The consensus conference: pitfalls and problems

Consensus conferences in medicine are frequently conducted to formulate recommendations primarily relating to contentious areas in the diagnosis and management of disease and in the assessment of prognostic markers. While these conferences have the potential to provide recommendations that will be of benefit to both the patient and relevant professional group, there are potential pitfalls which can bias results. Of interest, there is an opinion that experts cannot be relied on to reach a reliable consensus on facts relating to their own area of expertise. Even with the best intentions, little consideration is usually given to issues which could lead to the endorsement of recommendations that may not be evidence-based and/or supported by the profession. The potential for bias may result from the selection process for choosing conference participants, the choice of topics nominated for discussion, and the formulation of questions presented to the audience for voting. Bullying, peer pressure, social influence, confirmation bias, communal reinforcement of incorrect concepts, and a desire to conform and achieve acceptance within a peer group may all influence the consensus process, thus limiting the validity of results. It is the responsibility of the conference organizers to ensure that proposed conferences are relevant, objective, evidence-based, and likely to produce meaningful results. It is also incumbent on journal editors and peer reviewers to ensure that the published proceedings report novel, meaningful recommendations that advance the profession and/or improve patient outcomes.