Delphi methodology in healthcare research: How to decide its appropriateness

Developing a Competency Assessment Index System for Hematology Nurses in China: Delphi Study Insights

PURPOSE

Patient management, care, and education are influenced by the core competencies of hematology nurses. Nurse specialists enhance patient safety and nursing care quality. However, no study has constructed an index of core competence assessment for hematology nurses.

DESIGN

In this study, a literature review, theoretical analysis, and group discussion were performed to construct the core competency evaluation index system for hematology nurses.

METHODS

Twenty-six experts from 7 provinces and cities across China were selected by purposive sampling for 2 rounds of Delphi expert consultation, and the indicators were selected based on the mean importance score >3.5 and coefficient of variation <0.25. A precedence chart determined the indicator weights at all levels.

RESULTS

The evaluation index included 6 primary, 18 secondary, and 70 tertiary indicators. The positive coefficients of the questionnaire on the 2 rounds were 100% and 92.86%. The Kendall's harmony coefficients for indicators at all levels were 0.176 to 0.461 and 0.197 to 0.220. Experts' familiarity, judgment, and authority coefficients were 0.892, 0.871, and 0.882, respectively.

CONCLUSIONS

The evaluation index system may provide references for the training, curriculum setting, assessment, and qualification certification of hematology nurses.

Establishing Research Priorities in Geriatric Nephrology: A Delphi Study of Clinicians and Researchers

RATIONALE & OBJECTIVE

Despite substantial growth of the population of older adults with kidney disease, there remains a lack of evidence to guide clinical care for this group. The Kidney Disease and Aging Research Collaborative conducted a Delphi study to build consensus on research priorities for clinical geriatric nephrology.

STUDY DESIGN

Asynchronous modified Delphi study.

SETTING & PARTICIPANTS

Clinicians and researchers in the United States and Canada with clinical experience and/or research expertise in geriatric nephrology.

OUTCOME

Research priorities in geriatric nephrology.

ANALYTICAL APPROACH

In the first Delphi round, participants submitted free-text descriptions of research priorities considered important for improving the clinical care of older adults with kidney disease. Delphi moderators used inductive content analysis to group concepts into categories. In the second and third rounds, participants iteratively reviewed topics, selected their top 5 priorities, and offered comments used to revise categories.

RESULTS

Among 121 who were invited, 57 participants (47%) completed the first Delphi round and 48 (84% of enrolled participants) completed all rounds. After 3 rounds, the 5 priorities with the highest proportion of agreement were (1) communication and decision-making about treatment options for older adults with kidney failure (69% agreement), (2) quality of life, symptom management, and palliative care (67%), (3) frailty and physical function (54%), (4) tailoring therapies for kidney disease to specific needs of older adults (42%), and (5) caregiver and social support (35%). Health equity and person-centricity were identified as cross-cutting features that informed all topics.

LIMITATIONS

Relatively low response rate and limited participation by private practitioners and older clinicians and researchers.

CONCLUSIONS

Experts in geriatric nephrology identified clinical research priorities with the greatest potential to improve care for older adults with kidney disease. These findings provide a road map for the geriatric nephrology community to harmonize and maximize the impact of research efforts.

Cardio-oncology rehabilitation and exercise: evidence, priorities, and research standards from the ICOS-CORE working group

The aim of this whitepaper is to review the current state of the literature on the effects of cardio-oncology rehabilitation and exercise (CORE) programmes and provide a roadmap for improving the evidence-based to support the implementation of CORE. There is an urgent need to reinforce and extend the evidence informing the cardiovascular care of cancer survivors. CORE is an attractive model that is potentially scalable to improve the cardiovascular health of cancer survivors as it leverages many of the existing frameworks developed through decades of delivery of cardiac rehabilitation. However, there are several challenges within this burgeoning field, including limited evidence of the efficacy of this approach in patients with cancer. In this paper, a multidisciplinary team of international experts highlights priorities for future research in this field and recommends standards for the conduct of research.

A Delphi Consensus Project to Capture Greek Experts' Opinion on the Position of Triple Therapies in COPD: Why, When and to Whom

Background

In recent years, COPD treatment has become more personalized considering specific patient's characteristics.

Aim and Methods

We have performed a DELPHI consensus project to assess the level of consensus among Greek experts on the use of triple therapy in COPD as an initial and follow-up treatment. A three-round Delphi online survey was developed. The questionnaire was developed by a 6-member steering committee, included 54 statements, and divided into 3 domains: (A) triple therapy as initial treatment (divided into subdomains examining the impact of exacerbations based on lung function, bronchodilation reversibility and/or blood eosinophil count, smoking, symptoms, and comorbidities), (B) escalation to triple therapy from dual bronchodilation and (C) de-escalation from triple therapy to dual bronchodilation. The survey was funded by AstraZeneca and was hosted and analysed by an independent external company.

Results

Consensus was reached in 84.8%, 63% and 80% of statements for domains A, B and C, respectively. Experts agreed that initial treatment with triple therapy is a reasonable option for specific patients, while escalation from dual bronchodilation to triple therapy could be considered, besides frequent exacerbators, also in patients with a history of one moderate exacerbation, mainly in the presence of marked bronchodilator reversibility or high blood eosinophil count. Finally, there was a consensus that de-escalation from triple therapy to dual bronchodilation was inappropriate in patients who had experienced one moderate exacerbation in the previous year.

Conclusion

Although consensus was generated in several statements, panelists failed to reach consensus in many aspects of the use of triple therapy, identifying areas for further research.

Criteria for medication reconciliation in major orthopedic surgery in high-risk patients: A consensus based on the Delphi method

BACKGROUND

Medication reconciliation is relevant in transitional care, however, given limited resources, it is necessary to identify the patients who benefit most from this activity.

AIM

To validate criteria to identify patients at high risk of medication errors undergoing major orthopedic surgery.

METHOD

Delphi Method in 3 phases, April to June 2023, to obtain consensus on the inclusion criteria, previously defined. Each expert rated criteria according to a 5-point Likert scale. Consensus was assumed in round 1 if the rate average was more than 4 (inclusion) or less than 2 (exclusion) and in round 2 and 3 if 50% of the responses were more than 4 (inclusion) or less than 2 (exclusion). It was possible to suggest the inclusion of new criteria.

RESULTS

10 experts from Faculties of Pharmacy and Medicine participated. In the first phase, consensus was reached on 18 criteria: polypharmacy, anticoagulants, oral chemotherapy (not hormone), immunosuppressants, antiretrovirals, antimyasthenics, insulin, corticoids, neuroleptics, antiarrhythmics, digoxin, carbamazepine, phenytoin, valproate, thyroid drugs, anti-glaucoma, anti-aggregants, and urgent surgery. Systemic antifungals and opioids were suggested. In the second phase, consensus was reached on eleven criteria: anti-parkinsonics, beta-blockers, age more than65 years, length of stay more than 5 days, lamotrigine, diuretics, antidepressants, angiotensin converting enzyme inhibitors, angiotensin II receptor antagonists, anxiolytics, opioids, and systemic antifungals. In the last phase, one criterion reached consensus (sulfonylureas) and one criterion did not reach consensus (calcium channel blockers).

CONCLUSIONS

We develop and validate a list of 30 criteria to identify patients at high risk of experiencing medication errors undergoing major orthopedic surgery. These may help improve human resource management for clinical pharmacy activities by prioritizing patients who would benefit most.

Group exercise in long-term care facilities, alignment with World Health Organization recommendations: a cross-sectional survey

BACKGROUND

Maintaining functional status in institutionalized older people is a challenge for long-term care (LTC) institutions. In this regard, exercise may have positive effects. The World Health Organization (WHO) has issued guidelines which include recommendations of exercise for each population group. Nonetheless, the literature shows that the levels of exercise among institutionalized population are still low.

AIMS

This study sought to determine: (1) the characteristics of exercise programs for older people performed by health professionals in LTC facilities, (2) the knowledge and use of the WHO recommendations and guidelines for exercising among older people in LTC facilities; (3) the limitations identified by health professionals regarding the application of the WHO guidelines.

MATERIALS AND METHODS

A cross-sectional national survey following STROBE guideline was performed.

SAMPLE

professionals developing exercise programs for institutionalized older people. A Delphi study was conducted to create the survey which included sociodemographic data, exercise characteristics, knowledge about WHO recommendations and limitations regarding their application. Descriptive statistics were used on the data, such as Pearson's χ2 and independent t- test.

RESULTS

Many professionals do not know (27,5%) or do not follow (52%) the guidelines proposed by the WHO. There is a low weekly frequency for strength exercises (30%) and aerobic exercise (51%). The professional contract influences the weekly frequency of exercise. Most identified limitations for using the WHO recommendations were the lack of time and large groups.

DISCUSSION AND CONCLUSIONS

Recommendations of WHO guidelines are familiar to many professionals, however, some are difficult to implement in exercise programs in LTC facilities.

Factors influencing clinically trained pharmacists to pursue management roles: A modified Delphi survey

PURPOSE

This study aimed to establish consensus among a sample of pharmacist clinicians on factors that would make them more or less likely to transition from a position primarily in direct patient care to a management position that included direct reports.

METHODS

A 3-round modified Delphi survey was conducted. Pharmacists were selected as panelists to gain further information on the transition from a clinician to a managerial role. Study investigators utilized their professional network of pharmacy leaders nationwide who may have had staff who met the inclusion criteria. Participating pharmacy leaders emailed staff an interest survey, and participant email addresses were collected. During the round 1 survey, 2 open-ended questions were used to identify both positive and negative factors influencing pursuit of a managerial roles and responses were analyzed for factor development. In round 2, factors that met or exceeded a predetermined consensus agreement threshold of 70% were included in the round 3 survey. In round 3, a 4-point Likert scale was utilized for respondents to indicate agreement with each factor remaining.

