Consensus development methods: Considerations for national and global frameworks and policy development

National Consensus on the Assessment of Visual Function for Driving in Switzerland

PURPOSE

To establish a national consensus on assessing visual function for fitness to drive in Switzerland.

METHODS

The minimum medical requirements for visual function for fitness to drive are regulated by Swiss Federal Law, namely, by the Traffic Licensing Ordinance (TLO). The medical examination techniques relevant in this context and their assessment are not further specified therein, which leads to legal inequality among drivers and uncertainty among examiners. We established a study group of representatives of the Traffic Medicine Section of the Swiss Society of Forensic Medicine and the Traffic Commission of the Swiss Society of Ophthalmology to develop a national consensus on assessing visual function for fitness to drive in Switzerland. In structured meetings, the authors discussed medical examination techniques and available international and local recommendations on this topic, with respect to Swiss legislation. In the event of a contrary opinion, the topic was discussed again in a follow-up session until we reached an agreement. We defined consensus as complete agreement on the subject under discussion.

RESULTS

The study group held five in-person meetings between March 2019 and January 2023. The authors developed recommendations intended for all professional groups assessing driving fitness. We prepared an aid for daily practice on how to examine the minimum medical requirements for visual function listed in the TLO Annex 1, using standardized test procedures and considered how to interpret the findings obtained, accounting for aspects of traffic medicine and ophthalmology.

CONCLUSIONS

A consensus on the assessment of visual function for fitness to drive in Switzerland is crucial to ensure legal equality for drivers and legal certainty for examiners. Regular review of the consensus is imperative if we are to consider future legal developments and new scientific evidence in assessing fitness to drive.

Young people with disabilities and their sexual health: a descriptive review of needs, recommendations and interventions

BACKGROUND

Worldwide, almost 180 million young people aged between 10 and 24 live with disability. They are often perceived as asexual, lacking in sexual desires, or as sexually inadequate. The sexual health of young people with disabilities thus remains a blind spot in health promotion. The aim of this descriptive review was to describe and analyze articles exploring needs, recommendations and interventions for promoting the sexual health (SH) of young people with disabilities.

METHODS

We searched the PubMed and PsycINFO databases for international scientific articles on SH needs, recommendations or health promotion interventions for young people with disabilities (aged 10-24), published after 2013. Data were extracted using a standardized grid and analyzed quantitatively and qualitatively.

RESULTS

Twenty-one articles were included, encompassing 13 SH interventions, 6 SH need studies, and 2 recommendations studies. Most studies were carried out in the United States (12/21), focusing on intellectual disability (6/21), with 7/21 studies involving parents. Among the needs studies, 2/6 explored the specific needs of young people, while the remaining 4 asked about their difficulties. None of the interventions were designed, co-constructed, or facilitated by young people with disabilities.

CONCLUSION

Very few studies have been done to understand the needs and to develop relevant interventions for promoting the sexual health of young people with disabilities. Research with rigorous methodologies is still required to better understand needs and to intervene as relevantly as possible. To this end, participatory research would be a valuable methodology, as it involves target audiences in the various stages of research.

PROSPERO REGISTRATION NUMBER

PROSPERO 2023 CRD42023421365.

Triangulating evidence from the GALENOS living systematic review on trace amine-associated receptor 1 (TAAR1) agonists in psychosis

BACKGROUND

Trace amine-associated receptor 1 (TAAR1) agonists offer a new approach, but there is uncertainty regarding their effects, exact mechanism of action and potential role in treating psychosis.

AIMS

To evaluate the available evidence on TAAR1 agonists in psychosis, using triangulation of the output of living systematic reviews (LSRs) of animal and human studies, and provide recommendations for future research prioritisation.

METHOD

This study is part of GALENOS (Global Alliance for Living Evidence on aNxiety, depressiOn and pSychosis). In the triangulation process, a multidisciplinary group of experts, including those with lived experience, met and appraised the first co-produced living systematic reviews from GALENOS, on TAAR1 agonists.

RESULTS

The animal data suggested a potential antipsychotic effect, as TAAR1 agonists reduced locomotor activity induced by pro-psychotic drug treatment. Human studies showed few differences for ulotaront and ralmitaront compared with placebo in improving overall symptoms in adults with acute schizophrenia (four studies, n = 1291 participants, standardised mean difference (SMD) 0.15, 95% CI -0.05 to 0.34). Large placebo responses were seen in ulotaront phase three trials. Ralmitaront was less efficacious than risperidone (one study, n = 156 participants, SMD = -0.53, 95% CI -0.86 to -0.20). The side-effect profile of TAAR1 agonists was favourable compared with existing antipsychotics. Priorities for future studies included (a) using different animal models of psychosis with greater translational validity; (b) animal and human studies with wider outcomes including cognitive and affective symptoms and (c) mechanistic studies and investigations of other potential applications, such as adjunctive treatments and long-term outcomes. Recommendations for future iterations of the LSRs included (a) meta-analysis of individual human participant data, (b) including studies that used different methodologies and (c) assessing other disorders and symptoms.

