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At least 19 recordsLinked to original sources
PubMed1991

The epistemology and ethics of consensus: uses and misuses of 'ethical' expertise.

In this paper I examine the epistemology and ethics of consensus, focusing on the ways in which decision makers use/misuse ethical expertise. The major questions I raise and tentative answers I give are the following: First, are the 'experts' really experts? My tentative answer is that they are bona fide experts who often represent specific interest groups. Second, is the experts' authority merely epistemological or is it also ethical? My tentative answer is that the experts' authority consists not only in their command over specific matters of fact and/or value, but also in their ability to achieve 'consensus' about what is 'true'/'false', or 'right'/'wrong'. Third, should the authority of expertise be limited? My tentative answer is that it should be limited in the area of facts but especially in the area of values. Persons who are ethics 'experts' must be particularly careful to practice an ethics of persuasion rather than an ethics of compulsion. Their role is not to force their group consensus upon decision makers' individual moral perceptions and deliberations; rather it is to help decision makers come to their own conclusions about what they ought to do.

Advisory Committees↗
PubMed1991

Words without action? The production, dissemination, and impact of consensus recommendations.

When existing evaluations find little or no evidence of consensus recommendations leading to action, one can justifiably ask why so much of this review was dedicated to analyzing alternative ways of producing such "words without action." There are, however, at least two reasons why consensus recommendations should be produced with care and attention to validity. First, recommendations do sometimes have an impact on behavior as a consequence of mere dissemination activity--the Dutch program, for instance, was more successful than most. This success may occur when the target audience is already particularly receptive to change and the message is timely and delivered by a credible source in a clinically relevant way. Thus, although "such a conjunction of favorable conditions is probably the exception rather than the rule for consensus topics" (46, 240) it does happen. Second, the output from consensus processes is increasingly a potential input to other processes. Consensus recommendations can be used as the criteria for evaluation and appraisal aimed at changing practice behavior, making administrative decisions on resource allocation, or defining research protocols. For instance, quality assurance activities, such as peer assessment, practitioner certification, or utilization review, are actively seeking criteria with which to make judgments and elicit changes in practice to improve the quality of care. Funding agencies are looking for information to help make reimbursement, capital expenditure, or fee-for-service decisions on cessation of insurance for particular procedures or approaches. These uses of the consensus criteria are potentially major and controversial. Therefore, even if dissemination rarely leads to action, consensus processes should still be done carefully and with valid techniques. The use of their recommendations embedded within other activities may well lead to (forced) changes in behavior. On ethical grounds alone, we should be as sure as possible that the behavior changes being implied and encouraged are indeed advisable. For these reasons, the review describes the decision points in the production process for consensus recommendations as a start on the development of a set of recognized standards. The review offers a critical appraisal of the various methodological choices available at each decision point. The seven decision points are selecting a topic, picking the consensus group, providing background preparation, identifying information inputs, choosing a group judgment process, defining the criteria for recommendations, and choosing a report preparation procedure and format. At least two important points emerged from this review. First, the research is often not well enough developed to give clear indications for many of the choices on what is the "best" alternative.(ABSTRACT TRUNCATED AT 400 WORDS)

Canada↗
PubMed1990

Changing practice patterns in the management of primary breast cancer: Consensus Development Program.

In the last decade, new knowledge has emerged concerning the efficacy of treatment for breast cancer. For that reason, the National Institutes of Health devoted a consensus conference to this topic. To determine whether the consensus conference had influenced practice patterns, and to evaluate the level of quality of care given to women with breast cancer, the medical records of 573 patients treated in ten hospitals throughout the state of Washington were abstracted and analyzed. Results showed no changes with respect to the consensus conference's recommendations for use of a total mastectomy with axillary dissection or the use of a two-step procedure in which the biopsy is performed first and therapeutic options are discussed before a definitive surgery is undertaken. Analyses of quality of care issues not addressed by the consensus conference revealed that 4 percent of the sample were explicitly staged preoperatively and 29 percent postoperatively and that little changed over time in the use of sentinel laboratory tests. These results also show that consensus recommendations will not necessarily change physicians' behavior even where change is possible, and that quality of care in diagnosis and treatment of breast cancer still needs to be addressed.

Adult↗
PubMedDate not supplied

Adjuvant therapy for colorectal carcinoma.

In Western industrialized countries, colorectal adenocarcinoma is the second most common solid malignant tumor. Despite radical surgery in 75% to 80% of all cases, about 50% of patients with colorectal carcinoma die of this tumor. The essential advances of the last years are the reduction in the surgical complication rate and postoperative mortality. Recent studies show that radiotherapy for rectal carcinoma and chemotherapy (5-Fluorouracil in combination with levamisole) for colon carcinoma as additional measures in certain subgroups can significantly improve results. However, such multimodality treatment concepts need adequate equipment and experience and should only be implemented, whenever possible, in controlled clinical trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1992

The case for intensive dissemination: adoption of practice guidelines in the coronary care unit.

Medical practice guidelines are being embraced enthusiastically by subspecialty and government organizations, but although hundreds have been developed at great public and private expense, there are few examples of how they have improved the quality of care or reduced health care costs. This article reports documented experience in changing physician behavior after implementing medical practice guidelines in the coronary care unit without altering physician incentives or imposing the threat of sanctions. Guideline adoption did require significant attention to the implementation process, including endorsement of guidelines by local "opinion leaders," validation by local data, and an intensive and concurrent implementation strategy.

Chest Pain↗
PubMed1992

Asymptomatic impacted teeth in edentulous jaws undergoing preprosthetic surgery. A long-term evaluation.

A long-term evaluation is made of 15 patients with asymptomatic impacted teeth in edentulous jaws. Seventeen impacted teeth in 15 patients were recorded and analysed. They were located in denture-bearing areas and in areas undergoing preprosthetic surgery. All patients, except one lost after 1-year period, were followed clinically and radiographically for 1 to 10 years with an average of 4 years. The asymptomatic impacted teeth in edentulous jaws embedded in bone or covered with mucosa did not cause any problem to the patients. The findings of this study support the view that removal of asymptomatic impacted teeth in denture-bearing areas, or in areas undergoing preprosthetic surgery, is unnecessary as long as the integrity of the covering tissues is preserved. A policy or radiological surveillance is recommended.

Adult↗
PubMed1992

The Consensus Development Program. Detecting changes in medical practice following a consensus conference on the treatment of prostate cancer.

The treatment of prostate cancer was reviewed at a U.S. National Institutes of Health Consensus Development Conference in June 1987. Data from the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results tumor registries were analyzed and showed that the proportion of eligible prostate cancer patients receiving the recommended therapies did not increase at a faster rate after the conference than before.

Aged↗
PubMed1992

The technology assessment and practice guidelines forum. A modified group judgment method.

This article describes a new group-judgment process, modified from the consensus development approach of the U.S. National Institutes of Health. It is called the "forum" method, a shorthand term for "technology assessment and practice guidelines forum." This approach is aimed at (a) describing the current state of knowledge of the technology under study; (b) developing practice guidelines for the use of the technology; and (c) providing information for insurers, consumers, policymakers, and others. A pilot study was conducted focusing on total parenteral nutrition. The validity of the process and of the recommendations and their acceptability were evaluated in a survey of participants and a selected group of nonparticipants. Based on the survey results, the forum method appears to be a valuable method for assessing technologies, defining their clinical role, and developing practice guidelines.

Consensus Development Conferences, NIH as Topic↗