RESULTS

For each consecutive round, the survey response rate was 63% (96/152), 83% (79/96), and 87% (69/79), respectively. A total of 595 factor terms submitted by panelists in round 1 were consolidated into 30 "more likely" and 27 "less likely" factors by round 3. In round 3, the 70% agreement threshold was met across all factors. One less likely factor regarding workload expectations reached 100% total agreement.

CONCLUSION

The survey results may assist pharmacy administrative leaders in optimizing transitions to managerial roles by considering clinician perspectives.

Improving awareness of rabies and free-roaming dogs in schools of Guwahati, Assam, India: exploring the educators' perspective

BACKGROUND

Rabies poses a significant threat to public health in India, with schoolchildren comprising approximately 40% of mortality due to this zoonotic disease. Despite ongoing interventions in schools to increase awareness about rabies and free-roaming dogs (FRD), the incidence of dog bites and rabies cases among schoolchildren continues to rise. This study addresses the limitations of existing awareness programs by exploring educators' perspectives and proposing innovative, feasible, and cost-effective interventions in schools.

METHODS

A three-day workshop involving 19 teachers from seven schools representing diverse socio-economic backgrounds by adopting a modified Delphi method to achieve consensus on interventions identified during the process.

RESULTS

The workshop recommends (a) promoting awareness in morning assemblies, (b) starting a wall magazine on One Health, (c) distributing and displaying information, education, and communication (IEC) materials, (d) encouraging infographics, paintings, sketches, and reels, (e) integrating rabies-related topics in co-curricular activities, (f) initiating interdisciplinary projects focusing on rabies awareness (g) displaying in rabies awareness stalls during exhibitions/school functions, and (h) discussing in parent-teachers meets.

CONCLUSIONS

This study identifies sustainable and pedagogically sound interventions to raise awareness about rabies and FRD in schools, contributing to the broader goal of reducing rabies-related mortality among school children.

Identifying Research Priorities in Digital Education for Health Care: Umbrella Review and Modified Delphi Method Study

BACKGROUND

In recent years, the use of digital technology in the education of health care professionals has surged, partly driven by the COVID-19 pandemic. However, there is still a need for focused research to establish evidence of its effectiveness.

OBJECTIVE

This study aimed to define the gaps in the evidence for the efficacy of digital education and to identify priority areas where future research has the potential to contribute to our understanding and use of digital education.

METHODS

We used a 2-stage approach to identify research priorities. First, an umbrella review of the recent literature (published between 2020 and 2023) was performed to identify and build on existing work. Second, expert consensus on the priority research questions was obtained using a modified Delphi method.

RESULTS

A total of 8857 potentially relevant papers were identified. Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, we included 217 papers for full review. All papers were either systematic reviews or meta-analyses. A total of 151 research recommendations were extracted from the 217 papers. These were analyzed, recategorized, and consolidated to create a final list of 63 questions. From these, a modified Delphi process with 42 experts was used to produce the top-five rated research priorities: (1) How do we measure the learning transfer from digital education into the clinical setting? (2) How can we optimize the use of artificial intelligence, machine learning, and deep learning to facilitate education and training? (3) What are the methodological requirements for high-quality rigorous studies assessing the outcomes of digital health education? (4) How does the design of digital education interventions (eg, format and modality) in health professionals' education and training curriculum affect learning outcomes? and (5) How should learning outcomes in the field of health professions' digital education be defined and standardized?

CONCLUSIONS

This review provides a prioritized list of research gaps in digital education in health care, which will be of use to researchers, educators, education providers, and funding agencies. Additional proposals are discussed regarding the next steps needed to advance this agenda, aiming to promote meaningful and practical research on the use of digital technologies and drive excellence in health care education.

UK Defence Rehabilitation consensus agreement for the conservative management of Achilles and patellar tendinopathy: a modified Delphi approach

Achilles and patellar tendinopathy are common in military personnel due to the repetitive high loads and challenging extrinsic risk factors associated with the demands of their role. Sports medicine is rapidly evolving. Up-to-date evidence-based research is essential, alongside clinical reasoning, to deliver best-practice treatment to service personnel, underpinned by the duty of care to their long-term career.The aim of this research was to develop recommendations on conservative management of Achilles and patellar tendinopathy in relation to the military population. A systematic review was conducted by a multidisciplinary clinical panel from across Defence Rehabilitation. The panel was split into four subgroups (diagnosis and outcome measures, medical, exercise and adjuncts). Each subgroup proposed recommendations for voting across the wider authorship in a modified Delphi process. 28 recommendations achieved substantial agreement following a chaired meeting attended by all authors. A summary infographic was produced to highlight themes relevant to the military patient population.Diagnosis of Achilles and patellar tendinopathy remains clinical. The consensus panel strongly advocates exercise rehabilitation as the primary management of Achilles and patellar tendinopathy. Medical interventions should respect the long-term occupational needs of the military population. Education is advised, but further adjunctive interventions should only be considered on a case-by-case basis. This consensus agreement provides a framework for the development of local guidelines for the management of Achilles and patellar tendinopathy in the UK military population.

Unmet needs in the management of migraine in Greece from the perspective of medical experts: a Delphi consensus

Introduction

Migraine is a chronic, debilitating neurological disorder affecting billions worldwide. While not life-threatening, migraine patients experience significant unmet needs in diagnosis and management. Addressing these challenges could result in improvement of patient outcomes and reduction of the socioeconomic burden migraine imposes on individuals, healthcare system and the society.

Objective

This survey aimed to capture in Greece the perspective of medical experts (neurologists) specializing in migraine management regarding the socioeconomic burden of migraine and the unmet needs in diagnosis and treatment.

Methods

An online Delphi-based survey was conducted with 13 neurologists, experts in migraine. The survey consisted of 55 statements derived from literature research, regarding the burden of disease, diagnosis, treatment and unmet needs. Participants' level of agreement for each statement was measured through a 5-point Likert scale ("Strongly Agree," "Agree," "Neither Agree nor Disagree," "Disagree" and "Strongly Disagree"). Three rounds of voting were conducted to achieve consensus. The consensus threshold was set at 70% of responses, focusing on "Strongly Agree"/ "Agree" or "Disagree"/ "Strongly Disagree."

Results

Most experts agreed on statements emphasizing on financial and social impact of the disease and its epidemiology. However, consensus was not reached on statements concerning patient preferences for treatment administration, treatment adherence, opioid use, and frequency of visits to neurologists. Consensus was reached on the need for better healthcare professional training and the development of effective, safe treatments.

Conclusion

This survey highlighted the challenges of prompt diagnosis and effective management of migraine. Addressing these needs requires patient-centered approaches, enhanced healthcare-provider training, tailored therapeutic interventions, and advanced communication platforms.

Developing a Prototype Home-Based Toothbrushing Support Tool for Families in Scotland: A Mixed-Methods Study With Modified Delphi Survey and Semi-Structured Interviews

BACKGROUND

Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (Uitblinkers) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice.

METHODS

A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (n = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from Uitblinkers, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis.

RESULTS

From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical 'paper' tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are workable; (4) the tool is generally feasible within the operation of Childsmile home visits; (5) the tool is not less applicable for children with additional support needs.

CONCLUSIONS

A card-based conversational intervention to provide targeted home toothbrushing support for families of young children (0-3 years) in the home setting in Scotland, drawing from a template from the Netherlands, has been deemed worthy of further testing based on expert consensus and staff views on barriers faced, appropriate behaviour change techniques to address these and the design of a physical tool.

Development and validation of the respite care model for adults with cancer in Iran: study protocol for a multimethod research project

INTRODUCTION

The primary caregivers of patients with cancer, especially in advanced stages, experience significant physical and emotional strain and require comprehensive support. Respite care has been acknowledged as an effective strategy to aid primary caregivers, and different models have been established in Western nations. However, implementing these models poses challenges due to notable cultural, social and healthcare system variances between Western and non-Western regions like Iran and other Middle Eastern countries. It is crucial to develop a model tailored to the country's specific needs, culture and resources to systematically support caregivers and ensure care continuity. Hence, this study aims to develop and validate a respite care model for adult patients with cancer in Iran.

METHODS AND ANALYSIS

This study will use a multimethod approach across three stages. In the first phase, a scoping review will be conducted to identify, describe, conceptualise and implement the respite care system based on available documents and evidence. Then, a directed content analysis will be carried out to clarify care requirements and system establishment needs from stakeholders' perspectives. Data from the scoping review and directed content analysis will be integrated to identify the crucial components of the model using the Delphi method in the second phase. In the third phase, another Delphi study will be conducted to assess the importance, scientific credibility and feasibility of the model, with the aim of finalising it.

ETHICS AND DISSEMINATION

This research project has received the code of ethics (IR.TBZMED.REC.1402.720) from Ethics Committee of Tabriz University of Medical Sciences. The findings of this study will be published in reputable journals and disseminated in accessible formats through various media channels.

Establishing primary care physician commitment in Canadian long-term care homes: a protocol for a modified e-Delphi study

INTRODUCTION

The delivery of medical services by primary care physicians (PCPs) in long-term care (LTC) homes lacks consistency. There is no Canadian standard for PCP commitment in the LTC home setting, which can influence the quality of care delivered and resident health outcomes. The PCP's commitment to LTC practice is theorised as the proportion of a physician's practice dedicated to LTC, the number of residents for whom they provide care and the time spent on individual resident encounters. We aim to establish consensus on expectations concerning PCP commitment in Canadian LTC homes.

METHODS AND ANALYSIS

We describe a protocol for a two-round modified e-Delphi study assessing the consensus of an expert panel, guided by the RAND methodological guidance for conducting Delphi panels and the ACcurate COnsensus Reporting Document (ACCORD) guideline for healthcare-based consensus studies. We will recruit pan-Canadian experts who demonstrate extensive knowledge and experience in medical care delivery and medical practice models in the Canadian LTC sector. A literature review will generate a candidate list of statements constituting PCP commitment. The first round evaluates the relevance and feasibility of candidate statements through an online questionnaire. Panellists may also write open-ended, qualitative responses to add rationales, suggest alternatives and share new ideas. We will then host a virtual synchronous meeting to have an in-depth discussion about the results from round one. A second questionnaire will be distributed to evaluate the remaining statements that have not reached consensus, and any new statements added based on the same criteria.

