ESSKA consensus initiative: why, when and how?

The goal of a Consensus in clinical practice is to provide daily practitioners with evidence- based recommendations on data from the literature, clinical expertise and expectations of professionals and patients. In this context, a consensus aligns with the principles of evidence-based medicine in clinical practice and is consequently regarded as a scientific work of a certain level of evidence (LOE). It is expected that such a project may contribute to filling the gap observed between scientific evidence and reality of the daily practice. A Clinical Consensus is particularly needed for those topics that are of interest to daily practice but controversial due to lack of evidence, and for which expert agreement can provide valuable support in reaching conclusions. A Consensus requires a strict methodology, based on two principles: an iterative process with independence of the involved groups and pluralism (geographical and professional representation). These processes guarantee the scientific quality of the recommendations. Among the various consensus modalities, ESSKA has adopted the Formal Consensus derived from the Delphi method, and the RAND/UCLA appropriateness method. These two methods are complementary. The first one, based on questions-answers sets, is particularly suitable for questions of terminology, diagnosis, planning, strategy. The second one is based on the concept of scenarios, particularly adapted to treatment indications. These two methods can also be used within the same consensus. The aim of this article is to define what is a consensus initiative, to detail the methodology ESSKA has chosen, and to point out the key role of the dissemination.