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Strauss P, Marion L, Hill NT, Gilbey D, Waters Z, Moore JK, Costanza M, Lamblin M, Robinson J, Lin A, Perry Y. Development of best practice guidelines for clinical and community service providers to prevent suicide in LGBTQA+ young people: A Delphi expert consensus study. Aust N Z J Psychiatry 2024; 58:425-434. [PMID: 38217434 DOI: 10.1177/00048674231223697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
OBJECTIVE The aim of this study was to develop best practice guidelines for preventing suicide and reducing suicidal thoughts and behaviours in LGBTQA+ young people (lesbian, gay, bisexual, trans, queer/questioning, asexual, and those of other diverse sexualities and genders) within clinical and community service settings in Australia. METHODS We conducted a Delphi expert consensus study. A systematic literature search and interviews with key informants informed an initial 270-item questionnaire. Two expert panels completed the questionnaire, delivered over two rounds: (1) Australian professionals with expertise in LGBTQA+ mental health/suicide prevention and (2) Australian LGBTQA+ young people aged 14-25 with lived experience of suicidal thoughts and/or behaviours. Items endorsed as 'essential' or 'important' by >80% of both expert panels were included in the guidelines. RESULTS A total of 115 people participated in the Delphi process; n = 52 professionals completed Round 1, and n = 42 completed Round 2; n = 63 LGBTQA+ young people completed Round 1, and n = 50 completed Round 2. A total of 290 items were included in the guidelines and grouped into: (1) general principles for creating an affirming and inclusive environment for LGBTQA+ young people; (2) assessing suicide risk and working with suicidal LGBTQA+ young people; (3) considerations for specific LGBTQA+ populations; and (4) advocating for LGBTQA+ young people. CONCLUSION These guidelines are the first of their kind in Australia. They provide practical support to service providers regardless of prior training in LGBTQ+ identities or mental health, with the aim of reducing suicidal thoughts and behaviours, and preventing suicide, in LGBTQA+ young people.
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Affiliation(s)
- Penelope Strauss
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | | | - Nicole Tm Hill
- Telethon Kids Institute, Nedlands, WA, Australia
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Dylan Gilbey
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Julia K Moore
- The Gender Diversity Service, Child and Adolescent Health Service - Mental Health, Perth Children's Hospital, Perth, WA, Australia
| | - Marco Costanza
- Telethon Kids Institute, Nedlands, WA, Australia
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Michelle Lamblin
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jo Robinson
- Orygen, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Ashleigh Lin
- Telethon Kids Institute, Nedlands, WA, Australia
| | - Yael Perry
- Telethon Kids Institute, Nedlands, WA, Australia
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Fraticelli L, Verot E, Späth HM, Genton MC, Kempf C, Clement C, Darlington-Bernard A, Roy S, Dussart C, Mick G, Carrouel F. Glossary of healthcare pathways: a methodological approach involving a transdisciplinary team in public health. Front Public Health 2024; 12:1347774. [PMID: 38645449 PMCID: PMC11026848 DOI: 10.3389/fpubh.2024.1347774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The healthcare pathway is at the heart of public health organization concerns, but communication between the various players can be an obstacle. This work, produced by a French transdisciplinary team, offers a methodological approach based on formalized consensus to elaborate a glossary of healthcare pathways. A two-steps procedure was elaborated, including a double rounded Delphi method to formalize expert consensus, and two groups of experts: a workgroup and a review group. Methods The workgroup provided a list of words or expressions that, in their opinion, described, evaluated or compared the healthcare pathways for patients, caregivers or regulators. The review group checked this list and added or deleted words or expressions. Then, definitions were added by the workgroup based into account three dimensions: official, academic and from the field. The review group validated the definitions and provided complementary proposals if needed. Results After pooling the list of words proposed by each of the six members of the working group, 417 words/expressions were ranked. After the two rounds of evaluation, 294 words/expressions were rated "appropriate" and were analyzed by the review group. This group, after two rounds of evaluation, agreed on 263 words/expressions that were transmitted to the working group who defined them. These definitions were rated by the review group. The first round of evaluation established 195 definitions as being appropriated whereas 68 definitions were amended by the review group. Conclusion This glossary supports transdisciplinary communication, reduces the extent of variations in practice and optimizes decision-making. International debate on all aspects might be strengthened by an improved understanding of the concept of health pathway.