ETHICS AND DISSEMINATION

The Hamilton Integrated Research Ethics Board (Project ID #17321) approved our study. The findings will be disseminated through manuscripts, presentations, and the lead author's thesis.

TRIAL REGISTRATION NUMBER

The ISRCTN Registry: #35125526.

Delphi definition of general practice/family medicine specialty for a post-COVID world: in-person and remote care delivery

INTRODUCTION

The evolving landscape of general practice (GP)/family medicine (FM) in the post-COVID-19 era, focussing on integrating telemedicine and remote consultations requires a new definition for this specialty. Hence, a broader consensus-based definition of post-COVID-19 GP/FM is warranted.

METHODS

This study involved a modified electronic Delphi technique involving 27 specialists working in primary care recruited via convenient and snowball sampling. The Delphi survey was conducted online between August 2022 and April 2023, utilizing the Google Forms platform. Descriptive statistics were employed to analyse consensus across Delphi rounds.

RESULTS

Twenty-six international experts participated in the survey. The retention rate through the second and third Delphi rounds was 96.2% (n = 25). The broader consensus definition emphasizes person-centred care, collaborative patient-physician partnerships, and a holistic approach to health, including managing acute and chronic conditions through in-person or remote access based on patient preferences, medical needs, and local health system organization.

CONCLUSION

The study highlights the importance of continuity of care, prevention, and coordination with other healthcare professionals as core values of primary care. It also reflects the role of GP/FM in addressing new challenges post-pandemic, such as healthcare delivery beyond standard face-to-face care (e.g. remote consultations) and an increasingly important role in the prevention of infectious diseases. This underscores the need for ongoing research and patient involvement to continually refine and improve primary healthcare delivery in response to changing healthcare landscapes.

AI for IMPACTS Framework for Evaluating the Long-Term Real-World Impacts of AI-Powered Clinician Tools: Systematic Review and Narrative Synthesis

BACKGROUND

Artificial intelligence (AI) has the potential to revolutionize health care by enhancing both clinical outcomes and operational efficiency. However, its clinical adoption has been slower than anticipated, largely due to the absence of comprehensive evaluation frameworks. Existing frameworks remain insufficient and tend to emphasize technical metrics such as accuracy and validation, while overlooking critical real-world factors such as clinical impact, integration, and economic sustainability. This narrow focus prevents AI tools from being effectively implemented, limiting their broader impact and long-term viability in clinical practice.

OBJECTIVE

This study aimed to create a framework for assessing AI in health care, extending beyond technical metrics to incorporate social and organizational dimensions. The framework was developed by systematically reviewing, analyzing, and synthesizing the evaluation criteria necessary for successful implementation, focusing on the long-term real-world impact of AI in clinical practice.

METHODS

A search was performed in July 2024 across the PubMed, Cochrane, Scopus, and IEEE Xplore databases to identify relevant studies published in English between January 2019 and mid-July 2024, yielding 3528 results, among which 44 studies met the inclusion criteria. The systematic review followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines and the Cochrane Handbook for Systematic Reviews. Data were analyzed using NVivo through thematic analysis and narrative synthesis to identify key emergent themes in the studies.

RESULTS

By synthesizing the included studies, we developed a framework that goes beyond the traditional focus on technical metrics or study-level methodologies. It integrates clinical context and real-world implementation factors, offering a more comprehensive approach to evaluating AI tools. With our focus on assessing the long-term real-world impact of AI technologies in health care, we named the framework AI for IMPACTS. The criteria are organized into seven key clusters, each corresponding to a letter in the acronym: (1) I-integration, interoperability, and workflow; (2) M-monitoring, governance, and accountability; (3) P-performance and quality metrics; (4) A-acceptability, trust, and training; (5) C-cost and economic evaluation; (6) T-technological safety and transparency; and (7) S-scalability and impact. These are further broken down into 28 specific subcriteria.

CONCLUSIONS

The AI for IMPACTS framework offers a holistic approach to evaluate the long-term real-world impact of AI tools in the heterogeneous and challenging health care context and lays the groundwork for further validation through expert consensus and testing of the framework in real-world health care settings. It is important to emphasize that multidisciplinary expertise is essential for assessment, yet many assessors lack the necessary training. In addition, traditional evaluation methods struggle to keep pace with AI's rapid development. To ensure successful AI integration, flexible, fast-tracked assessment processes and proper assessor training are needed to maintain rigorous standards while adapting to AI's dynamic evolution.

TRIAL REGISTRATION

reviewregistry1859; https://tinyurl.com/ysn2d7sh.

A qualitative study of how clinicians reach agreement in perioperative pathway development: the Consensus Model for Standardising Healthcare

BACKGROUND

Variation in perioperative care persists globally. Consensus discussions may facilitate standardisation, yet the processes used to reach agreement are poorly understood. This study aimed to develop a model for conducting local consensus discussions when implementing standardised perioperative pathways. Specifically, we 1) describe how local consensus discussions are operationalised; 2) identify what guides decision making and consensus between clinicians; and 3) formulate explanatory mechanisms and identify determinants that facilitate consensus discussions.

METHODS

A qualitative, modified grounded theory study was conducted in one private hospital in metropolitan Sydney, Australia. Thirty-one participants from clinical disciplines and hospital management/leadership were included. Data were collected from nine semi-structured interviews and 16 h of participant observations during consensus development or implementation meetings. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Interviews and field notes were recorded and transcribed verbatim. Data were analysed using coding, constant comparison, detailed memo writing and data interpretation.

RESULTS

Seven individual and contextual factors crucial for building consensus, and eight mechanisms for reaching agreement were identified and integrated into a conceptual model. Seeking evidence to support decision-making emerged as the primary driver of consensus. Strong research evidence in support of a pathway component facilitated swift agreement. Where there was ambiguous evidence for a pathway component, clinicians based their decisions on a desire for professional autonomy, consideration of how their peers practice, patient preferences, practices from external organisations, or the feasibility of implementing the pathway component.

CONCLUSIONS

The Consensus Model for Standardising Healthcare provides a map for healthcare organisations seeking to conduct local consensus discussions to reduce variation in care. Our findings advance our understanding of how local consensus discussions are conducted and factors that impact success when standardising care amongst clinicians.

European Stroke Organisation (ESO) standard operating procedure for white papers (expert consensus based clinical guidance)

Promoting the highest quality, evidence-based research across Europe is a priority of the European Stroke Organisation (ESO). The ESO Guideline Board communicate and promote evidence-based recommendations for clinical practice through their Guidelines. However, there are many aspects of stroke care where robust scientific evidence may be unavailable or difficult to obtain. Thus, there is a need for practical, consensus guidance, produced following robust, consistent, and transparent methods, that is suitable for high-priority clinical scenarios where evidence is currently lacking. The ESO Guideline Board developed methods for producing practical clinical guidance based on expert consensus in response to this need. These ESO' White Papers' are intended to complement standard ESO Guidelines. Here, we outline the ESO White Papers' standard operating procedure (SOP). We will describe the motivation for creating White Papers, the preferred composition of writing groups and expert consensus panellists, the methods for achieving consensus, and how results will be communicated. To ensure that all voting members have an equal voice, our methods are based upon the Delphi process of repeated rounds of anonymous voting, feedback and review. We hope that the White Papers will add further value to the clinical practice guidance that is offered by ESO. We look forward to receiving suggestions for White Paper topics from the stroke community.

"Like, we can't keep adding": a mixed methods study to explore the feasibility of implementing co-produced 24-Hour Movement Guideline content

Background

Medical students must demonstrate competency in health promotion and illness prevention; however, movement behaviour promotion content is lacking in medical curricula. Canada's 24-Hour Movement Guidelines (24HMG) present an opportunity to transform medical curricula to promote movement behaviours within a 24-hour paradigm. We previously co-produced a 24HMG curriculum map and 14 curriculum objectives at one Canadian medical school. The aim of this study was to gain consensus on the curriculum map and objectives among faculty and medical students and explore implementation determinants.

Methods

This study followed a concurrent nested mixed methods design using a modified Delphi method to assess the level of (dis)agreement with map components followed by interviews to explore the implementability of the map. A preliminary survey was distributed to collect demographic and movement behaviour data, followed by three online modified Delphi surveys. Suggested improvements to the map were solicited through open-text boxes. Interviews were semi-structured and conducted online. Interview data were analyzed using content analysis guided by the Consolidated Framework for Implementation Research (CFIR) 2.0.

Results

Consensus was reached on 156/180 items (86.7%) in Survey 1 (faculty, n = 6; students, n = 8), 49/51 items (96.1%) in Survey 2 (faculty, n = 4; students, n = 7), and 8/8 items (100%) in Survey 3 (faculty, n = 3; students, n = 7). Implementation determinants encompassed all five CFIR 2.0 domains, mostly the inner setting (e.g., culture, structural barriers).

Conclusions

Reciprocity and open communication between medical schools and external change agents should be prioritized when co-producing curriculum change in the present landscape of inflation and medical professional burnout.

A Modified Delphi Process to Achieve Consensus on Social/Administrative Science Topics in Pharmacy Curricula

OBJECTIVE

This study aimed to identify a consensus among pharmacy educators regarding relevant social and administrative science (SAS) topic areas and their priorities within pharmacy curricula.

METHODS

A modified Delphi process was conducted with members of selected American Association of Colleges of Pharmacy affinity groups as the expert panel. A total of 83 potential topic areas across 12 domains were gathered via an informal literature review. Four rounds of electronic surveys were conducted in June 2023, September 2023, January 2024, and March 2024. Questionnaires queried the importance and tiered priority ranking of topics using methodology adapted from the American College of Clinical Pharmacy Pharmacotherapy Didactic Curriculum Toolkit.