CONCLUSIONS

This co-produced, international triangulation examined the available evidence and developed recommendations for future research and clinical applications for TAAR1 agonists in psychosis. Broader challenges included difficulties in assessing the risk of bias, reproducibility, translation and interpretability of animal models to clinical outcomes, and a lack of individual and clinical characteristics in the human data. The research will inform a separate, independent prioritisation process, led by lived experience experts, to prioritise directions for future research.

Developing evaluation metrics to measure the US national institute of health plans to enhance diverse perspectives: a protocol for a consensus-based study

INTRODUCTION

The diversity of participating investigators representing diverse disciplines, career stages, stakeholder groups, regions and types of institutions is essential for the success of large-scale research programmes. In 2021, the National Institutes of Health introduced a requirement for some of its large grants to include a separate section that describes the project's plan for enhancing diverse perspectives (PEDPs). Our project aims to develop consensus-based PEDP evaluation metrics and instruments that can be systematically and sustainably collected across the projects.

METHODS AND ANALYSIS

Evaluation work is organised into three objectives. First, shared knowledge about PEDP infrastructures, activities and outcomes will be elicited through the review of the PEDP texts of funded projects, with 15 as the target sample size. Data will be analysed using a cultural domain analysis approach and assessed for recurrence and salience of PEDP metrics. Second, consensus-based evaluation metrics will be developed using a three-round Delphi method. The descriptive statistics (mean, SD and IQR) and cultural consensus analyses will be applied to the first and last rounds of the Delphi survey. Third, metrics will be piloted for implementation and validation within one of the Human BioMolecular Atlas Programme sites. Work will be completed by Fall 2025.

ETHICS AND DISSEMINATION

The long-term goal of the effort reported in this paper is to develop PEDP common metrics that are generalisable and feasible across diverse projects. This rigorous, focused evaluation development effort aims to inform scientific practices and policies around implementing the plans to enhance diverse perspectives.

International Consensus Recommendations of Diagnostic Criteria and Terminologies for Extranodal Extension in Head and Neck Squamous Cell Carcinoma: An HN CLEAR Initiative (Update 1)

PURPOSE

Extranodal extension (ENE) increases the risk of recurrence and death in head and neck squamous cell carcinoma (HNSCC) patients and is an indication for treatment escalation. Histopathology forms the mainstay of diagnosing ENE. There is substantial variation in the diagnosis of ENE and related terminology. Harmonising the diagnostic criteria for ENE was identified as a priority by the Head and Neck Consensus Language for Ease of Reproducibility (HN CLEAR) Steering Committee and its global stakeholders.

METHODS

An international working group including 16 head and neck pathologists from eight countries across five continents evaluated whole slide images of haematoxylin and eosin-stained sections depicting potential diagnostic problems through nine virtual meetings to develop consensus guidelines.

RESULTS

ENE should be diagnosed only when viable carcinoma extends through the primary lymph node (LN) capsule and directly interacts with the extranodal host environment with or without desmoplastic stromal response. Identifying the original LN capsule and reconstruction of its contour can assist in the detection and assessment of ENE. The term matting is recommended for confluence of two or more nodes due to histologically identifiable tumour extending from one LN to another. Matting constitutes major form of ENE. On the other hand, the terms fusion/adhesion/confluence/conglomeration and other synonyms of adhesion should be limited to confluence due to fibrosis or inflammation without histologically identifiable tumour between involved lymph nodes. Tumour extension along narrow needle tracks or spillage of cyst contents following an FNA do not constitute ENE.

CONCLUSIONS

The consensus recommendations encompassing the definition of ENE, macroscopic and histologic examination of lymph nodes (LN) and practical guidelines for handling challenging cases are provided.

Impact of Chinese criteria on potentially inappropriate medication use in China

Background

In 2018, China issued a set of criteria for effectively identifying and managing potentially inappropriate medication (PIM) use in older adults. However, there is currently a lack of evidence regarding the impact of these criteria on PIM use among older Chinese adults.

Methods

We used interrupted time series analysis on the prescription data of older outpatients from 59 hospitals in six major geographic regions of China to compare changes in the overall prevalence of PIM use, the prevalence of PIM use stratified by different numbers of PIMs, and the prevalence of top five PIMs (i.e. clopidogrel, estazolam, zolpidem, sliding-scale insulin, and alprazolam) from 2015 (before) to 2021 (after) the release of criteria in 2018.

Results

We included 982 605 older outpatients. Compared with trends prior to the publication of the criteria, there were significant decreases in the coefficient for change in the slope of the overall prevalence of PIM use (β = -0.607; 95% confidence interval (CI) = -0.881, -0.482; P < 0.001), the prevalence of single PIM use (β = -0.368; 95% CI = -0.465, -0.272; P < 0.001), the prevalence of multiple PIM use (β = -0.104; 95% CI = -0.173, -0.080; P = 0.019), the prevalence of clopidogrel (β = -0.342; 95% CI = -0.463, -0.227; P = 0.006), and the prevalence of estazolam (β = -0.077; 95% CI = -0.124, -0.037; P = 0.009) post-publication. Conversely, there was a significant increase in the prevalence of zolpidem, after the criteria were released (β = 0.030; 95% CI = 0.002, 0.057; P = 0.036).

