Turning controversy into consensus in an advisory board meeting
by Stephen D. Lande, PhD
"These are experts! Why can't these advisors agree on the TPP?" complains a commercial lead disappointed with the outcome of a pharmaceutical advisory board meeting. And his colleagues from R&D and market access are also disappointed since they too are depending on expert guidance to complete their work.
Advisory board meetings are often used by our life sciences clients to obtain clear guidance to support the development of a new drug or device. And yet advisors often have divergent opinions and make conflicting recommendations. How can we reconcile these conflicts? How can we facilitate expert consensus?
In response to this challenge, we first ask our clients, "Is consensus really necessary?" In many cases, consensus is not a reasonable or necessary goal of an advisory board meeting. In fact, the primary goal of the meeting may be to gain information and brainstorm new ideas. The client may not be able to disclose key, confidential facts to advisors, and therefore advisor consensus may not be meaningful. In many situations, the information and opinions collected from advisors are used after a meeting primarily to facilitate good decision making by the client.
In contrast, there are many situations in which consensus among advisors can offer great value. Here are four examples for which consensus was used to accomplish key program objectives.
- Finalize a target product profile (TPP) of a new drug for use in infectious disease
- Prioritize the importance to payers of a series of proposed health economics and outcomes research projects for a blood cancer drug.
- Refine a speaker slide deck used to present disease state and product specific information to clinicians about a product for chronic pain
- Create a set of clinical practice recommendations for use in assessment and treatment for a product for major depressive disorder
Let's take the example above of a recent advisory board from which the client wanted to finalize a TPP. In advance of the meeting, we interviewed a sample of the experts in order to make obvious TPP revisions, collate comments and suggestions, and develop questions for discussion at the meeting. We also sent out several journal articles to provide a foundation of information to advisors - likely providing new information to some and a refresher for others.
At the meeting, we used the interview findings and prepared questions to trigger discussion. After making live edits to each element of the TPP, we called upon advisors to vote on the strength of their agreement with that element. If there was overwhelming agreement, we went onto the next element. If there were outliers, we solicited the opinions of those advisors responsible for the divergent votes, and had further discussion. Sometimes the element required further editing. Often the advisors holding divergent opinions simply wanted their opinion recognized, and that opinion was noted in the report as an issue for later consideration. At that point a revote often yields greater strength of agreement.
After completion of this exercise, the client had a finalized TPP and a list of issues for future investigation. The advisors all had the opportunity to express opinions and contribute to the final product. And the post-meeting program evaluation reflected a positive opinion of the process.
Here are five suggestions for creating consensus among a group of experts:
- Provide pre-meeting assignments. These should include both article reprints and a survey or interviews. The articles provide a foundation of information for advisors who may have divergent backgrounds and interests, and makes it less likely that knowledge gaps are the source of divergent opinions. The assignment helps refine the meeting content and stimulates advisors to begin thinking about the meeting objectives.
- Present pre-meeting survey results. Presenting a PowerPoint compilation of the results of the pre-meeting surveys and interviews is a valuable method of triggering discussion at the meeting.
- Discuss the key questions. Carefully prepared questions can be used to tease out critical issues, bring forth new information, and uncover barriers to consensus.
- Vote on key issues. Voting makes it easier for all voices to be heard, rather than having less aggressive individuals capitulating to those who are more dominant.
- Summarize the consensus opinion and the outliers. Consensus doesn't mean that everyone is in agreement; just that the weight of the opinion falls in one direction.
Establishing consensus of opinion among a group of expert advisors can be very challenging, but can also provide tremendous value. If it is determined that consensus is a meaningful goal of an advisory board meeting, it is essential to establish a set of criteria for consensus and a process by which consensus is reached. We should be mindful of the fact that consensus does not mean that everyone agrees with every word of every conclusion.