Tuning up the chords of consensus research with the ACcurate COnsensus Reporting Document (ACCORD) (2024)

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The BJD receives a substantial number of consensus-based papers, yet their quality varies considerably. To address this, the BJD now requires authors to adhere to the ACcurate COnsensus Reporting Document (ACCORD) and include the completed checklist with their submissions.

Consensus methods are extensively utilized for complex scenarios, particularly those involving decision making when objective evidence is limited, contradictory or absent.^1–3 In dermatology, consensus methods are applied for several purposes such as developing clinical practice guidelines, disease classification, core outcome sets and establishing research priorities.^1,4 A range of methods is available, from informal ‘expert consensus meetings’ to more structured methods such as the Delphi method, Nominal Group Technique and RAND/UCLA Appropriateness Method.^1–3 These differ in terms of anonymity, number of participants, face-to-face meetings and required timeframes.

Consensus obtained through formal methods involving a group of experts is generally seen as being more reliable than relying solely on individual opinions and experiences.^1,2 These formal methods mitigate challenges inherent in group decision making by fostering interactions, stimulating critical thinking and questioning conventional viewpoints. Structured approaches minimize risks associated with unstructured group dynamics, such as one individual monopolizing discussions, misrepresenting unanimous agreement when dissenting opinions exist, or allowing group biases to influence decision making.¹

Despite the frequent application of consensus methods, shortcomings in their reporting have been well documented, such as a lack of adequate detail and transparency.^2,3 Many study designs have established reporting guidelines to ensure consistency and quality in research publications.⁴ Examples in the BJD author guidance include the PRISMA and CONSORT guidelines.

Until recently there was no universal reporting guideline applicable to all consensus methods. Two reporting guidelines offer some guidance: Appraisal of Guidelines, Research and Evaluation (AGREE)-II, used for clinical practice guidelines, containing one item on consensus,⁵ and Core Outcome Set–STAndards for Reporting (COS-STAR), for core outcome set development, with three items.⁶ Furthermore, the Conducting and Reporting Delphi Studies (CREDES) guideline is designed for Delphi studies, with a focus on palliative care.⁷ However, ACCORD goes further than just Delphi methods, encompassing all consensus techniques in different health-related domains. The ACCORD checklist comprises 35 items, with the majority focusing on methodological aspects (Table 1).^1,8

Certain aspects of ACCORD align with other reporting guidelines. For instance, the title should clearly indicate the type of research, explicitly stating that the study is a consensus exercise, in addition to specifying the consensus method used. In the introduction, authors must define the aim of the study, the intended audience and the geographical scope. This may seem obvious, but these details are frequently overlooked, leading to ambiguity about who should use the research and where it applies. Authors should identify whether the recommendations are designed for healthcare providers (and specify which type of healthcare provider), patients, researchers, policymakers or a broader mix of stakeholders. Additionally, authors must clarify the geographical scope of their research, i.e. is this study relevant at an international, regional or national level?

Some other key areas that need to be reported to ensure clarity, transparency and integrity are highlighted below.

Protocol registration establishes a clear roadmap for the process minimizing the risk of selective reporting and promoting transparency. If registered, authors should include the platform and provide a link to the registration. This indicates that the study follows a structured approach and allows for independent verification.

Description of the procedure for selecting the steering committee (SC) and panellists contributes to the credibility of the study. Authors should explain who was involved in directing the consensus exercise, their roles and their areas of expertise. The study should describe how the participants were chosen and by whom, and clarify the criteria for panellist inclusion, detailing who was responsible for the selection and how the recruitment process was managed. This level of detail helps readers understand the expertise behind the consensus process, and increases trust in the findings of the study. Furthermore, authors should describe the role of any members of the public, patients or carers involved in the study. Patients and public involvement (PPI) has become increasingly important in health research, providing valuable insights from a user perspective. Some journals require authors to report PPI involvement in their studies.⁸

Another critical aspect is the definition of consensus, as this informs readers about the level of agreement sought among the panel. This definition, often expressed as a percentage of panellists who agree, a certain number of agreeing responses or a categorical scale such as ‘agree’ or ‘strongly agree’, can vary based on the context of the study. For critical topics, e.g. patient safety in dermatological procedures, a higher threshold of agreement might be required. Conversely, more subjective topics, e.g. treatment preferences for conditions such as psoriasis or eczema, might permit a lower threshold owing to a broader range of acceptable opinions and subjective interpretations, allowing for greater flexibility. Therefore, it is important to specify and justify the consensus threshold.

Furthermore, it is crucial to describe how feedback was provided to panellists at each step of the consensus process. This includes clarifying whether the feedback was quantitative, e.g. approval rates per topic or item; qualitative, e.g. through comments; or a combination of both. Authors should indicate whether feedback was anonymized and describe the steps taken to ensure anonymity, specifying who remained anonymous and which methods were used to maintain anonymity. If applicable, authors should indicate whether the SC was involved in decision making alongside the consensus panel, and whether they had voting rights or other forms of influence. Participation can be influenced by various factors, so it is worth noting any incentives provided to encourage responses or participation in the consensus process. Additionally, the study should describe any adaptations made to improve accessibility, such as conducting surveys or meetings in multiple languages or providing translations and plain language summaries to ensure broader understanding and engagement. Finally, conflicts of interest among the SC and panellists must be disclosed, along with measures taken to manage them. Authors should specify the source of funding and the role the funder played in the study, indicating whether the funder had any influence on the design or execution of the study. By focusing on these aspects, researchers can ensure a more transparent and rigorous approach to reporting consensus exercises. The BJD aims to uphold high standards in this area, especially in guideline development, emphasizing ‘the minimization of authors’ conflicts of interest and a clear and detailed conflicts of interest and funding statement’.⁴ ACCORD can be a valuable tool for authors and reviewers to ensure high-­quality, transparent consensus publications.

Acknowledgements

I would like to thank Bernd Arents, Patient Associate Editor at BJD for his valuable feedback.

Funding sources

This editorial received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

Not applicable.

Ethics statement

Not applicable.

References

Author notes

Conflicts of interest E.J.v.Z. is a member of the ACCORD development team.

© The Author(s) 2024. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.

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