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Affiliation(s)
- Laurie Fraticelli
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Elise Verot
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Presage Institute, University Jean Monnet, Saint-Etienne, France
- CIC 1408 Inserm, CHU of Saint-Etienne, Saint-Etienne, France
| | - Hans-Martin Späth
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Marine C. Genton
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Cédric Kempf
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Celine Clement
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Laboratory Interpsy, UR4432, University of Lorraine, Nancy, France
| | - Adeline Darlington-Bernard
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Sylvain Roy
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
| | - Claude Dussart
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- Hospices Civils of Lyon, Lyon, France
| | - Gérard Mick
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
- CHU Grenoble-Alpes-Voiron, Voiron, France
| | - Florence Carrouel
- Health, Systemic, Process, UR 4129 Research Unit, University Claude Bernard Lyon 1, University of Lyon, Lyon, France
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Murray NM, Yadav K, Daoust R, James D, Nath A, Halil R, Zayed M, Eagles D. Emergency department opioid discharge instructions: a multidisciplinary national Delphi study. CAN J EMERG MED 2022. [PMID: 35969328 DOI: 10.1007/s43678-022-00352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/21/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVES Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting. METHODS We conducted a modified Delphi study between May and August 2021. The national multidisciplinary panel consisted of 23 healthcare professionals and one patient partner. The survey consisted of 19 initial concepts developed after a review of the literature and a meeting with local experts. The panel added four new concepts after the first survey round. Three rounds of online surveys were distributed in total. Panel consensus was defined a priori as a disagreement index score less than 1, in accordance with the RAND/UCLA Appropriateness Method. RESULTS We achieved a 100% response rate in round one and a 96% response rate in rounds two and three of our Delphi study. There was group consensus (disagreement index = 0.66, median importance = 9) that all patients receiving opioid prescriptions from the ED should receive written discharge instructions. The interdisciplinary panel arrived at a consensus on 21/23 concepts for ED opioid discharge instructions. The concepts with the highest level of agreement were related to minimizing the use of the prescribed opioid medication and opioid use safety (mixing with drugs/alcohol, storage, and impairment). CONCLUSION This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED.
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Gasana J, Vainio H, Longenecker J, Loney T, Ádám B, Al-Zoughool M. Identification of public health priorities, barriers, and solutions for Kuwait using the modified Delphi method for stakeholder consensus. Int J Health Plann Manage 2021; 36:1830-1846. [PMID: 34176157 DOI: 10.1002/hpm.3270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/05/2022] Open
Abstract
The rapid modernization and economic developments in Kuwait, have been accompanied by substantial lifestyle changes such as unhealthy diet and physical inactivity. These modifiable behaviours have contributed to increased rates of non-communicable diseases including diabetes and cardiovascular diseases. Delphi Consensus Method was implemented in the current study to draw stakeholders from all sectors together to develop a consensus on the major public health priorities, barriers and solutions. The process involves administration of a series of questions to selected stakeholders through an iterative process that ends when a consensus has been reached among participants. Results of the iteration process identified obesity, diabetes, cardiovascular diseases along with lack of enforcement of laws and regulation as priority health issues. Results also identified lack of national vision for the development of a public health system, lack of multidisciplinary research investigating sources of disease and methods of prevention and improving efficiency with existing resources in implementation and efficiency as the main barriers identified were. Solutions suggested included investing in healthcare prevention, strengthening communication between all involved sectors through intersectoral collaboration, awareness at the primary healthcare setting and use of electronic health records. The results offer an important opportunity for stakeholders in Kuwait to tackle these priority health issues employing the suggested approaches and solution.
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Affiliation(s)
- Janvier Gasana
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Harri Vainio
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Joseph Longenecker
- Department of Epidemiology, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University for Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Balázs Ádám
- Department of Public Health and Preventive Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mustafa Al-Zoughool
- Department of Environmental and Occupational Health, Faculty of Public Health, Kuwait University, Kuwait, Kuwait
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Perrenot C, Bresler L, Berdah S, Carretier M, Faure JP, Frileux P, Mabrut JY, Beyer-Berjot L. Development of a program for teaching practical skills in visceral and digestive surgery by simulation. J Visc Surg 2020; 157:S101-16. [PMID: 32387026 DOI: 10.1016/j.jviscsurg.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Up until 2013 in France, practical training for DES/DESC (advanced level) residents in visceral and digestive surgery was not standardized. Since 2017, the third cycle of medical studies has been restructured around three major thematic axes: academic knowledge, and technical and non-technical skills. The curriculum now includes a practical training program by means of simulation outside the operating theater, and it is structured, uniformized and standardized nationwide. Development of this training program is derived from the deliberations of a national consensus panel working under the umbrella of the French college of visceral and digestive surgery, program presenting a training guide to all future surgeons in the specialty. Four consensus conference sessions bringing together an eight-member commission have led to the drafting of a "Resident's manual for practical teaching in visceral and digestive surgery". As a reference document, the manual details in 272 pages the objectives (phase I), the learning resources for each skill (phase II) and, lastly, the means of evaluation for the cornerstone phases as well as the in-depth phases of an advanced degree (DES) in visceral and digestive surgery. As a complement to the manual, we have conducted a review of the structuring and implementation of the program as of November 2017 on a nationwide scale; the conclusions of the review are detailed at the end of this article.