RESULTS

A total of 147, 140, 139, and 111 respondents participated in each of the 4 rounds, respectively. Approximately two-thirds of respondents were women, with just over half working at public institutions, and had a median of 12 to 15 years of experience in academia. The final list of SAS topics after 4 rounds included 76 topics across 11 domains, with 35 topics (46%) placed in tier 1, 28 topics (37%) in tier 2, and 13 (17%) in tier 3.

CONCLUSION

A tiered prioritization of SAS topics results can assist institutions in curricular mapping and preparation of graduates for pharmacy practice of today and the future.

Expert consensus on serratus anterior plane block education and credentialing: A modified-Delphi study

OBJECTIVE

The serratus anterior plane block (SAPB) is a regional anaesthesia technique with increasing use as an analgesic adjunct in patients with rib fractures. The present study aimed to generate consensus of the requirements of education, training and credentialing for the use of a 'single shot' SAPB in the management of rib fractures.

METHODS

A modified Delphi process was designed using online questionnaires. Expert panellists from Australian and Aotearoa New Zealand were invited from the fields of Emergency Medicine and Anaesthesia and were asked to rate the importance of different components of SAPB education, training and credentialling on a 9-point Likert scale. Consensus was achieved if ≥70% of experts provided a score of seven or greater on this scale for any given statement.

RESULTS

Thirty specialists (60% FACEM, 40% FANZCA) representing New Zealand plus all states and territories of Australia formed the expert panel. Participant response rates were 100% (first round), 83% (second round) and 63% (final round). At the end of three survey rounds, 59 consensus statements were formed (27 for education, 5 for training and 17 for credentialing).

CONCLUSIONS

This series of expert statements provides consensus on the education, training and credentialling of the SAPB for the management of rib fractures. These serve as the minimum standard by which this procedure should be taught while providing clinicians with a syllabus for the development of training programmes.

Overview of statistics teaching within undergraduate programmes in UK and Ireland dental schools

Introduction The United Kingdom (UK) General Dental Council's (GDC's) learning outcomes for undergraduate dental students briefly mention critical appraisal but not statistics. Hence, wide variation in statistics teaching across the dental schools is likely but has not yet been well-documented.Methods A survey was conducted to capture the main features of each of the dental degrees in the 18 UK and Ireland dental schools in terms of statistics-related (standalone or as part of other courses/modules) teaching.Results Representatives from all 18 dental schools completed the survey. There were some similarities, such as most using teaching materials specifically developed for their school, and aiming to teach students to understand/interpret but not generate statistics. However, the number/type of staff delivering the teaching, student contact hours, number of statistical concepts taught, whether statistical theory/formulae/packages were used and inclusion in summative assessments varied extensively. Most reported that this teaching was negatively perceived by the students and many felt that changes were needed.Discussion and conclusion This comprehensive review of undergraduate dental statistics-related provision allows dental schools to compare and contrast their own teaching, which is very timely given the imminent need to implement a new GDC framework. Guidelines to encourage more standardised teaching should be developed to improve the ability of newly qualified dentists to practise evidence-based dentistry.

Areas of uncertainty on the diagnosis, treatment, and follow-up of hypophosphatemia in adults: an Italian Delphi consensus

PURPOSE

The study aimed to present the results of a Delphi consensus involving Italian experts focusing on the management of hypophosphatemia in adults.

METHODS

A multidisciplinary advisory board of nine physicians, experts in hypophosphatemia management, was established. Next, a literature search was performed to identify international guidelines, consensus, and clinical pathways, which were later presented to the advisory board. Collaboratively, the advisory board and authoring team selected key statements for the consensus process and focused on areas of uncertainty related to the management of hypophosphatemia. The advisory board also indicated the experts to be invited to participate in the consensus process. The Delphi method was employed to reach a consensus.

RESULTS

The literature search yielded one guideline, five consensus documents, and one clinical pathway. While our search strategy aimed to identify documents on the management of all types of hypophosphatemia, most of the guidelines and consensus documents retrieved focused on X-linked hypophosphatemia. The consensus process focused on 11 key issues, achieving strong convergence (over 70% consensus) in the first Delphi round for 8 out of the 11 statements. Three statements proceeded to the second round, with strong agreement reached for two. Notably, consensus was not reached for the statement concerning the measurement of fibroblast growth factor 23 for diagnostic purposes.

CONCLUSION

The study revealed that the community of clinical experts is well-informed and in agreement regarding hypophosphatemia management. It emphasized the importance of developing clear national guidance documents to support clinicians and multidisciplinary teams in patient management. These documents are crucial not only for healthcare professionals but also for those responsible for defining pathways and services, facilitating a more accurate management of hypophosphatemic patients.

Best Practices for Delivering Neoadjuvant Therapy in Pancreatic Ductal Adenocarcinoma

Importance

Neoadjuvant therapy (NT) is an increasingly used treatment strategy for patients with localized pancreatic ductal adenocarcinoma (PDAC). Little research has been conducted on cancer care delivery during NT, and the standards for optimal delivery of NT have not been defined.

Objective

To develop consensus best practices for delivering NT to patients with localized PDAC.

Design, Setting, and Participants

This study used a modified Delphi approach consisting of 2 rounds of voting, and a series of virtual conferences (from October to December 2023) to reach expert consensus on candidate best practice statements generated from a systematic review of the literature and expert opinion. An interdisciplinary panel was formed including 47 North American experts from surgical, medical, and radiation oncology, radiology, pathology, gastroenterology, integrative oncology, anesthesia, pharmacy, nursing, cancer care delivery research, and nutrition as well as patient and caregiver stakeholders.

Main Outcome and Measures

Statements that reached 75% agreement or greater were included in final consensus statements.

Results

Of the 47 participating panel members, 27 (57.64%) were male, and the mean (SD) age was 47.6 (8.2) years. Physicians reported completing training a mean (SD) 14.6 (8.6) years prior and seeing a mean (SD) 110.6 (38.4) patients with PDAC annually; 35 (77.7%) were in academic practice. Final consensus was reached on 82 best practices for delivering NT. Of these, 38 statements focused on pre-NT practices, including diagnosis and staging (n = 15), evaluation and optimization (n = 20), and decision-making (n = 3); 29 statements defined best practices during NT, including initiation (n = 3), delivery of therapy (n = 8), restaging practices (n = 12), and management of complications during NT (n = 6); and 15 best practices were identified to guide treatment post-NT, focusing on surgery (n = 7), pathology (n = 4), and follow-up (n = 3).

Conclusions

Using a modified Delphi consensus technique, best practice guidelines were developed focusing on the optimal standards for delivering NT to patients with localized PDAC. Given the prognostic importance of completing multimodality therapy, efforts to standardize and optimize the delivery of NT represent an immediate opportunity to decrease care variation and improve outcomes for patients with PDAC. Future research should focus on validating and implementing best practice standards into clinical practice.

A child-centred research checklist to improve the design and reporting of paediatric research studies: A descriptive mixed methods study

BACKGROUND

No internationally developed child-centred research checklist is currently available to enhance the quality and transparency of the development, reporting and evaluation of research undertaken with children.

OBJECTIVE

To develop an internationally relevant, expert informed child-centred research checklist.

DESIGN

A descriptive mixed methods study was undertaken in five sequential phases, including a Delphi component.

SETTING(S)

Academic/international context.

METHODS

This study involved five sequential stages: 1. Literature review using four databases (CINAHL, MEDLINE, Scopus, PsycINFO) and analysis to identify key themes in child-centred research (January 2020). 2. Generate a questionnaire based on the key themes for international experts in child research to provide their opinions on what should be included in a child-centred research checklist (March 2020). 3. Inductive thematic analysis of the experts' responses to generate the initial draft checklist (June 2020). 4. The checklist progressed through three rounds of Delphi study for a wider range of experts to provide their consensus on what a child-centred research checklist should contain (August 2020-February 2021). 5. Refinement of the child-centred research checklist based on the Delphi study (March 2021-November 2022).

RESULTS

A total of 160 articles met the inclusion criteria for review and were considered in the development of a 10-item open-ended questionnaire, adapted for four age-brackets (0-1 yrs., 2-4 yrs., 5-10 yrs., >11 yrs). Responses from 14 experts across 10 countries generated 205 generic statements and 76 examples to inform a child-centred research checklist. Following this, 158 experts from eleven disciplines across 18 countries participated in the three round Delphi study (38 % retention rate over the three rounds). The final checklist includes 11 statements and 17 examples represented under three categories of "child-parent consent, assent and dissent", "code of conduct" and "child focused methods".

CONCLUSION

The child-centred research checklist was generated from a mixed methods study undertaken in five sequential phases, with input by 172 experts from 11 disciplines across 19 countries. The child-centred research checklist is the first international, expert informed tool to support good quality and transparent child-centred research. We call on researchers, clinicians, journal editors, organisations, and ethics committees to use this checklist for future research with children. The next phase of this project is engagement with children and their families to refine the checklist.

TWEETABLE ABSTRACT

New checklist to support good quality child research practices @IFNAorg.

Endoscopic Epidurolysis for the Management of Chronic Spinal Pain: A Delphi-Based Italian Experts Consensus

INTRODUCTION

Endoscopic epidurolysis (EE) is a minimally invasive procedure used to manage chronic spinal pain, particularly in cases unresponsive to traditional treatments. Despite its growing recognition, the literature lacks comprehensive guidelines on its optimal use. This study utilized a modified Delphi approach to gather expert consensus on best practices for EE in the Italian pain therapy network.

METHODS

The study's scientific board conducted an extensive literature review to define key investigation topics, including clinical indications, preoperative assessments, and technical aspects of EE. A semi-structured questionnaire was developed and administered to a panel of experts. A two-round Delphi process was implemented, with consensus defined as at least 70% agreement on a 7-point Likert scale (agree or strongly agree). Statements that did not reach consensus in the first round were rephrased and resubmitted in the second round.

RESULTS

Twenty-six clinicians participated in the study, with a 100% response rate in both rounds. In the first round, consensus was achieved for 9 out of 19 statements. In the second round, 8 out of 10 rephrased statements reached the consensus threshold. Key areas of agreement included the clinical indications for EE, the importance of preoperative imaging and anesthetic assessments, and the use of specific techniques and tools for EE. However, consensus was not reached on the use of EE for disc herniation with radicular pain and the safety of interlaminar access compared to sacral hiatus access.