Conclusions

We found that the release of criteria for effectively identifying and managing PIM use has had a positive effect on its prevalence among older outpatients in China.

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.

A Systematic Scoping Review of Essential Methodological Elements for Developing a Tool to Improve the Reporting of Consensus Studies in Classification, Diagnostic Criteria, and Guidelines Development

Introduction

A consensus is a general agreement among group members that is pivotal in gathering expert input for classification, diagnostic criteria, and guideline development. However, the absence of established methodological standards presents challenges in conducting and analyzing these studies.

Objective

This scoping review explored the evidence on essential elements in consensus studies to create a list of candidate items for a standardized reporting tool. This tool is intended to improve the critical appraisal and methodological rigor of consensus studies.

Methods

A systematic scoping review was conducted using predetermined criteria for study selecting studies and extracting data. A comprehensive literature search was performed without imposing date restrictions, covering multiple databases, including Medline, Embase, LILACS, SciELO, and up to March 2022. We included only English-language publications and excluded incomplete articles and conference reports. The risk of bias was assessed using the CASP checklist, and the study selection and data extraction were performed independently by two researchers in duplicate.

Results

We identified 8360 references; 20 publications were included for data extraction. The majority (70%) used the Delphi method, and the remainder (30%) employed the modified Delphi method. Inconsistencies in reporting conflicts of interest and consensus timing were observed. Other methodologies, such as RAND/UCLA and Nominal Group Technique were excluded due to methodological limitations. Most studies exhibited a low risk of bias.

Discussion

Our findings underscored the need for more standardization in definitions, methodology, and reporting within consensus studies. To address these gaps, we developed a checklist of key reporting items aimed at improving the planning, execution, and reporting consensus studies. Although the developed checklist requires validation, it offers a practical framework to enhance methodological transparency and reliability.

Conclusion

Deficiencies and variability in consensus methodologies reporting underscore the need for a standardized approach. We propose the adoption of a checklist to strengthen the robustness of consensus studies, supporting advances in classification, diagnostic criteria, and guideline development.

Developing lifestyle intervention program for pre-hypertensive patients; consensus building using a modified Delphi approach

BACKGROUND

Prehypertension is a preclinical state of hypertension which leads to an increased likelihood of coronary heart disease, myocardial infarction, cerebrovascular disease as well as target organ damage. Addressing pre-hypertension through early lifestyle interventions is crucial to mitigating these detrimental effects and improving long-term health outcomes. So, the main objective of this study is to develop a lifestyle intervention program (LSIP) for the management of prehypertension using consensus building approach.

METHODS

It was a three round online modified Delphi study with 70 members panellists. All panellists had an experience of prehypertension either as patients (n = 30) or professionals (n = 40). Round 1 included initial recommendations developed from a previous systematic review and metanalysis, which were rated by panellists for their importance on a 5-point Likert scale. Panellists could also suggest additional items in the Round 1. Round 2 and 3 included all items from the Round 1 with new items suggested by the panellists. Data was analysed descriptively using SPSS version 29. All items receiving at least 70% of all respondents combined rating of 'Important' and 'Very Important' in Round 3 were included in the final set of recommendations.

RESULTS

Fifty-one panellists (80.9%) (patients = 25, professionals = 26) completed Round 3. Twenty-six recommendation items were included in the Round 1. Twenty new items were added in Round 2 with 46 total items in Round 2 and 3. Thirty-five of these items reached consensus in Round 3. The final set of recommendation comprised of 15 educational. 10 dietary, and 10 exercise recommendations.

CONCLUSION

This modified Delphi study developed a comprehensive LSIP for the prevention of prehypertension, incorporating a holistic approach with educational, dietary, and exercise components aimed at the general population. Previously established standards of care (SOC) for managing prehypertension varied significantly and often provided fragmented guidance particularly on physical activity and education. This preventive model offers a novel and scalable approach for early intervention in prehypertension, potentially reducing reliance on medications and improving long-term health outcomes.

Consensus-Building Processes for Implementing Perioperative Care Pathways in Common Elective Surgeries: A Systematic Review

AIMS

To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.

DESIGN

Systematic review.

DATA SOURCES

Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.

METHODS

Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.

RESULTS

The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.

CONCLUSIONS

Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.

IMPACT

These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.

REPORTING METHOD

This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. No patient or public contribution.

TRIAL REGISTRATION

CRD42023413817.

Pioneering a multi-phase framework to harmonize self-reported sleep data across cohorts

STUDY OBJECTIVES

Harmonizing and aggregating data across studies enables pooled analyses that support external validation and enhance replicability and generalizability. However, the multidimensional nature of sleep poses challenges for data harmonization and aggregation. Here we describe and implement our process for harmonizing self-reported sleep data.

