Kumar Vinidh Paleri |
| author_sort | John C. Hardman |
| collection | DOAJ |
| description | Abstract Background Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. Methods A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. Results Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached ‘strong agreement’ (n = 25, 2, 0 for each round, respectively), a single statement achieved ‘agreement’ only (round 3), and ‘no agreement’ could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. Conclusions The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service. |
| first_indexed | 2024-04-14T04:31:42Z |
| format | Article |
| id | doaj.art-74787c180cd84b73b76f17a79679c549 |
| institution | Directory Open Access Journal |
| issn | 1471-2288 |
| language | English |
| last_indexed | 2024-04-14T04:31:42Z |
| publishDate | 2022-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Research Methodology |
| spelling | doaj.art-74787c180cd84b73b76f17a79679c5492022-12-22T02:12:02ZengBMCBMC Medical Research Methodology1471-22882022-07-0122111210.1186/s12874-022-01667-wMethodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiativeJohn C. Hardman0Kevin Harrington1Tom Roques2Sanjai Sood3Jemy Jose4Shane Lester5Paul Pracy6Ricard Simo7Costa Repanos8Frank Stafford9Chris Jennings10Stuart C. Winter11Hugh Wheatly12Jarrod Homer13B. Nirmal Kumar14Vinidh Paleri15Head and Neck Unit, The Royal Marsden NHS Foundation TrustHead and Neck Unit, The Royal Marsden NHS Foundation TrustDepartment of Oncology, Norfolk and Norwich University Hospitals NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Bradford Teaching Hospitals NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Hull and East Yorkshire Hospitals NHS TrustDepartment of Otolaryngology, Head and Neck Surgery, South Tees Hospitals NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Guy’s and St Thomas’ NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Portsmouth Hospitals NHS TrustDepartment of Otolaryngology, Head and Neck Surgery, South Tyneside and Sunderland NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, University Hospitals Birmingham NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Oxford University Hospitals NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Manchester University NHS Foundation TrustDepartment of Otolaryngology, Head and Neck Surgery, Wrightington Wigan & Leigh NHS Foundation TrustHead and Neck Unit, The Royal Marsden NHS Foundation TrustAbstract Background Methods for developing national recommendations vary widely. The successful adoption of new guidance into routine practice is dependent on buy-in from the clinicians delivering day-to-day patient care and must be considerate of existing resource constraints, as well as being aspirational in its scope. This initiative aimed to produce guidelines for the management of head and neck squamous cell carcinoma of unknown primary (HNSCCUP) using a novel methodology to maximise the likelihood of national adoption. Methods A voluntary steering committee oversaw 3 phases of development: 1) clarification of topic areas, data collection and assimilation, including systematic reviews and a National Audit of Practice; 2) a National Consensus Day, presenting data from the above to generate candidate consensus statements for indicative voting by attendees; and 3) a National Delphi Exercise seeking agreement on the candidate consensus statements, including representatives from all 58 UK Head and Neck Multidisciplinary Teams (MDT). Methodology was published online in advance of the Consensus Day and Delphi exercise. Results Four topic areas were identified to frame guideline development. The National Consensus Day was attended by 227 participants (54 in-person and 173 virtual). Results from 7 new systematic reviews were presented, alongside 7 expert stakeholder presentations and interim data from the National Audit and from relevant ongoing Clinical Trials. This resulted in the generation of 35 statements for indicative voting by attendees which, following steering committee ratification, led to 30 statements entering the National Delphi exercise. After 3 rounds (with a further statement added after round 1), 27 statements had reached ‘strong agreement’ (n = 25, 2, 0 for each round, respectively), a single statement achieved ‘agreement’ only (round 3), and ‘no agreement’ could be reached for 3 statements (response rate 98% for each round). Subsequently, 28 statements were adopted into the National MDT Guidelines for HNSCCUP. Conclusions The described methodology demonstrated an effective multi-phase strategy for the development of national practice recommendations. It may serve as a cost-effective model for future guideline development for controversial or rare conditions where there is a paucity of available evidence or where there is significant variability in management practices across a healthcare service.https://doi.org/10.1186/s12874-022-01667-wDelphiAuditCost effectivenessGuidelinesHead and neck cancerUnknown primary |
| spellingShingle | John C. Hardman Kevin Harrington Tom Roques Sanjai Sood Jemy Jose Shane Lester Paul Pracy Ricard Simo Costa Repanos Frank Stafford Chris Jennings Stuart C. Winter Hugh Wheatly Jarrod Homer B. Nirmal Kumar Vinidh Paleri Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative BMC Medical Research Methodology Delphi Audit Cost effectiveness Guidelines Head and neck cancer Unknown primary |
| title | Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative |
| title_full | Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative |
| title_fullStr | Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative |
| title_full_unstemmed | Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative |
| title_short | Methodology for the development of National Multidisciplinary Management Recommendations using a multi-stage meta-consensus initiative |
| title_sort | methodology for the development of national multidisciplinary management recommendations using a multi stage meta consensus initiative |
| topic | Delphi Audit Cost effectiveness Guidelines Head and neck cancer Unknown primary |
| url | https://doi.org/10.1186/s12874-022-01667-w |
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