Discussion
The inclusion of PwDCM-generated word clouds in a JLA PSP enabled stakeholders to generate more research uncertainties. Whilst this did not lead to the formation of additional research questions, research uncertainties submitted in response to the word clouds were more likely to map to the number one research priority: raising awareness.The JLA, following some initial iterations, has continued to use a single and proven methodology [Unlike many other consensus processes [As only one research uncertainty is required to generate a research question, and uncertainties based on the word clouds alone did not generate a unique research question, it may appear that word clouds were unnecessary and lead to inefficiency. However, the fact that word clouds stimulated individual participants to generate new ideas reflects a positive impact on creativity. Furthermore, the identification of themes for summary questions will invariably be partly informed by the frequency of their representation [It is too early to conclude definitively whether word clouds had a positive impact, but these are all promising indications. Further research is required, but it is of note that the JLA has now decided to conduct a consultation looking at a role for developing a research methodology stream including how different research methodologies could affect consensus-building. This is particularly welcome in the context of an expanding literature demonstrating the challenges of end-user participation in the traditional PSP [