METHODS

We established a multi-phase framework to harmonize self-reported sleep data: (1) compile items, (2) group items into domains, (3) harmonize items, and (4) evaluate harmonizability. We applied this process to produce a pooled multi-cohort sample of five US cohorts plus a separate yet fully harmonized sample from Rotterdam, Netherlands. Sleep and sociodemographic data are described and compared to demonstrate the utility of harmonization and aggregation.

RESULTS

We collected 190 unique self-reported sleep items and grouped them into 15 conceptual domains. Using these domains as guiderails, we developed 14 harmonized items measuring aspects of satisfaction, alertness/sleepiness, timing, efficiency, duration, insomnia, and sleep apnea. External raters determined that 13 of these 14 items had moderate-to-high harmonizability. Alertness/Sleepiness items had lower harmonizability, while continuous, quantitative items (e.g. timing, total sleep time, and efficiency) had higher harmonizability. Descriptive statistics identified features that are more consistent (e.g. wake-up time and duration) and more heterogeneous (e.g. time in bed and bedtime) across samples.

CONCLUSIONS

Our process can guide researchers and cohort stewards toward effective sleep harmonization and provide a foundation for further methodological development in this expanding field. Broader national and international initiatives promoting common data elements across cohorts are needed to enhance future harmonization and aggregation efforts.

Standards for conducting and reporting consensus and recommendation documents: European Society of Cardiovascular Radiology policy from the Guidelines Committee

Cardiovascular imaging is exponentially increasing in the diagnosis, risk stratification, and therapeutic management of patients with cardiovascular disease. The European Society of Cardiovascular Radiology (ESCR) is a non-profit scientific medical society dedicated to promoting and coordinating activities in cardiovascular imaging. The purpose of this paper, written by ESCR committees and Executive board members and approved by the ESCR Executive Board and Guidelines committee, is to codify a standardized approach to creating ESCR scientific documents. Indeed, consensus development methods must be adopted to ensure transparent decision-making that optimizes national and global health and reaches a certain scientific credibility. ESCR consensus documents developed based on a rigorous methodology will improve their scientific impact on the management of patients with cardiac involvement. CRITICAL RELEVANCE STATEMENT: This document aims to codify the methodology for producing consensus documents of the ESCR. These ESCR indications will broaden the scientific quality and credibility of further publications and, consequently, the impact on the diagnostic management of patients with cardiac involvement. KEY POINTS: Cardiovascular imaging is exponentially increasing for diagnosis, risk stratification, and therapeutic management. The ESCR is committed to promoting cardiovascular imaging. A rigorous methodology for ESCR consensus documents will improve their scientific impact.

Application of the Delphi method to the development of common data elements for social drivers of health: A systematic scoping review

Collaborative data science requires standardized, harmonized, interoperable, and ethically sourced data. Developing an agreed-upon set of elements requires capturing different perspectives on the importance and feasibility of the data elements through a consensus development approach. This study reports on the systematic scoping review of literature that examined the inclusion of diverse stakeholder groups and sources of social drivers of health variables in consensus-based common data element (CDE) sets. This systematic scoping review included sources from PubMed, Embase, CINAHL, WoS MEDLINE, and PsycINFO databases. Extracted data included the stakeholder groups engaged in the Delphi process, sources of CDE sets, and inclusion of social drivers data across 11 individual and 6 social domains. Of the 384 studies matching the search string, 22 were included in the final review. All studies involved experts with healthcare expertise directly relevant to the developed CDE set, and only six (27%) studies engaged health consumers. Literature reviews and expert input were the most frequent sources of CDE sets. Seven studies (32%) did not report the inclusion of any demographic variables in the CDE sets, and each demographic SDoH domain was included in at least one study with age and sex assigned at birth included in all studies, and social driver domains included only in four studies (18%). The Delphi technique engages diverse expert groups around the development of SDoH data elements. Future studies can benefit by involving health consumers as experts.

Implementation of medication reviews in community pharmacy: reaching consensus on stakeholders' recommendations for mechanisms of change using the nominal group technique

BACKGROUND

Since 2022, patients with five or more medicines are eligible for a medication review (MR) in a community pharmacy remunerated by the German health system. However, implementation has been slow, with few pharmacies providing MRs. Stakeholders' input is necessary to detail how implementation strategies can be executed effectively on a national level. Prior research identified "external facilitation" and "altering incentives" as crucial strategies to achieve implementation outcomes.

AIM

To gather stakeholders' recommendations for, and obtain consensus on, mechanisms of change that allow implementation strategies to work in practice.

METHOD

The consensus method used was the nominal group technique (NGT) with NGT-discussions held separately with pharmacy owners and pharmacy chambers employees. Votes were summed and the relative importance (rI) calculated, defined as (score achieved for a mechanism)/(maximum possible score) × 100. Content analysis provided context for the highest ranked mechanisms and allowed linking to implementation outcomes.