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Bodmer NS, Häuselmann HJ, Frey D, Aeberli D, Bachmann LM. Expert consensus on relevant risk predictors for the occurrence of osteoporotic fractures in specific clinical subgroups - Delphi survey. BMC Rheumatol 2019; 3:50. [PMID: 31742245 PMCID: PMC6849295 DOI: 10.1186/s41927-019-0099-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an ongoing discussion about incorporating additional risk factors to established WHO fracture risk assessment tool (FRAX) to improve the prediction accuracy in clinical subgroups. We aimed to reach an expert consensus on possible additional predictive parameters for specific clinical subgroups. METHODS Two-round modified Delphi survey: We generated a shortlist of experts from the authors' lists of the pertinent literature and complemented the list with experts known to the authors. Participants were asked to name possible relevant risk factors besides the FRAX-parameters for the occurrence of osteoporotic fractures. Experts specified these possible predictors for specific subgroups of patients. In the second round the expert panel was asked to weight each parameter of every subgroup assigning a number between one (not important) to ten (very important). We defined the threshold for an expert consensus if the interquartile range (IQR) of a predictor was ≤2. The cut-off value of the median attributed weights for a relevant predictor was set at ≥7. RESULTS Eleven experts of seven countries completed both rounds of the Delphi. The participants agreed on nine additional parameters for seven categories. For the category "secondary osteoporosis", "older adults" and "nursing home patients", there was a consensus that history of previous falls was relevant, while for men and postmenopausal women, there was a consensus that the spine fracture status was important. For the group "primary and secondary osteoporosis" the experts agreed on the parameters "high risk of falls", "lumbar spine bone mineral density (BMD)" and "sarcopenia". CONCLUSION This Delphi survey reached a consensus on various parameters that could be used to refine the currently existing FRAX for specific clinical situations or patient groups. The results may be useful for studies aiming at improving the predictive properties of instruments for fracture prediction.
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Affiliation(s)
- Nicolas S. Bodmer
- Medignition Inc. Medical Research Consultants, Verena Conzett-Strasse 9, 8004 Zurich, Switzerland
- University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland
| | - Hans Jörg Häuselmann
- Center for Rheumatology and Bone Disease, Bellariastrasse 38, 8038 Zurich, Switzerland
| | - Diana Frey
- Division of Rheumatology, University Hospital Zurich, Gloriastrasse 25, 8091 Zurich, Switzerland
| | - Daniel Aeberli
- Department of Rheumatology and Clinical Immunology/Allergology, University Hospital Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Lucas M. Bachmann
- Medignition Inc. Medical Research Consultants, Verena Conzett-Strasse 9, 8004 Zurich, Switzerland
- University of Zurich, Rämistrasse 71, 8006 Zurich, Switzerland
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Pellacani G, Scope A, Gonzalez S, Guitera P, Farnetani F, Malvehy J, Witkowski A, De Carvalho N, Lupi O, Longo C. Reflectance confocal microscopy made easy: The 4 must-know key features for the diagnosis of melanoma and nonmelanoma skin cancers. J Am Acad Dermatol 2019; 81:520-6. [PMID: 30954581 DOI: 10.1016/j.jaad.2019.03.085] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 02/21/2019] [Accepted: 03/31/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM)-based skin cancer diagnosis requires proficiency. OBJECTIVE To identify a short list of key RCM features of skin cancers and test their diagnostic utility. METHODS We identified key RCM features through consensus among 6 experts using a modified Delphi method. To test the diagnostic utility of these RCM key features, 10 novice RCM readers evaluated a subset of 100 RCM cases from a retrospective data set of benign and malignant skin neoplasms. RESULTS From 56 features reported in the literature, the experts identified 18 RCM features as highly valuable for skin cancer diagnosis. On the basis of consensus definitions, these RCM features were further clustered into 2 melanoma-specific key features (atypical cells and dermoepidermal junction disarray), 1 basal cell carcinoma-specific key feature (basaloid cords/islands), and 1 squamous cell carcinoma-specific key feature (keratinocyte disarray). The novice reading study showed that the presence of at least 1 of the 4 key features was associated with an overall sensitivity for skin cancer diagnosis of 91%, with a sensitivity for melanoma of 93%, a sensitivity for basal cell carcinoma of 92%, and a sensitivity for squamous cell carcinoma of 67%, and an overall specificity of 57%. LIMITATIONS The consensus was based on only six RCM experts and the validation study was retrospective. CONCLUSIONS A consensus terminology short list identifying the 4 RCM key features for skin cancer diagnosis may facilitate dissemination of RCM to novice users.
