Consensus exercise with clinical and patient and carer advisors

A workshop will be organised with members of our patient and clinical expert advisory groups and clinicians from local psychiatric intervention services, including about 15 participants. The final prognostic model and its predictive performance will be presented along with results of the decision model. We will use graphics that are accessible to both clinicians and patient representative, in order to illustrate the expected benefits and harms of clozapine at different levels of predicted risk of treatment resistance. We will use an adapted nominal group technique (NGT) as a consensus building exercise to agree optimal thresholds for clozapine prescribing. The NGT is a group process involving problem identification, solution generation and decision-making through ranking or voting that is time-efficient and involves low burden for participants.^{62 63} It allows a rapid process of decision-making, while taking every workshop participant’s opinion into account.

The following issues will be discussed: (1) predictive performance of the model, (2) profiles of subgroups of patients with schizophrenia at varying levels of predicted TRS risk, (3) effect estimates of clozapine at varying levels of predicted TRS risk and (4) balance of benefits, risks and costs of clozapine treatment at varying levels of predicted TRS risk, before achieving consensus regarding proposed thresholds for clozapine prescribing based on the prognostic model. The meetings will be facilitated by an experienced researcher, clinical member of the study team and PPIE team member. Meetings will be audio-recorded and transcribed to ensure that the decision-making process is captured, including the different views prior to agreement regarding each factor.