An independent jury-based consensus conference model for the development of recommendations in medico-surgical practice Micka€ el Lesurtel, MD, PhD, a Arnaud Perrier, MD, b Patrick M. M. Bossuyt, PhD, c Bernard Langer, MD, d and Pierre-Alain Clavien, MD, PhD, a Zurich and Geneva, Switzerland, Amsterdam, The Netherlands, and Toronto, Canada Background. There is an increasing demand for standardization in the choice of treatments for specific conditions, so-called personalized medicine. The task is far from trivial, because the perspectives from many stakeholders must be respected, including patients and health care providers, as well as payers or governments to better control costs while optimizing quality of care. One approach to provide widely accepted therapies is the consensus conference. Methods. We describe a novel methodology to achieve consensus in controversial areas with the main goal to minimize biases. Results. The principle of this approach relies on a clear distinction between those who provide the evidence (experts) and those who draw the final recommendations (the jury). The jury consists of individuals with sufficient background knowledge to cover the perspectives of all stakeholders’ without being involved directly in the topic under evaluation. The organizing committee, the experts, and the jury interact within 3 phases: Preparation, the actual consensus conference, and deliberations. Each question is addressed by a panel of experts, leading to the proposition of recommendations at the conference meeting, which are challenged by the jury and the audience. Based on all available information, the jury finalizes the consensus recommendations, which are eventually published and made available to all. Conclusion. This novel model of consensus conference allows the construction of consensual, evidence- based, explicit recommendations for therapies in a process that may also identify issues for further research, eventually fostering progress in the field. (Surgery 2014;155:390-7.) From the Department of Surgery, a University Hospital Zurich, Zurich; the Department of Internal Medicine, b University Hospital of Geneva, Geneva, Switzerland; the Department of Clinical Epidemiology and Bio- statistics, c Academic Medical Center, Amsterdam, The Netherlands; and the Department of Surgery, d Uni- versity of Toronto, Toronto, Canada THE GROWING COMPLEXITY of medical care and its accompanying increase in cost are worldwide con- cerns. In addition, there still exist substantial vari- ations in practice, even in situations where there are established clinical guidelines. Practice guide- lines have been developed for clinical situations in which large, randomized, controlled trials are available. In most situations, however, the best available evidence comes from less rigorous and smaller studies with a risk of bias and low precision. In the current era of economic pressure, stake- holders, such as health insurance companies, hospital leadership, and government health min- istries, expect physicians to decrease unnecessary practice variability and to promote effective and cost-conscious care. In doing so, many participants also insist on including the patient perspective in decision making. Achieving these aims cannot be based on evidence from scientific studies only, but requires multiple judgments, no matter how strong the research is. Outcome measures for trials have to be identified, and their relevance must be ranked. Threats to the validity of studies have to be included in statements about the correspond- ing effects. Benefits of interventions have to be Accepted for publication October 7, 2013. Reprint requests: Pierre-Alain Clavien, MD, PhD, Department of Surgery, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland. E-mail: clavien@access.uzh.ch. 0039-6060/$ - see front matter Ó 2014 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2013.10.003 390 SURGERY