Background: Patient Blood Management (PBM) aims to optimise the care of patients who might need a blood transfusion. An international consortium of European, American, Canadian and Australian organizations organized a two-day International Consensus Conference (ICC-PBM) to develop recommendations on three PBM topics: preoperative anaemia, red blood cell transfusion triggers and implementation of PBM programmes.
Objectives: to enhance shared decision making in formulating recommendations for 17 PICO (patient, intervention, comparison, outcome) questions relevant for the field of PBM.
Methods: we organized a two-day conference (ICC-PBM) with a multidisciplinary set of speakers, chairs, rapporteurs, decision-making panels including 10 to 15 healthcare professionals and patient representatives, and general audience to formulate evidence-based recommendations. We used GRADE’s Evidence-to-Decision (EtD) framework (10 items), the GRADEpro software, and indicative opinion polls via a smartphone/laptop application (Mentimeter™ software) to facilitate the discussions during the plenary/open sessions and to translate the evidence reviews into recommendations (conditional, strong) during the closed/private sessions (Figure 1).
Results: 186 healthcare professionals from five continents, who were affiliated to 63 (university/academic) hospitals, 28 blood services, 23 (patient) organizations, 12 (pharmaceutical) companies and five governmental bodies attended the conference. On day 1, 17 reviews were presented in three open sessions, after which discussions with the general audience were initiated according to GRADE’s EtD framework, and opinion polls on the EtD items that were not covered by the evidence reviews were performed (i.e. values and preferences, equity, acceptability and feasibility of the intervention, general response rate: 65 ± 12%). Subsequently, three multidisciplinary decision-making panels formulated draft evidence-based recommendations in three closed sessions. On day 2, draft recommendations and underlying justifications were presented to the general audience in a plenary session after which opinion polls (general response rate: 69 ± 4%) and discussions were organized to identify the level of agreement The decision-making panels finally formulated three strong and seven conditional clinical recommendations.
Conclusions: the use of the formal consensus development conference format with a multidisciplinary audience, GRADE’s EtD framework/software and opinion polls via smartphone/laptop application improves and enhances shared decision making when formulating recommendations.
Patient or healthcare consumer involvement: the systematic use of evidence-based methodologies should be the new standard to evaluate (cost-)effective treatment in order to avoid recommendations based on expert opinion solely and/or strongly held traditions or opinions on religious (e.g. Jehova's Witnesses) or commercial (e.g. pharmaceutical industry) grounds.