RESULTS

Four NGT-discussions were held in 2023 (n = 2 owners; n = 2 chamber employees) with a total of 17 participants. The overall highest ranked mechanisms were fit-for-purpose software (rI = 154.7) detailed process support (rI = 104.9) and an expert support line (rI = 77.7). These together with financial viability (rI = 40.0) were prioritised by both participant groups. Three mechanisms were favoured for both implementation strategies, namely software, process support and materials (rI = 34.3).

CONCLUSION

This study identified stakeholders' priorities for mechanisms of change to implement MRs in community pharmacies. Focusing efforts on the prioritised mechanisms is likely to significantly advance a national implementation plan for countries which are at an early implementation stage.

Patient, caregiver and other knowledge user engagement in consensus-building healthcare initiatives: a scoping review protocol

INTRODUCTION

Patient engagement and integrated knowledge translation (iKT) processes improve health outcomes and care experiences through meaningful partnerships in consensus-building initiatives and research. Consensus-building is essential for engaging a diverse group of experienced knowledge users in co-developing and supporting a solution where none readily exists or is less optimal. Patients and caregivers provide invaluable insights for building consensus in decision-making around healthcare, policy and research. However, despite emerging evidence, patient engagement remains sparse within consensus-building initiatives. Specifically, our research has identified a lack of opportunity for youth living with chronic health conditions and their caregivers to participate in developing consensus on indicators/benchmarks for transition into adult care. To bridge this gap and inform our consensus-building approach with youth/caregivers, this scoping review will synthesise the extent of the literature on patient and other knowledge user engagement in consensus-building healthcare initiatives.

METHODS AND ANALYSIS

Following the scoping review methodology from Joanna Briggs Institute, published literature will be searched in MEDLINE, EMBASE, CINAHL and PsycINFO databases from inception to July 2023. Grey literature will be hand-searched. Two independent reviewers will determine the eligibility of articles in a two-stage process, with disagreements resolved by a third reviewer. Included studies must be consensus-building studies within the healthcare context that involve patient engagement strategies. Data from eligible studies will be extracted and charted on a standardised form. Abstracted data will be analysed quantitatively and descriptively, according to specific consensus methodologies, and patient engagement models and/or strategies.

ETHICS AND DISSEMINATION

Ethics approval is not required for this scoping review protocol. The review process and findings will be shared with and informed by relevant knowledge users. Dissemination of findings will also include peer-reviewed publications and conference presentations. The results will offer new insights for supporting patient engagement in consensus-building healthcare initiatives.

PROTOCOL REGISTRATION

https://osf.io/beqjr.

Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions

BACKGROUND

Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI).

OBJECTIVE

An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI.

METHODS

The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group.

RESULTS

Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI.

CONCLUSIONS

The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.

Identifying Nursing-Sensitive Indicators for Hospitals: A Modified Delphi Approach

BACKGROUND

Nursing-sensitive indicators (NSIs) play a crucial role in measuring the quality of care specific to nursing practice. Currently, hospitals monitor several NSIs which may vary between hospitals. Conducting research on NSIs can enhance the monitoring of nursing practice.

AIM

The aim is to identify NSIs for hospitals in Jordan.

METHODS AND MATERIAL

The Delphi approach was utilized to establish a consensus among a panel of national nursing experts (N=60). An initial list of 52 indicators was developed through a rigorous process and subsequently distributed to the panel members. The panelists provided their quantitative responses in three rounds. Consensus was determined based on the following criteria: agreement greater than 51.0%, interquartile range (IQR) below 1.5, standard deviation (SD) below 1, and moderate Kendall's coefficient of concordance (Kendall's W).

RESULTS

By the conclusion of the third round, a total of 42 indicators achieved group agreement. The agreed-upon indicators consisted of 10 structure, 16 process, and 16 outcome indicators.

CONCLUSION

This study successfully established a consensus and identified a comprehensive set of indicators that capture the distinct contributions of nursing in the hospital setting. The results demonstrate a wide range of agreed-upon indicators across the domains of structure, process, and outcome. These findings are valuable in enhancing the monitoring and evaluation of nursing practice in hospitals.

PRACTICAL IMPLICATIONS

 The findings of this study provide a solid foundation for monitoring and reporting the quality of nursing practice in hospitals. Nursing policymakers can utilize these findings to develop policies that promote the voluntary reporting of NSIs.

Multicenter exploration of tenecteplase transition factors: A quantitative analysis

BACKGROUND

Tenecteplase (TNK) is gaining recognition as a novel therapy for acute ischemic stroke (AIS). Despite TNK offering a longer half-life, time and cost saving benefits and comparable treatment and safety profiles to Alteplase (ALT), the adoption of TNK as a treatment for AIS presents challenges for hospital systems.

OBJECTIVE

Identify barriers and facilitators of TNK implementation at acute care hospitals in Texas.

METHODS

This prospective survey used open-ended questions and Likert statements generated from content experts and informed by qualitative research. Stroke clinicians and nurses working at 40 different hospitals in Texas were surveyed using a virtual platform.

