Recommendations of the 6th long-term oxygen therapy consensus conference.

In 1986, the first of the series of long-term oxygen therapy (LTOT) consensus conferences was held in Denver, Colorado. Its aim and the aim of those that followed was to consider emerging issues and problems in LTOT prescribing, reimbursement, and access, as well as education and research challenges. Subsequent conferences were held in 1987, 1990, 1993, and 1999. The reports of these were published.1–5 These conferences helped to create and pave the way for advances in prescribing LTOT, such as the Certificate of Medical Necessity for LTOT (ie, the oxygen prescription and reimbursement criteria). These conferences also stressed the challenges for the education of physicians and other respiratory professionals involved in the care of LTOT patients, and the need for technological standards. Each conference used a modification of the Delbecq nominal-group interactive method.6 This method assures that all participants’ issues are aired in an anonymous and/or open-forum fashion, and that all thoughts are considered in small breakout groups and then again in a final session where consensus recommendations are finalized by all participants. It was important for all participants to understand that the development of consensus is a group process, and not an individual dominance, a majority rule, nor a “voting” method. This process was first used in America by the Quakers, who needed a nonconfrontational “common sense” (consensus) method in dealing with contentious issues. In the consensus-development method, no votes are taken. This method avoids dualism. This is intended to be a rational way of seeking general agreement. Consensus does not mean unanimity. Those who participate in consensus development do not always get their way; they agree with the group that moving forward in areas of minor disagreement, as well as in areas of agreement, is better than strife over individual issues. This was the concept that the organizers put forth and the participants of the 6th LTOT Consensus Conference followed. The first day and a half of the conference provided state-of-the-art lectures and discussions by experts in subjects of relevance in LTOT, from “History” to “Current Evidence” to “Current Practical Aspects” to “Needed Research” in the LTOT arena. On the afternoon of the second Dennis E Doherty MD is affiliated with the Division of Pulmonary, Critical Care, and Sleep Medicine, University of Kentucky, Lexington, Kentucky and is Chairman of the National Lung Health Education Program. Thomas L Petty MD is affiliated with the Department of Medicine, University of Colorado Health Sciences Center, and the National Lung Health Education Program, Denver, Colorado.