CONCLUSION

The study highlights the need for standardized protocols in EE to ensure consistent and effective treatment of chronic spinal pain. The consensus reached by the expert panel provides a framework for best practices, which can guide clinical decision-making and improve patient outcomes. Further research is necessary to validate these findings and address areas where consensus was not achieved.

Practice recommendations for culturally sensitive communication at the end of life in intensive care: A modified eDelphi study

BACKGROUND

Clinicians need specific knowledge and skills to effectively communicate with patients and their family when a patient is dying in the ICU. End-of-life communication is compounded by language differences and diverse cultural and religious beliefs.

AIM

The aim was to develop and evaluate practice recommendations for culturally sensitive communication at the end of life.

METHOD

Modified two-round eDelphi study. An Australian national sample of 58 expert ICU clinicians of nursing and medical backgrounds participated in an online survey to rate the relevance of 13 practice recommendations. Ten clinicians participated in a subsequent expert panel interview to provide face validity and comprehensive details about the practical context of the recommendations. Survey data were analysed using descriptive statistics, interview data using deductive content analysis.

RESULTS

All 13 practice recommendations achieved item content validity index (I-CVI) above 0.8, and scale content validity index (S-CVI) of 0.95, indicating sufficient consensus. Recommendations prioritising use of professional interpreters and nurse involvement in family meetings achieved near perfect agreement amongst participants. Recommendations to facilitate family in undertaking cultural, spiritual and religious rituals and customs, advocate for family participation in treatment limitation discussions, and clinician access to professional development opportunities about culturally sensitive communication also achieved high level consensus.

CONCLUSION

These practice recommendations provide guidance for ICU clinicians in their communication with patients and families from culturally diverse backgrounds.

IMPLICATIONS FOR CLINICAL PRACTICE

Clinicians want practice recommendations that are understandable and broadly applicable across diverse ICU contexts. The high consensus scores confirm these practice recommendations are relevant and feasible to clinicians who provide end-of-life care for patients and their family members. The recommendations also provide clear guidance for ICU leaders, managers and organisational policy makers.

Global emergency medicine research priorities: a mapping review

Recognizing and prioritizing research areas in emergency care is crucial for generating evidence and advancing research programs, aiming to enhance health outcomes for both individuals and populations. The objective of this review is to document global clinical and nonclinical research priorities. The Emergency Medicine Education and Research by Global Experts network, consisting of 22 sites across six continents, conducted a mapping review of publications on emergency medicine research priorities (2000-2022) across seven databases. We included studies with replicable methodologies for determining research priorities, excluding those limited to individual diseases. Three reviewers independently screened, selected, and categorized results into clinical and nonclinical topics. Discrepancies were resolved by an independent investigator and consensus. Outcomes measures and analysis include descriptive analysis of research priorities grouped into clinical and nonclinical topics, characteristics of publications including countries represented in the author list, target audience (such as researchers or policy makers), participants (e.g. patients), and methods (e.g. Delphi) of priority setting. Among 968 screened papers, 57 publications from all WHO regions were included. Most (36, 63%) had authors from only a single country, primarily in North America and Europe. Patient representatives were included in only 10 (18%). Clinical research priorities clustered into resuscitation, cardiology, central nervous system, emergency medical services, infectious disease, mental health, respiratory disease, and trauma. Distribution was broad in North America and Europe but focused on infectious diseases and resuscitation in Africa and Asia. Eleven nonclinical topics included access to care, health policy, screening/triage, social determinants of health, staffing, technology/simulation, shared decision making, cross-sectoral collaboration, education, patient-centered care, and research networks. Nonclinical topics were broad in Europe and America, focused on access to care and health screening in Africa, and mostly absent in other WHO regions. Published research priorities in emergency medicine are heterogeneous and geographically limited, mostly containing groups of authors from the same country. The majority of publications in global research priority setting stem from Western countries, covering a broad spectrum of clinical and nonclinical topics. Research priorities from Africa and Asia tend to focus on specific issues more prevalent in those regions of the world.

State of the art and the future of microbiome-based biomarkers: a multidisciplinary Delphi consensus

Although microbiome signatures have been identified in various contexts (ie, pathogenesis of non-communicable diseases and treatment response), qualified microbiome-based biomarkers are currently not in use in clinical practice. The Human Microbiome Action consortium initiated a Delphi survey to establish a consensus on the needs, challenges, and limitations in developing qualified microbiome-based biomarkers. The questionnaire was developed by a scientific committee via literature review and expert interviews. To ensure broad applicability of the results, 307 experts were invited to participate; 114 of them responded to the first round of the survey, 93 of whom completed the second and final round as well. The survey highlighted the experts' confidence in the potential of microbiome-based biomarkers for several indications or pathologies. The paucity of validated analytical methods appears to be the principal factor hindering the qualification of these biomarkers. The survey also showed that clinical implementation of these biomarkers would only be possible if kitted and validated molecular assays with simple interpretation are developed. This initiative serves as a foundation for designing and implementing public-private collaborative projects to overcome the challenges and promote clinical application of microbiome-based biomarkers.

Rehabilitation Management of Neck Pain-Development of a Diagnostic Framework Based on the Pain and Disability Drivers Management Model

RATIONALE

Neck pain is a major cause of disability worldwide, and current rehabilitation strategies show limited effectiveness. Subgrouping patients by their primary pain and disability drivers can help tailor treatments. At this end, the Pain and Disability Drivers Management (PDDM) was developed and has demonstrated preliminary effectiveness in the management of low back pain. Nevertheless, the PDDM model was only validated for this population. Adapting this framework to patients with neck pain would provide a more global view of the patient's experience of pain and support a genuine biopsychosocial intervention.

AIMS AND OBJECTIVES

The aim of this study was to develop and validate the content of the PDDM model for patients living with neck pain.

METHODS

Through a modified DELPHI study design, participants with clinical and research expertize in rehabilitation of neck pain were invited to participate. A questionnaire was developed using literature reviews and endorsed by a steering committee. The relevance of each element of the newly adapted model was evaluated on a 4-point Likert scale. An item reached consensus if it obtained the predefined threshold of > 78% "relevant" and "very relevant." Participants left comments on terminology and recommended items to add in early rounds. Quantitative and qualitative analyses were performed.

RESULTS

An invitation was sent to 1650 potential participants, from which 155 accessed the survey, 64 completed the first round and 55 the second round. A total of 70 elements met consensus and were distributed across six domains: "Nociceptive pain drivers", "nociplastic pain drivers," "drivers associated with neuropathic pain", "comorbidity drivers", "cognitive-emotional drivers" and "environmental or lifestyle drivers, and social determinants of health."

CONCLUSION

Through a modified DELPHI study, the PDDM model was updated and adapted to people with neck pain. Subsequent steps include clinical integration and measures of efficacy when used for assessment/treatment.

Effectiveness of using implementation frameworks to facilitate the implementation of a stroke management guideline in the traditional Chinese medicine hospitals in China: protocol for a factorial randomised controlled trial

INTRODUCTION

Traditional Chinese medicine (TCM) is commonly used alongside Western medicine for stroke management in China. However, there is significant variation in TCM practice, and the utilisation of evidence-based clinical practice guidelines is inadequate. This study aims to evaluate the effectiveness of three popular frameworks-Consolidated Framework for Implementation Research (CFIR), Theoretical Domains Framework (TDF) and Normalization Process Theory (NPT)-in improving implementation outcomes for the integrated TCM and Western medicine clinical practice guideline for stroke management.

METHODS AND ANALYSIS

This study employs a hybrid type III design with a factorial randomised controlled trial, where 45 TCM hospitals will be randomly assigned to one of eight experimental conditions based on the use or non-use of each framework (CFIR, TDF, NPT). The factorial design allows for the evaluation of the main effects of each framework and their two-way and three-way interactions, offering insights into which combination of frameworks is most effective in enhancing implementation outcomes. The factorial design provides greater efficiency compared with traditional designs by enabling the simultaneous testing of multiple interventions and their combinations with the same sample size, which increases statistical power. Implementation facilitators will be trained to support the guideline adoption process, with interventions aligned to specific framework components (eg, CFIR for identifying barriers and facilitators, TDF for understanding behavioural influences and NPT for normalising practices within organisational routines). Outcomes will be evaluated using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance). Hierarchical logistic regression models will test the study hypotheses, and qualitative methods, such as interviews and focus groups, will provide contextual understanding. Additionally, a cost-effectiveness analysis will be conducted to assess the economic feasibility of the implementation strategies.

ETHICS AND DISSEMINATION

This trial has been approved by the Institutional Review Board of Southern Medical University (approval number: #202261) and follows all relevant ethical guidelines for research involving human participants. On completion, the findings will be shared with patients, healthcare providers and stakeholders through various dissemination activities, including workshops and presentations within relevant TCM and stroke management networks. The results will be published in peer-reviewed academic journals and presented at national and international conferences to inform future practice and policy on the integration of TCM and Western medicine for stroke management.

TRIAL REGISTRATION DETAILS

This study has been registered on the Open Science Framework with the DOI: 10.17605/OSF.IO/NJEVB.

Developing a set of key principles for care planning within older adult care homes: study protocol for a modified Delphi survey

BACKGROUND

Older adult care homes in England are required to develop care plans on behalf of each of their residents and to make these documents available to those who provide care. However, there is a lack of formal agreement around the key principles that should inform the development of care plans in care homes for older adults. Using a modified Delphi survey, we intend to generate consensus on a set of key principles that should inform the care planning process.