RESULTS

The 40 hospitals had a median of 34 (IQR 24.5-49) emergency department beds and 42.5 (IQR 23.5-64.5) inpatient stroke beds with 506.5 (IQR 350-797.5) annual stroke admissions. Fifty percent of the hospitals were Comprehensive Stroke Centers, and 18 (45 %) were solely using ALT for treatment of eligible AIS patients. Primary facilitators to TNK transition were team buy-in and a willingness of stroke physicians, nurses, and pharmacists to adopt TNK. Leading barriers were lack of clinical evidence supporting TNK safety profile inadequate evidence supporting TNK use and a lack of American Heart Association guidelines support for TNK administration in all AIS cases.

CONCLUSION

Understanding common barriers and facilitators to TNK adoption can assist acute care hospitals deciding to implement TNK as a treatment for AIS. These findings will be used to design a TNK adoption Toolkit, utilizing implementation science techniques, to address identified obstacles and to leverage facilitators.

Developing a competency framework for training with simulations in healthcare: a qualitative study

BACKGROUND

Simulation is a technique used to create an experience without going through the real event. Competency-based medical education focuses on outcomes and ensures professionals have the necessary knowledge, skills, and attitudes. The purpose of this study was to develop a set of competencies for the instructors providing basic and advanced levels of simulation-based training in healthcare.

METHODS

We conducted a qualitative study in three steps, with each next step building on and influenced by the previous one. First, we conducted a literature review, then a consensus development panel, and finally a three-step Delphi process. The participants were experts in the fields of healthcare, education, and simulations.

RESULTS

The six main competencies identified for the instructor providing simulation-based training at the basic level in healthcare include knowledge of simulation training, education/training development, education/training performance, human factors, ethics in simulation, and assessment. An instructor providing simulation-based training at an advanced level in healthcare should also possess the following five competencies: policies and procedures, organisation and coordination, research, quality improvement, and crisis management.

CONCLUSION

The identified competencies can serve as a valuable resource for simulation educators and organisations involved in simulation education, to plan curriculum and implement a continuous train-the-trainers programme.

A case study of using community-based consensus methods to facilitate shared decision-making among a spinal cord injury network

Spinal cord injury (SCI) research and policy decisions are rarely made in partnership with people with SCI, making them less relevant, applicable, and used by those whom the decisions are intended to support. Across disciplines, consensus methods have been promoted as a viable solution for supporting shared research and policy-based decision-making. In this paper, we describe a partnered approach between academic researchers and the Ontario SCI Alliance, a non-profit, SCI community mobilization network to co-develop and co-disseminate a community-based consensus exercise. The community-based consensus exercise included two modified Delphi surveys and one in-person retreat. The partnership's goal with this exercise was to facilitate shared decision-making for the development of their upcoming strategic plan. We then interviewed partners and participants from the Delphi and in-person retreat to discuss successes, challenges, and lessons learned from the exercise. Survey 1 was disseminated to over 2,500 members of the Ontario SCI community and received 374 responses (276 coming from people with SCI). Survey 2 had 118 responses, with 87 coming from people with SCI. The retreat had 73 attendees, including people with SCI, family/friends of people with SCI, clinicians, researchers, and SCI community and research organization staff/volunteers. The retreat included a presentation of the survey results, a clinician/researcher panel, and externally-facilitated working groups. All survey responses and retreat materials were synthesized. Using the synthesized feedback, the Ontario SCI Alliance was able to implement several changes for the Ontario SCI community, including higher-quality primary care experiences (reduced wait times, more accessible examining rooms), the development of a wound care strategy with the Ontario government, and an advocacy campaign for public coverage for catheters and urinary care supplies. From the five interviews conducted, five themes were co-constructed regarding the successes, challenges, and lessons learned from the exercise: (1) Inclusion, Diversity, Equity, and Accessibility; (2) Partnership; (3) Design Considerations; (4) Transparency and Clarity in Communication; and (5) Sustainability. Findings from this community case study demonstrate the feasibility of conducting a community-level consensus exercise among an equity-deserving group while providing detailed guidance for how to ensure future research and policy-based decision-making is shared across diverse knowledge users.

[Results of the first All-Russian consensus conference on bariatric surgery]

Until now, there has not been organized consensus for standardization in bariatric surgery In Russia. We present the results of the first Bariatric Surgery Consensus Conference conducted in Barnaul (March, 2023). A list of questions was proposed within 6 blocks: 1) general issues of bariatric surgery, 2) sleeve gastrectomy, 3) one-anastomosis gastric bypass («mini-gastric bypass»), 4) Roux-en-Y Gastric Bypass, 5) Single Anastomosis Duodenal Switch and other options for biliopancreatic bypass, 6) rare procedures. Consensus (>70% agreement) was reached for 51 out of 96 statements. Stratification by the level of expertise was carried out, and responses of the expert group were compared with responses of all participants.

