Decision Conferences
Decision conferences are face-to-face workshops of experts who are guided by a facilitator in constructing a multi-criteria decision analysis (MCDA) model of the issues under consideration. For medical conditions, the experts include specialists and researchers knowledgeable about the medical condition, clinicians with experience in treating patients, and others authorised to prescribe the drugs, as well as patients who can represent the voices of other patients.
Options considered by the participants include all the major drugs authorised to be prescribed for the medical condition. Benefits and risks are scored by the particitants on all favourable and unfavourable criteria to establish each drug's effectiveness and safety. The real-world difference in performance between the most and least preferred drugs on each criterion is assigned a weight to establish it's clinical importance. An algorithm multiplies the scores by the weights and sums the product to give an overall weighted preference value for each drug.
Options considered by the participants include all the major drugs authorised to be prescribed for the medical condition. Benefits and risks are scored by the particitants on all favourable and unfavourable criteria to establish each drug's effectiveness and safety. The real-world difference in performance between the most and least preferred drugs on each criterion is assigned a weight to establish it's clinical importance. An algorithm multiplies the scores by the weights and sums the product to give an overall weighted preference value for each drug.
The model clearly separates facts from value judgements, but brings them together by applying the theory of decisions with multiple objectives. The group explores the results to see the effects of imprecision and differences of opinion, which leads to revisions of the model as experiences are shared, further data are considered, and intuitions change. Usually, a final model that sufficiently represents the reality of actual drug use is agreed, and the rank ordering is accepted by the experts.
The decision conferencing process is designed to minimise or eliminate bias in four ways:
The decision conferencing process is designed to minimise or eliminate bias in four ways:
- participants are chosen to ensure diversity of viewpoints and differences in experience,
- participants quantify their judgements to minimise misinterpretations,
- peer review occurs on the spot, so that the validity and reliability of data and judgements can be explored and debated, and,
- the facilitator only guides the process and the model’s structure, but does not contribute to the content (neither the available scientific evidence nor judgements about the data and the criteria weights).
Click here for an easy-to-read tutorial on MCDA in Chapter 6.