METHODS AND ANALYSIS

A two-stage modified Delphi survey will be used to try to reach a consensus on a set of key principles to inform care planning within older adult care homes in England. An interdisciplinary panel of approximately 50 people with experience in care planning will be convened and invited to provide feedback on a set of key principles. We will use an iterative, quasi-anonymous, multistage approach with controlled feedback. In the first round, panellists will be asked to provide feedback on a draft document whose contents have been informed by a systematic scoping review and consultations with care home staff. The first round will be administered and subsequently analysed. The results from the first round will be fed back to the panel members and panellists will be asked to complete a second survey. In each round, panel members will use a 5-point unipolar scale to rate their agreement with the item. Consensus will be considered if ≥75% of participants rate an item as 4-5.

ETHICS AND DISSEMINATION

This study to which this protocol relates has been granted ethical approval by the University of Kent's Division for the Study of Law, Society and Social Justice Research Committee Ethics Panel (reference: 1006) on 9 April 2024. The results of this project will be disseminated through conferences and one or more peer-reviewed journals. In a subsequent research phase, the research team plans to share the key principles document developed through this modified Delphi survey with care home residents and their families and friends. We plan to invite their feedback through a series of focus groups with a view to developing a related document for the family and friends of care home residents.

Why is it so difficult to understand why we don't understand human systemic lupus erythematosus? Contemplating facts, conflicts, and impact of "the causality cascade paradigm"

In attempts to understand systemic lupus erythematosus (SLE), we find ourselves in the intellectual cross-point between nosology, pathogenicity-oriented science, philosophy, empiricism, and qualified conjectures. A vital consequence in science theory is that scientific hypotheses that are not critically investigated are in danger of being transformed into scientific dogmas. This statement has consequences for this study. Two central problematic aspects are discussed. For the first, we have to consider new selection principles for classification criteria-implying integration of the causality principle. Second, central historical data must be implemented if we aim to understand SLE. These data comprise famous descriptions of distinct, dynamically changing DNA structures linked to the genetic machinery. These unique structures have since their discoveries decades ago mostly been ignored in SLE research. Likewise, inconclusive dogmatic data indicate that different glomerular ligands are recognized by nephritogenic anti-dsDNA antibodies-exposed chromatin fragments or inherent membrane ligands. These incongruent models have not been comparatively and systematically investigated. Three research areas will be critically discussed: (i) selection and role of SLE classification criteria, a process that must imply the causality principle; (ii) definition and impact of anti-dsDNA structure-specific antibodies; (iii) incongruent pathogenic models that account for lupus nephritis. A precise and critically important question is if SLE itself is a response to a dominant unified cause that initiates a cascade of downstream effects (criteria) or if SLE represents combined responses to a random interplay of multiple cause-effect events. These principally different explanations are formally not excluded or accepted today. Currently, SLE may be regarded as a disease with phenotypic diversity, independently segregated manifestations with unresolved etiologies that are not unique to a single SLE phenotype. The focus for the present discussion is basically how we, by critical hypotheses, can re-consider science-based selection of SLE classification criteria in order to delimitate and rationalize SLE. Classification criteria, autoimmunity, DNA structures, and anti-dsDNA antibodies are integrated aspects in this discussion.

Seeking consensus on dilemmas related to euthanasia in dementia based on an advance directive: a Delphi study from a medical, ethical and legal perspective

Euthanasia in dementia based on advance euthanasia directives (AEDs) is possible within the Dutch Euthanasia law. Yet, physicians struggle with the responsibility of interpreting the law's open norms in cases of advanced dementia, which includes the fulfilment of the due care criteria. This Delphi study aims to analyse arguments and seek consensus from medical, ethical and legal perspectives on ethical dilemmas in such cases. Thirty participants, equally divided in expertise, took part in a three-round Delphi with a total of 11 statements on ethical dilemmas. Despite differences in opinions and argumentations between panellists, consensus was reached on seven statements regarding different topics. Consensus was reached that the (behavioural) expressions of a person with dementia should be considered throughout the progression of decision-making disabilities. In such cases, a wish to live should be prioritised over an AED. Although substitute decision-making is not an option in case of euthanasia requests, both people around the person with dementia as well as their AED can be supportive in the decision-making process. Advance directives with formulations such as 'if I have to admitted to a nursing home, then I want euthanasia' are found to be infeasible. At all times, it is important to pay attention to alternatives to euthanasia, which includes following existing guidelines on problem behaviour. Physicians may benefit from the arguments pertaining to dilemmas encountered and the fulfilment of the due care criteria to either justify their decisions in euthanasia cases based on an AED, or to support decisions to refrain from euthanasia.

Clinical Swallow Examination Following Laryngectomy: An International e-Delphi Consensus Process

Clinical swallow examination (CSE) following laryngectomy (± pharyngeal resection) remains a critical step in dysphagia evaluation. Whilst the core components of a standard CSE service a broad spectrum of patient populations, no evidence exists examining the essential assessment items specific to CSE in the laryngectomy population. The aim of this study was to identify the tasks, measures and observations considered necessary to include in a CSE post laryngectomy. Using an e-Delphi approach, a 4-round online survey series was undertaken with 34 speech pathologists experienced in laryngectomy swallowing management from 6 countries. In the first round (item generation) participants were provided with the questions from the swallowing outcomes after laryngectomy (SOAL) as stimulus, to generate a list of tasks, measures and observations as well as clarifying questions they would ask the patient during a CSE. In the subsequent e-Delphi rounds the participants rated the importance of the compiled assessment items. A total of 34 items were rated of critical importance for inclusion in a laryngectomy CSE by ≥ 75% of participants. Two thirds of the consensus items (23 items) were patient history and interview questions incorporating medical and swallowing history (4 items) and patient interview (19 items). The remaining 11 items related to swallow tasks and observations (9 items) and onward referral (2 items). These 34 consensus items can be considered as a draft framework for laryngectomy CSE to guide clinical practice and research.

Developing generic clinical trial animated explainer videos in the UK: results of a survey and case study

BACKGROUND

Animated short videos used to explain a concept or project are often called animated explainer videos (AEVs). AEVs can supplement or provide an alternative to participant information sheets as a means of giving information about clinical research to potential participants. Current use of AEVs tends to focus on the specifics of a particular trial, yet there are many common aspects of clinical research regardless of the interventions being investigated that can be poorly covered in current trial materials. The EXPLAIN initiative aimed to determine the top generic clinical trial topics considered most important by different UK trial stakeholders. The top three topics were then turned into AEVs and have been made freely available for use.

METHOD

A list of generic clinical trial topics which often need explaining to potential trial participants when they are approached to take part in research was developed. Using a two-round Delphi survey of stakeholder groups (trial participants, patients, members of the public, site staff and clinical trials unit staff), the list of topics was expanded and prioritised to identify the topics most in need of clear explanation. The top three topics formed the basis of three AEVs, co-developed with patient and public partners.

RESULTS

Two hundred twenty-eight responses were received to the first round of the Delphi survey, and 167 of these respondents also completed the second round of the survey. The three topics prioritised for creation of animated explainer videos were as follows: (1) What is consent? (2) Who decides what treatment I get/What is randomisation? (3) Is it safe to take part in a trial/How do you know a trial is safe? Following virtual meetings with patient and public partners recruited from the Delphi respondents, a script for each AEV was co-produced before being developed into an AEV by a company specialising in animated video production.

CONCLUSION

There are a wide range of generic concepts in which the use of animated explainer videos could be useful to improve participant understanding of clinical research. Via consensus survey across multiple stakeholders, we have determined a hierarchy of the importance of explaining these concepts. We envisage that the three AEVs created from this project will form the basis of a readily accessible library of animations to be utilised by trialists.

Management of CAR-T cell therapy in patients with multiple myeloma: a systematic review and expert consensus in Australia

Background

Regulatory bodies have recently approved chimeric antigen receptor (CAR)-T cell therapies for patients with multiple myeloma (MM), but the treatment process involves complex decision making. To support the introduction of these therapies, we aimed to establish consensus expert opinion on best practices of all aspects of the management of patients with MM undergoing CAR-T cell therapy in Australia.

Methods

We conducted a modified RAND/UCLA two-round Delphi panel informed by a systematic literature review (SLR). The SLR included evidence from clinical practice guidelines, interventional trials, and observational studies for CAR-T cell therapy for patients with MM, to synthesize methodological aspects of CAR-T cell therapy related to patient management. The Delphi panel comprised eight hematologists from across Australia, each with significant experience directly treating patients using CAR-T therapy or referring patients for CAR-T cell therapy. Panelists completed the surveys electronically, and attended a virtual meeting held before the second-round questionnaire to discuss the first-round questionnaire responses. Consensus was defined a priori as at least 70% agreement on survey questions.

Results

The SLR identified 22 interventional or observational studies and 5 clinical practice guidelines reporting on selection and management of patients with MM treated with CAR-T cell therapy from various global regions. The Delphi panel reached consensus on practices related to patient referral, screening, selection, prioritization, treatments requiring wash-out, bridging therapy, lymphodepletion, infusion, and post-infusion monitoring and management. Most consensus results aligned with consistently recommended practices within guidelines included in the SLR. Consensus was not reached for statements related to specific screening practices and post-treatment monitoring, suggesting differing opinions on the specific best practices to implement.

Conclusion

Our Delphi panel established expert consensus on key considerations for patient selection, administrative processes, and aftercare for patients with MM in Australia undergoing CAR-T therapy. This will guide the development of clinical practice guidelines which are relevant and feasible to Australian health systems.

Optimizing Prescribing for Individuals With Type 2 Diabetes and Chronic Kidney Disease Through the Development and Validation of Algorithms for Community Pharmacists

Background

Diabetes is the leading cause of kidney disease and contributes to 38% of kidney failure requiring dialysis. A gap in detection and management of type 2 diabetes (T2D) in chronic kidney disease (CKD) exists in primary care. Community pharmacists are positioned to support those not able to access kidney care through traditional pathways. Algorithms were developed and validated to assist community pharmacists in identifying individuals with T2D in CKD and prescribing kidney-protective medications.

Objective

The objective was to develop and validate pharmacist algorithms to confirm T2D and CKD and to prescribe guideline-directed therapies for individuals with an estimated glomerular filtration rate (eGFR) of 30 to 60 mL/min/1.73 m² in community pharmacy primary care clinics in Nova Scotia.

