Planning a consensus-based publication? Do's and don'ts

In the last year or two, I have had several projects on manuscripts based on #consensus statements. It has become very common to see #advisoryboard meetings being conducted to arrive at a consensus on a particular disease diagnosis/ treatment/ challenges with the final objective being a manuscript publication. However, few of these manuscripts get published by indexed journals with a high impact factor. I have come across instances when I know even when the project comes to me, that this particular manuscript will not achieve publication in a widely-read journal. However, by then it is too late to do anything because the meeting has already been conducted and the results of the consensus are handed to me to write a manuscript. The plot has already gone wrong beyond repair. I am sharing here some of the common pitfalls that should be avoided in such projects.

1. Do your research- do you have something new to offer or are you doing a consensus project only because your competitor did it last year?I once had a project where I was involved from the stage of creating the statements to be put up for voting. When I looked up the literature, I found that many of the to-be authors (KOLs) associated with this project had published a consensus on the same topic last year, sponsored by another company. There was no new literature on the topic and no change in the international guidelines. I asked the client why we were doing this exercise. The answer was - 'we want to engage with these KOLs. We already have them on board and there is no going back now.' First, the reason for the meeting itself is incorrect. The objective of consensus statements should be to influence current practice. There are various ways to engage with KOLs. Other options could have been thought of. Needless to say, until the last update, we did not succeed with the publication. Every journal had the same query- same authors, same topic, same consensus. What's new?
2. How is the consensus arrived at?

The ideal way to arrive at a consensus is the Delphi method. Statements need to be drafted based on current literature and discussion with KOLs. These need to be circulated to the panel along with supporting literature for them to read before the statements are put up for voting. To have a more robust consensus that is valued by well-known journals with a high impact factor, the panel should also be asked to vote on the robustness of the evidence. In the meeting that follows, the outcomes of the vote on statements as well as evidence should be shared. KOLs should be asked to present their views (based on evidence) in favor of and against statements that did not achieve consensus through voting. Following a discussion, these statements should be put up for voting again (they can be the same or modified based on discussions). Thus, it is advisable to have at least 2 rounds of voting and sometimes even 3.

However, I have seen that very often a consensus is arrived at only verbally, with no statements or evidence being sent as pre-read. In such a scenario, the views of the most popular and loudest KOLs are likely to prevail. Since it is mandatory to write the Methodology for arriving at a consensus in a manuscript, a consensus arrived at by voice vote is not favored by journals with a high impact factor.

3. The size of the team that arrived at the consensus

I have had instances where there were 100 HCPs invited to the meeting and the consensus was reached by voice vote. It can be a monumental challenge to achieve publication in such cases. It is obvious that there can be no discussion amid such a large crowd. It is often a one-way presentation and not a consensus in the real- sense. This is another publication we are struggling with.

4. Are you offering solutions?

In another case, I had a project where the consensus was only about challenges, and no solutions to mitigate or address the challenges were discussed. Experts creating a consensus statement are expected to offer solutions and not just leave after highlighting the problems. While this project is still ongoing, I am not very hopeful of a publication.

5. A consensus and survey are NOT the same

In one of the projects, a consensus was sought only through questionnaire circulation. A meeting was held before drafting the questionnaire but there was no discussion after the voting. This methodology cannot be called a consensus and the journal will insist it should be published as an HCP survey manuscript.

6. There is a difference between expert opinion and consensus

Another practice I have observed is multiple small group meetings are conducted (often online), all of them on a common topic and having the same agenda. Discussions are captured as notes during such meetings by a person. Notes of all such meetings are then planned to be published as a consensus-based manuscript. This again is not consensus- at best it can be described as expert opinion and should be attempted to be published as such. Submitting a manuscript based on this methodology as a consensus statement is unlikely to be accepted by renowned indexed journals.

Thus, planning a consensus involves a lot of scientific work that needs to start much before the actual meeting. Unfortunately, very often the team is focused on the operations and logistics of the meeting and science takes a backseat. If you are aiming to achieve change in practice through consensus statements, science needs to be the driver. Otherwise, it is just a perfunctory exercise with no business impact.

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