Developing a reference protocol for structured expert elicitation in health-care decision-making: a mixed-methods study.

ABSTRACT

BACKGROUND: Decisions in health care aim to maximise health, requiring judgements about treatments. The evidence used to make these judgements is typically uncertain. In these situations, the experience of experts is essential. Structured expert elicitation collects beliefs from experts. There are different guidelines available for structured expert elicitation; however, it is not clear if any of these be can be used in health-care decision-making, for example in considering if a treatment should be made available in the NHS. This project aimed to develop a guidance for structured expert elicitation to inform health-care decision-making. METHODS: Reviews and experimental techniques were used to gather a list of methods to conduct structured expert elicitation. The suitability of these choices in health-care decision-making was then determined by comparing these with a set of standards that support the use of structured expert elicitation in health-care decision-making. RESULTS: Different guidelines prefer different approaches to conduct structured expert elicitation. There is a lack of evidence available to determine which of these methods is most appropriate across the whole of health-care decision-making. It is possible to define reference protocol methods that could be used in a particular type of health-care decision-making, health technology assessment. This includes gathering experts with knowledge of the clinical area, asking experts about things that they observe in clinical practice and asking experts individually for their beliefs. For decision-makers working outside health technology assessment, for example at a local level, or for treatments that are not yet available to patients, these choices may not be appropriate. CONCLUSIONS: This flexibility of this guidance is a useful feature. It is possible for different decision-makers in health care to interpret the reference protocol for their own circumstances.