Design

Lynn's method was utilized for algorithm development and content validation. Interview data were analyzed using qualitative descriptive analysis.

Setting

Pharmacists working in primary care clinic settings completed content and face algorithm validation, and virtual interviews were conducted following each round of validation.

Patients

The algorithms aim to support individuals with T2D and CKD in primary care by optimizing the resources and capacity of community pharmacists while ensuring safety and quality of care through a team-based approach. Patient partners were not part of algorithm development and validation.

Measurements

Content validity was computed using an item-level content validity index (I-CVI) and scale-level content validity index (S-CVI/Ave) per round. To measure face validity, percentages of those that "agreed" or "strongly agreed" to five statements were calculated.

Methods

Evidence- and expert-informed algorithms were developed and revised using Lynn's 3-step method (domain identification, item generation per domain, and instrument formation). Best evidence was collated with literature searches, and experts in nephrology, endocrinology, family medicine, nursing, and pharmacy revised the algorithms until there was consensus agreement on 4 final algorithms (detection of T2D and CKD, initiation/titration of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and initiation/management of sodium-glucose cotransporter-2 inhibitors and finerenone). Six community pharmacists per round for 3 rounds were needed to validate the algorithms. A 2-part questionnaire was utilized where pharmacists rated content and face validity using Likert scales. I-CVI and S-CVI/Ave per round and across 3 rounds were determined. Percentages were calculated for the rating level of agreement to 5 statements. Interviews were conducted and analyzed. Revisions were made to the algorithms between rounds.

Results

Eighteen community pharmacists (6 per round) participated with a mean ± standard deviation of 18 ±11 years of experience. The I-CVI of each item of the algorithms per round ranged from 0.83 to 1, which met the content validity threshold of 0.83 (P < .05) for at least 6 participants. The overall S-CVI/Ave across 3 rounds was 0.97. The overall percentage of participants across 3 rounds who agreed or strongly agreed to 5 face validity statements ranged from 83% to 100%, which was above the prespecified threshold for face validity consensus.

Limitations

The algorithms are intended for individuals with an eGFR of 30 to 60 mL/min/1.73m². While guideline medications are indicated below this threshold, this cut point was selected as these individuals should typically be referred to a nephrologist. There is a potential for delays in initiation of kidney-protective medications below this threshold while waiting to be seen by nephrology.

Conclusions

This is the first study to develop and validate algorithms for a new model of care that utilizes community pharmacists to identify and manage T2D and CKD in primary care. The algorithms achieved high content and face validity. Future implementation and evaluation will determine the effectiveness and safety of the algorithms.

Trial Registration

Not registered.

Sleep for infants after discharge from a neonatal ward: Expert- and parent endorsed strategies

BACKGROUND

This study aims to outline sleep strategies grounded in scientific research and endorsed by sleep experts, integrating parental input into the evaluation process, to assist parents in supporting infant sleep after discharge from a neonatal ward.

METHODS

A Delphi method, consisting of three rounds, was employed. Sleep strategies based on scientific literature were presented to sleep experts and parents of infants discharged from a neonatal ward.

RESULTS

A literature search identified 11 sleep strategies. These strategies were incorporated in Delphi round 1. Out of 17 sleep experts, 13 reviewed and revised these 11 sleep strategies, resulting in a list of 8 sleep strategies. In round 2, these strategies were ranked by 14 out of 17 sleep experts, with "knowledge gathering" being ranked the most important sleep strategy. In round 3, the same list of 8 sleep strategies was ranked by 35 parents. They found "sleep hygiene" and "swaddling" the most important strategies.

CONCLUSION

This study offers 8 sleep strategies that are grounded in scientific research, supported by experts, and evaluated by parents. Experts and parents prioritize sleep strategies differently. Therefore, healthcare professionals should offer practical and customized sleep strategies that align with the unique needs of each family.

IMPACT

Experts and parents prioritize sleep strategies differently. This study offers a summary of sleep strategies that are grounded in scientific research, supported by experts, and include parental feedback in the evaluation process. Healthcare professionals can use these strategies to offer practical and customized sleep advise that aligns with the unique needs of each family.

Fostering early adolescent health and planetary well-being through nature: a Delphi study on nature-based literacy

Becoming nature 'literate' may promote nature engagement in early adolescence, supporting both health and well-being, while nurturing a sense of environmental stewardship. This study aimed to advance the formative research necessary for the development of a nature-based literacy framework including a set of indicators specific to its measurement during early adolescence. An e-Delphi study design was used with an expert panel comprised of international academics (n = 18) and practitioners (n = 8). After three rounds, experts agreed key components of nature-based literacy were knowledge, competence, confidence, motivation, experience, connection, and stewardship. The nature-based literacy framework comprehensively represents the intrapersonal factors and related indicators that influence nature engagement, particularly during early adolescence. This will support the development of interventions designed to enhance early adolescent health outcomes, strengthen their connection to nature, and inspire them to value and protect the natural world.

Delphi Consensus on the Management of Spanish Patients with Post-Stroke Hemiplegic Shoulder Pain Treated with Botulinum Toxin A: Result Study

The study aimed to identify expert opinions and obtain recommendations on the management of post-stroke hemiplegic shoulder pain (HSP) and treatment with botulinum toxin A (BoNT-A). A multicenter Delphi study was conducted using an online survey designed by a committee of experts with at least 10 years of experience in post-stroke HSP management with BoNT-A in Spain. Forty-seven panelists (specialists with at least 5 years of experience in post-stroke HSP management with BoNT-A) rated their level of agreement in two rounds based on acceptance by ≥66.7% of them. In round 1, 245 statements on three dimensions were evaluated (diagnosis, treatment, and follow-up of the HSP patients treated with BoNT-A). A total of 159 statements (70.9%) were finally accepted after round 2. Experts recommended BoNT-A as soon as spasticity affects daily activities. They considered ultrasound as the preferred guided technique. Experts recommended regular assessments using validated scales and patient-reported outcomes to evaluate treatment goals and safety. In case of lack of response, experts suggested increasing the dose or number of treated muscles or considering alternative treatments. These consensus-based recommendations offer clinicians an approach to the management of post-stroke HSP with BoNT-A, supporting informed decision making.

How Delphi studies in the health sciences find consensus: a scoping review

BACKGROUND

Delphi studies are primarily used in the health sciences to find consensus. They inform clinical practice and influence structures, processes, and framework conditions of healthcare. The practical research-how Delphi studies are conducted-has seldom been discussed methodologically or documented systematically. The aim of this scoping review is to fill this research gap and to identify shortcomings in the methodological presentation in the literature. On the basis of the analysis, we derive recommendations for the quality-assured implementation of Delphi studies.

METHODS

Forming the basis of this scoping review are publications on consensus Delphi studies in the health sciences between January 1, 2018, and April 21, 2021, in the databases Scopus, MEDLINE via PubMed, CINAHL, and Epistemonikos. Included were publications in German and English containing the words "Delphi" in the title and "health" and "consensus" in the title or abstract. The practical research was analyzed for the qualitative content of the publications according to three deductive main categories, to which an influence on the result of Delphi studies can be imputed (expert panel, questionnaire design, process and feedback design).

RESULTS

A total of 287 consensus Delphi studies were included in the review, whereby 43% reported having carried out a modified Delphi. In most cases, heterogeneous expert groups from research, clinical practice, health economics, and health policy were surveyed. In about a quarter of the Delphi studies, affected parties, such as patients, were part of the expert panel. In the Delphi questionnaires it was most common for standardized Likert scales to be combined with open-ended questions. Which method was used to analyze the open-ended responses was not reported in 62% of the Delphi studies. Consensus is largely (81%) defined as percentage agreement.

CONCLUSIONS

The results show considerable differences in how Delphi studies are carried out, making assessments and comparisons between them difficult. Sometimes an approach points to unintended effects, or biases in the individual judgments of the respondents and, thus, in the overall results of Delphi studies. For this reason, we extrapolate suggestions for how certain comparability and quality assurance can be achieved for Delphi studies.

Evaluating the Safety of Thread-Embedding Acupuncture: Protocol for a Multi-Center, Prospective, Observational Study in Clinical Practice

Background/Objectives: Medical therapies that apply biodegradable materials, such as polydioxanone, are widely used to treat various disorders. Thread-embedding acupuncture (TEA) is a unique form of acupuncture that exerts long-lasting therapeutic effects by inserting absorbable threads at specific acupuncture points, and is widely used to treat various diseases. However, there is currently a lack of research regarding the safety of TEA. This prospective observational trial aims to evaluate the safety of TEA by collecting and analyzing data related to adverse events in patients receiving TEA in actual practice. Methods: A total of 350 eligible participants who undergo TEA at one of three university-affiliated hospitals and two traditional Korean medicine clinics will be systemically observed for post-treatment adverse reactions. The patients will be monitored at three time points: 1 week, 1 month, and 3 months post-treatment. Safety evaluations will assess the incidence of adverse events and treatment discontinuation rates during the 3-month post-treatment period. Conclusions: This study will evaluate the safety of TEA and provide information for decision-making in clinical practice as well as basic data for future large-scale research.

Charting the path to the implementation of universal health coverage policy in Nigeria through the lens of Delphi methodology

BACKGROUND

Expanding access to equitable health insurance is an important lever towards the overall strategy for achieving universal health coverage. In Nigeria, health insurance coverage is low with a renewed government action on increasing access to and coverage of high-quality healthcare services to citizens, particularly for the vulnerable and poor population. Therefore, our study co-creates the priorities for expanding health insurance in Nigeria, focusing on key policy reforms, public advocacy, and innovative financing strategies to ensure broader and more equitable coverage for the population.

METHODOLOGY

We employed a Delphi approach methodology through strategic health insurance meetings with a diverse multidisciplinary panel of 125 stakeholders including representatives of accredited Health Insurance Maintenance Organizations, Heads of States Social Health Insurance Agencies, Development Partners representatives, academics, government officials, national health insurance authority expanded management team and experts in health insurance across all the states of Nigeria to recommend specific actions towards health insurance expansion and universal health coverage in Nigeria.