Kaleidoscopic integration: Advancing the integration of incommensurable knowledge in healthcare guidelines

The integration of different types of knowledge in epistemically hierarchical settings remains one of the greatest challenges when developing standards for healthcare practices. In this article, we open up the notion of knowledge integration and empirically examine the various ways in which different types of knowledge interact and can be integrated. To allow us to focus on the diverse forms of knowledge as well as their interaction and integration, we combine Moreira's work on repertoires of evaluation with that of Dewulf and Bouwen on frame interactions. We examine the quest for knowledge integration by studying interactions in the case of the development of the COVID-19 vaccination guideline in the Netherlands, a prime example of the encounter of a wide range and diversity of knowledge that needs to be appraised and integrated into guideline recommendations. Drawing on ethnographic observations of more than 70 guideline development meetings between 2021 and 2022, we first map the different types of knowledge and reasonings used by the guideline developers and subsequently analyze their interactions. We identified eight knowledge interaction patterns, being disconnection, polarization, accommodation, incorporation, reconnection, reconciliation, passive juxtaposition, and kaleidoscopic integration. We hereby draw attention to the various possible knowledge interactions encompassed in the concept of "knowledge integration", especially to those in which integration is achieved while differences and incompatibilities are maintained. Finally, we discuss potential ways to facilitate fruitful knowledge interactions during collaborative work which include the ability to accept and sustain tensions between different types of knowledge and making more explicit use of frame or rather repertoire reflection.

Topical Cellular/Tissue and Molecular Aspects Regarding Nonpharmacological Interventions in Alzheimer's Disease-A Systematic Review

One of the most complex and challenging developments at the beginning of the third millennium is the alarming increase in demographic aging, mainly-but not exclusively-affecting developed countries. This reality results in one of the harsh medical, social, and economic consequences: the continuously increasing number of people with dementia, including Alzheimer's disease (AD), which accounts for up to 80% of all such types of pathology. Its large and progressive disabling potential, which eventually leads to death, therefore represents an important public health matter, especially because there is no known cure for this disease. Consequently, periodic reappraisals of different therapeutic possibilities are necessary. For this purpose, we conducted this systematic literature review investigating nonpharmacological interventions for AD, including their currently known cellular and molecular action bases. This endeavor was based on the PRISMA method, by which we selected 116 eligible articles published during the last year. Because of the unfortunate lack of effective treatments for AD, it is necessary to enhance efforts toward identifying and improving various therapeutic and rehabilitative approaches, as well as related prophylactic measures.

How well did the consensus methods apply in the guideline development of traditional Chinese medicine: a web-based survey in China

BACKGROUND AND OBJECTIVE

Consensus methods are crucial in developing clinical guidelines. Different methods, such as the Delphi and nominal group techniques, are commonly used, but there is a lack of detailed instructions on how to implement them effectively. The survey aims to explore the opinions and attitudes of the chair, panel and working group on the critical elements of the consensus methods during guideline development.

METHODS

We used a cross-sectional design to conduct this study and sent a structured questionnaire to stakeholders, including the chair, panel members, and working group participants, through the popular mobile phone application WeChat.We selected participants using a combination of purposive and snowball sampling. The questionnaire gathered information on demographics, experiences, opinions, and concerns regarding consensus methods and guideline development.

RESULTS

The sample comprised 290 participants representing 31 provinces or municipalities. Among them, the most significant number of respondents (n = 107, 36.9%) were from Beijing. Most participants, specifically 211 (72.76%), held senior professional titles, while 186 (64.14%) adhered to ongoing guidelines. The Delphi method was the most commonly used consensus method (n = 132, 42.31%), but the respondents had only a preliminary understanding of it (n = 147, 47.12%). The consensus process also revealed the insufficiency of involving pharmacoeconomists, patients, and nurses.

CONCLUSIONS

Consensus methods have to be standardised and used consistently in the guideline development process. The findings of this study offer insights into diverse roles and more effective ways to apply the consensus process during guideline development.

A framework for transforming the professional identity and brand image of All Nurses as Leaders

BACKGROUND

The professional identity and brand image of nurses as leaders have not kept pace with the roles and scope of contemporary nursing practice.

PURPOSE

To provide a framework to transform the professional identity and brand image of nursing from a caring discipline to one of leaders.

METHODS

A Consensus Development Workgroup (CDW) design was used between the International Society for Professional Identity in Nursing (ISPIN) and the Institute for Brand Image of Nursing (IBIN) to advance the concept of All Nurses as Leaders across all settings and the public domain.

DISCUSSION

The goal is to occupy a position in the minds of all stakeholders that differentiates nursing in a manner that is positive, relevant, accurate, desirable, and consistent over time.

CONCLUSION

Current outcomes are endorsements, evidence-based strategies, and a framework to deconstruct the current brand image and align it with the desired brand image of All Nurses as Leaders.

