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Why is consensus important?

Even if guidelines are based on well-conducted clinical trials or other unbiased high-quality evidence, repeated studies have also shown that physician practice is often not concordant with existing guidelines.4┬áThere is similar lack of radiologists’ adherence to evidence-based imaging guidelines.5


Several explanations have been proposed for the discrepancy between clinical practice and evidence-based guidelines, including6:

Lack of awareness of the guidelines

Lengthy and unclear guidelines

Decreased willingness to change existing practice patterns

Absence of embedded guidelines in clinical workflow

Patient preference

Consensus Development

Four expert multispecialty panels will convene to build consensus based on available evidence (see right) on recommendations for diagnosis and management of findings that may lead to a diagnosis of lung, prostate, pancreatic or adrenal cancer. We will utilize a Modified Delphi process1 or nominal group technique (Expert Panel)2 to generate agreement on recommendations that will be implemented as CDS across MGB. The recommendations will be discussed as units of evidence. Guidelines, for instance, may contain more than 1 (often >10) units of evidence, or specific recommendations.

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Evidence to be represented as CDS and evaluated by units of evidence

Lung findings (e.g., nodules)

American College of Chest Physician guidelines,3 Fleischner Society guidelines4

Prostate lesions

Prostate Imaging Reporting & Data System (PI-RADS),5 International Society of Urological Pathology Gleason grading6

Pancreas lesions

International consensus Fukuoka guidelines,7 American College of Radiology white paper,8 Society of Abdominal Radiology panel,9 American Gastroenterological Association technical review10

Adrenal findings

American College of Radiology white paper,11 European Society of Endocrinology,12 Canadian Urological Association,13 American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons14

As part of the consensus process, surveys will be administered to panel members. Evidence will be assessed for consensus.

CDS development and implementation: We will represent the units of evidence derived from consensus as CDS.

The Harvard Medical School Library of Evidence (HMS-LOE)

A longtime collaborator of CEBI, the Harvard Medical Library of Evidence was led with the gial of creating a provider-led, sustainable, public repository of medical evidence. Harvard’s Public Repository of Evidence for Clinical Decision Support is free to the public.

The effective use of a clinical decision support system means patients get the right tests, the right medications, and the right treatment, particularly for chronic conditions.

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