RESULTS

The participants/panels were able to come up with a consensus on 66 priorities for health insurance expansion in Nigeria working with stakeholders within the Nigerian health insurance ecosystem across the 36 states and Nigeria's FCT. From these priorities, seven priority areas and 17 themes were derived that should be considered by the government, policymakers, regulators, and practitioners to deepen health insurance penetration in Nigeria. These seven priority areas that have been identified include enrolment, equity, organizational health and structure, data and technology, quality, market efficiency, and citizen engagement.

CONCLUSION

The priorities identified for health insurance expansion in Nigeria will go a long way in shaping health insurance. We hope that government, policymakers, regulators, and practitioners in the health ecosystem will use these social policy actions to set priorities for increasing health insurance coverage and address inadequacies to accelerate the drive towards the attainment of UHC by 2030.

Expert Consensus on Developing Information and Communication Technology-Based Patient Education Guidelines for Rheumatic Diseases in the Korea

BACKGROUND

This study aimed to identify key priorities for the development of guidelines for information and communication technology (ICT)-based patient education tailored to the needs of patients with rheumatic diseases (RDs) in the Republic of Korea, based on expert consensus.

METHODS

A two-round modified Delphi study was conducted with 20 rheumatology, patient education, and digital health literacy experts. A total of 35 items covering 7 domains and 18 subdomains were evaluated. Each item was evaluated for its level of importance, and the responses were rated on a 4-point Likert scale. Consensus levels were defined as "high" (interquartile range [IQR] ≤ 1, agreement ≥ 80%, content validity ratio [CVR] ≥ 0.7), "Moderate" (IQR ≥ 1, agreement 50-79%, CVR 0.5-0.7), and "Low" (IQR > 1, agreement < 50%, CVR < 0.5).

RESULTS

Strong consensus was reached for key priorities for developing guidelines in areas such as health literacy, digital health literacy, medical terminology, user interface, and user experience design for mobile apps. Chatbot use and video (e.g., YouTube) also achieved high consensus, whereas AI-powered platforms such as ChatGPT showed moderate-to-high agreement. Telemedicine was excluded because of insufficient consensus.

CONCLUSION

The key priorities identified in this study provide a foundation for the development of ICT-based patient education guidelines for RDs in the Republic of Korea. Future efforts should focus on integrating digital tools into clinical practice to enhance patient engagement and improve clinical outcomes.

Changing the trajectories of mental health difficulties in Norfolk and Suffolk: a research-priority-setting project with patients, the public, clinicians, policymakers and other stakeholders-study protocol

INTRODUCTION

Mental health problems are the most significant cause of disability and have high annual economic costs; hence, they are a priority for the government, service providers and policymakers. Consisting of largely coastal and rural communities, the populations of Norfolk and Suffolk, UK, have elevated burdens of mental health problems, areas with high levels of deprivation and an increasing migrant population. However, these communities are underserved by research and areas with the greatest mental health needs are not represented or engaged in research. This National Institute of Health and Care Research-funded project aims to bring together key stakeholders to conduct extensive scoping work to identify mental health needs and priorities as a basis for conducting larger research to address the identified priorities over the next 5 years.

METHODS AND ANALYSIS

This 12-month mixed-methods research-priority-setting project consists of five phases. It is being conducted in Norfolk and Suffolk counties in the East of England, UK. Underpinned by Delphi methodology, it will adopt the James Lind Alliance approach to identify priorities for mental health research for the populations of Norfolk and Suffolk. The project will use multiple methods, including mapping and identification of stakeholders, online questionnaires, face-to-face focus groups and interviews, and consensus meetings with experts and mental health stakeholders. Key evidence-informed priorities will be collaboratively ranked and documented, and a final top 10 research priorities will be identified to inform future research, policy and service provision.

ETHICS AND DISSEMINATION

This study was approved by the University of East Anglia's Faculty of Medicine and Health Research Ethics Committee (reference: ETH2324-2542), Norwich, UK. Research findings will be disseminated through workshops with stakeholders and collaborators and via peer-reviewed scientific publications, presentations at academic societies, blogs and social media.

Development of decision-aid of goal-setting for patients with distal radius fracture: Aid for decision-making in occupation choice for distal radius fracture

BACKGROUND

Patients with distal radius fractures (DRFs) encounter significant difficulties and challenges in their daily lives due to their medical condition and a lack of strategies for modifying activities. Occupation-based interventions have emerged as promising strategies to improve occupational performance and participation outcomes, addressing these challenges.

PURPOSE

This study aims to develop the aid for decision-making in occupation choice for distal radius fracture (ADOC-DRF), a novel decision-aid tool designed to facilitate patient-centered and occupation-based goal-setting by offering illustrations tailored to the postsurgical recovery period and prescribed activity loads.

STUDY DESIGN

We utilized consensus development methods, including the nominal group technique and a web-based Delphi survey.

METHODS

Through the nominal group technique with three experts, we established the development concept, items, and illustrations for the ADOC-DRF prototype. Subsequently, a Delphi web survey was conducted to gather expert opinions using a five-point Likert scale (1 = disagree and 5 = agree) and achieve consensus among 22 experts, aiming for a consensus point of 3.75 (75%) or higher.

RESULTS

Three rounds of Delphi web surveys were conducted, involving a variety of items and comments, ultimately achieving the required consensus rate. This process identified 52 items, which were categorized into four distinct post-DRF progression phases: phase 1: immobilization, phase 2 early: immobilization removal (start of active motion), phase 2 late: immobilization removal (callus formation), and phase 3: resistance period (bone healing).

CONCLUSIONS

The ADOC-DRF shows promise as an innovative tool for facilitating occupation-based intervention in hand therapy for DRF patients. However, its generalizability is currently limited to Japan. To ensure broader applicability and utility, it is essential to validate the tool in diverse cultural contexts through international multicenter studies, thereby enhancing its global relevance.

Generation of Indicators to Assess Quality of Health Care in Hospital at Home Through e-Delphi

BACKGROUND AND OBJECTIVES

The quality of health care in hospital at home (HaH) has been measured in different countries using simple indicators and clinical results that only contribute to some dimensions of the quality of health care. We sought to generate indicators to comprehensively evaluate the quality of health care provided to HaH users through the e-Delphi technique.

METHODS

The e-Delphi technique was performed with the participation of 17 HaH experts. The methodological strategy applied in this study was divided into the following 3 phases: a preparatory phase; consultation phase; and consensus phase. Three rounds of consultations were conducted with experts. In round 1, they were asked to identify which aspects of HaH they believed should be evaluated using an indicator for each of the following 6 dimensions of health care quality: effectiveness; efficiency; timeliness; patient-centered care; equity; and safety. In round 2, they were asked to rate each indicator using a 5-point Likert-type scale with the following values: (1) Totally disagree; (2) Disagree; (3) Moderately agree; (4) Agree; and (5) Totally agree. The criteria for evaluating each indicator were as follows: (1) The indicator is a useful measure for assessing the quality of health care provided to HaH users. (2) The indicator is clearly and specifically written and does not require modification. (3) The indicator is essential and incorporates information that can be extracted from HaH program records. An indicator was considered approved if it received at least 65% approval from the expert panel for each evaluation criterion. In round 3, experts were asked to reassess their ratings, taking into account the opinions of the other experts. The reliability of this technique was ensured through credibility, reliability, and confirmability. We obtained ethical approval of the corresponding institutions and informed consent from the participating experts.

RESULTS

Nine unpublished and reliable indicators were generated. In addition, 13 indicators were incorporated that evaluate aspects previously analyzed by other authors and/or national and international institutions, which were adapted to be used in HaH. The total indicators generated (n = 22) represented all dimensions of the quality of health care: safety; opportunity; effectiveness; efficiency; equity; and patient-centered care.

CONCLUSIONS

The 22 indicators generated through the e-Delphi technique permit a comprehensive evaluation of the quality of health care provided to HaH users.

Nutcracker syndrome (a Delphi consensus)

BACKGROUND

Nutcracker syndrome (NCS) describes the symptomatic compression of the left renal vein between the aorta and superior mesenteric artery. Whereas asymptomatic compression is a common radiological finding, patients with NCS can report a range of symptoms. There are no specific diagnostic criteria and interventions include a range of open surgical and endovascular procedures. Therefore, we wished to develop an international consensus document covering aspects of diagnosis, management, and follow-up for patients with NCS.

METHODS

A three-stage modified Delphi consensus was performed. A steering committee developed 37 statements covering 3 categories for patients with NCS: diagnosis, management, and follow-up. These statements were reported individually by 20 international experts in the management of venous disease, using a 5-point Likert scale. Consensus was defined if ≥70% of respondents rated the statement between 1 and 2 (agreement) and between 4 and 5 (disagreement). Those statements without consensus were recirculated in a second round of voting. A third round of the questionnaire was performed with 14 additional statements to clarify diagnostic values of NCS.

RESULTS

Responses were returned by 20 of 20 experts (100%) in round one and 17 of 20 (85%) in round two. Initial consensus was reached in 24 of 37 statements (65%) spread over all categories. Round two achieved a further consensus on 5 out of 10 statements (50%). No categories reported consensus on all statements. In round two consensus was reached in the category of follow-up (4/5 statements [80%]). The final round reached consensus on 5 out of 14 statements (36%). Experts agreed that imaging is obligated to confirm NCS. Experts did not agree on specific diagnostic cut-off values. There was a consensus that the first choice of operative treatment is left renal vein transposition and that the risk of stent migration outweighs the advantages of a percutaneous procedure.

CONCLUSIONS

Consensus was achieved on most statements concerning the assessment and management of NCS. This Delphi consensus identified those areas in which further research is needed, such as antiplatelet therapy, endovascular treatment, and renal autotransplantation. A rare disease registry to improve data and reports of patient outcomes is warranted.