Digital mental health: challenges and next steps

Digital innovations in mental health offer great potential, but present unique challenges. Using a consensus development panel approach, an expert, international, cross-disciplinary panel met to provide a framework to conceptualise digital mental health innovations, research into mechanisms and effectiveness and approaches for clinical implementation. Key questions and outputs from the group were agreed by consensus, and are presented and discussed in the text and supported by case examples in an accompanying appendix. A number of key themes emerged. (1) Digital approaches may work best across traditional diagnostic systems: we do not have effective ontologies of mental illness and transdiagnostic/symptom-based approaches may be more fruitful. (2) Approaches in clinical implementation of digital tools/interventions need to be creative and require organisational change: not only do clinicians and patients need training and education to be more confident and skilled in using digital technologies to support shared care decision-making, but traditional roles need to be extended, with clinicians working alongside digital navigators and non-clinicians who are delivering protocolised treatments. (3) Designing appropriate studies to measure the effectiveness of implementation is also key: including digital data raises unique ethical issues, and measurement of potential harms is only just beginning. (4) Accessibility and codesign are needed to ensure innovations are long lasting. (5) Standardised guidelines for reporting would ensure effective synthesis of the evidence to inform clinical implementation. COVID-19 and the transition to virtual consultations have shown us the potential for digital innovations to improve access and quality of care in mental health: now is the ideal time to act.

Existing guidance on reporting of consensus methodology: a systematic review to inform ACCORD guideline development

OBJECTIVE

To identify evidence on the reporting quality of consensus methodology and to select potential checklist items for the ACcurate COnsensus Reporting Document (ACCORD) project to develop a consensus reporting guideline.

DESIGN

Systematic review.

DATA SOURCES

Embase, MEDLINE, Web of Science, PubMed, Cochrane Library, Emcare, Academic Search Premier and PsycINFO from inception until 7 January 2022.

ELIGIBILITY CRITERIA

Studies, reviews and published guidance addressing the reporting quality of consensus methodology for improvement of health outcomes in biomedicine or clinical practice. Reports of studies using or describing consensus methods but not commenting on their reporting quality were excluded. No language restrictions were applied.

DATA EXTRACTION AND SYNTHESIS

Screening and data extraction of eligible studies were carried out independently by two authors. Reporting quality items addressed by the studies were synthesised narratively.

RESULTS

Eighteen studies were included: five systematic reviews, four narrative reviews, three research papers, three conference abstracts, two research guidance papers and one protocol. The majority of studies indicated that the quality of reporting of consensus methodology could be improved. Commonly addressed items were: consensus panel composition; definition of consensus and the threshold for achieving consensus. Items least addressed were: public patient involvement (PPI); the role of the steering committee, chair, cochair; conflict of interest of panellists and funding. Data extracted from included studies revealed additional items that were not captured in the data extraction form such as justification of deviation from the protocol or incentives to encourage panellist response.

CONCLUSION

The results of this systematic review confirmed the need for a reporting checklist for consensus methodology and provided a range of potential checklist items to report. The next step in the ACCORD project builds on this systematic review and focuses on reaching consensus on these items to develop the reporting guideline.

PROTOCOL REGISTRATION

https://osf.io/2rzm9.

An international survey mapping practice and barriers for upper-limb assessments in movement analysis

BACKGROUND

Upper-limb movement analysis could improve our understanding of function, pathological mechanisms and inform rehabilitation and surgical decision-making. Despite the potential benefits, the use of clinical upper-limb motion analysis is not well established and it is not clear what the barriers to clinical motion analysis are.

RESEARCH QUESTION

What is current practice for assessment of the upper-limb and what are the barriers currently limiting upper-limb motion analysis being routinely used in clinical practice?

METHODS

A web-based questionnaire was used to collect responses through international professional movement analysis society coordinators over an 18 month-period.

RESULTS

A total of 55 responses were received and 75% of laboratories performed some form of upper-limb assessment. In total 44% of laboratories performed upper-limb assessments for clinical purposes and only 33% did 3D-movement analysis. The most commonly seen patient groups were those with neurological injury e.g. cerebral palsy (adults and children) and normal controls for comparative purposes. Barriers to upper-limb motion analysis were the availability of standard reference tasks, protocols, software, funding and clinical need. Practice was variable with no universally identified approaches to upper-limb movement analysis. Differences in practice were also identified between laboratories accredited by the Clinical Movement Analysis Society of the UK and Ireland and other international professional societies and affiliate laboratories.

SIGNIFICANCE

These findings may be used to inform the development of practice standards and progress the use of clinical motion analysis in the upper-limb. This study provides a summary and describes current practice, potentially providing access to peer support and experience for laboratories with an identified clinical need looking to conduct upper-limb assessment. A national picture (UK and Ireland) for practice regarding upper-limb assessment in this sub-population is presented. We have laid out further work which is needed to establish standards of practice or consensus initiatives for enhancing clinical upper-limb motion analysis.

ACCORD guideline for reporting consensus-based methods in biomedical research and clinical practice: a study protocol

BACKGROUND

Structured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus - for example, not clearly explaining the definition of consensus, or not stating how consensus group panellists were selected - can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.

METHODS

The ACCORD (ACcurate COnsensus Reporting Document) project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration (E&E) document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.

DISCUSSION

The ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes.