Qual Saf Health Care 14:240-245 doi:10.1136/qshc.2004.013227
  • Original Article

An experimental study of determinants of the extent of disagreement within clinical guideline development groups

  1. A Hutchings,
  2. R Raine,
  3. C Sanderson,
  4. N Black
  1. Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. Correspondence to:
 MrA Hutchings
 Health Services Research Unit, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK;
  • Accepted 10 April 2005


Objective: To assess the effect of design features and clinical and social cues on the extent of disagreement among participants in a formal consensus development process.

Methods: Factorial design involving 16 groups consisting of 135 general practitioners (GPs) and 42 mental health professionals from England. The groups rated the appropriateness of four mental health interventions for three conditions (chronic back pain, irritable bowel syndrome, and chronic fatigue syndrome) in the context of various clinical and social cues. The groups differed in three design features: provision of a systematic literature review (versus not provided), group composition (mixed versus GP only), and assumptions about the healthcare resources available (realistic versus idealistic). Disagreement was measured using the mean absolute deviation from a group’s median rating for a scenario.

Results: None of the design features significantly affected the extent of disagreement within groups (all p>0.3). Disagreement did differ between treatments (closer consensus for cognitive behavioural therapy and behavioural therapy than for brief psychodynamic intervention therapy and antidepressants) and cues (closer consensus for depressed patients and patients willing to try any treatment).

Conclusion: In terms of the extent of disagreement in the groups in this study, formal consensus development was a robust technique in that the results were not dependent on the way it was conducted.


  • The research programme is funded by a Medical Research Council (MRC) Clinician Scientist Fellowship for Rosalind Raine. The MRC was the sole funding source and they had no involvement in study design, collection, analysis and interpretation of data, in writing or submitting the paper.

  • All authors declare that they have no competing interests.