Consensus on Diagnosis and Management Recommendations - Center for Evidence-Based Imaging (CEBI)

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 There 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

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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.

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,¹³American 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.

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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.