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Deal SB, Alseidi AA, Chipman JG, Gauvin J, Meara M, Sidwell R, Stefanidis D, Schenarts PJ. Identifying Priorities for Faculty Development in General Surgery Using the Delphi Consensus Method. J Surg Educ 2018; 75:1504-1512. [PMID: 30115566 DOI: 10.1016/j.jsurg.2018.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 04/21/2018] [Accepted: 05/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Faculty teaching skills are critical for effective surgical education, however, which skills are most important to be taught in a faculty development program have not been well defined. The objective of this study was to identify priorities for faculty development as perceived by surgical educators. DESIGN We used a modified Delphi methodology to assess faculty perceptions of the value of faculty development activities, best learning modalities, as well as barriers and priorities for faculty development. An expert panel developed the initial survey and distributed it to the membership of the Association of Program Directors in Surgery. Responses were reviewed by the expert panel and condensed to 3 key questions that were redistributed to the survey participants for final ranking. PARTICIPANTS Seven experts reviewed responses to 8 questions by 110 participants. 35 participants determined the final ranking responses to 3 key questions. RESULTS The top three priorities for faculty development were: 1) Resident assessment/evaluation and feedback 2) Coaching for faculty teaching, and 3) Improving intraoperative teaching skills. The top 3 learning modalities were: 1) Coaching 2) Interactive small group sessions, and 3) Video-based education. Barriers to implementing faculty development included time limitations, clinical workload, faculty interest, and financial support. CONCLUSIONS Faculty development programs should focus on resident assessment methods, intraoperative and general faculty teaching skills using a combination of coaching, small group didactic and video-based education. Concerted efforts to recognize and financially reward the value of teaching and faculty development is required to support these endeavors and improve the learning environment for both residents and faculty.
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Affiliation(s)
- Shanley B Deal
- Virginia Mason Medical Center, General, Thoracic and Vascular Surgery, Seattle, Washington.
| | - Adnan A Alseidi
- Virginia Mason Medical Center, General, Thoracic and Vascular Surgery, Seattle, Washington
| | - Jeffrey G Chipman
- University of Minnesota, Department of Surgery, Minneapolis, Minnesota
| | - Jeffrey Gauvin
- Santa Barbara Cottage Hospital, Department of General Surgery, Santa Barbara, California
| | - Michael Meara
- Ohio State University Wexner College, Columbus, Ohio
| | | | | | - Paul J Schenarts
- University of Nebraska Medical Center, Department of Surgery, Omaha, Nebraska
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Scott AR, Sanderson CJ, Rush AJ, Alore EA, Naik AD, Berger DH, Suliburk JW. Constructing post-surgical discharge instructions through a Delphi consensus methodology. Patient Educ Couns 2018; 101:917-925. [PMID: 29254751 DOI: 10.1016/j.pec.2017.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 11/27/2017] [Accepted: 12/08/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patient education materials are a crucial part of physician-patient communication. We hypothesize that available discharge instructions are difficult to read and fail to address necessary topics. Our objective is to evaluate readability and content of surgical discharge instructions using thyroidectomy to develop standardized discharge materials. METHODS Thyroidectomy discharge materials were analyzed for readability and assessed for content. Fifteen endocrine surgeons participated in a modified Delphi consensus panel to select necessary topics. Using readability best practices, we created standardized discharge instructions which included all selected topics. RESULTS The panel evaluated 40 topics, selected 23, deemed 4 inappropriate, consolidated 5, and did not reach consensus on 8 topics after 4 rounds. The evaluated instructions' reading levels ranged from grade 6.5 to 13.2; none contained all consensus topics. CONCLUSION Current post surgical thyroidectomy discharge instructions are more difficult to read than recommended by literacy standards and omit consensus warning signs of major complications. Our easy-to-read discharge instructions cover pertinent topics and may enhance patient education. Delphi methodology is useful for developing post-surgical instructions. PRACTICE IMPLICATIONS Patient education materials need appropriate readability levels and content. We recommend the Delphi method to select content using consensus expert opinion whenever higher level data is lacking.
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Affiliation(s)
- Aaron R Scott
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, USA
| | - Cody J Sanderson
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
| | - Augustus J Rush
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
| | - Elizabeth A Alore
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA
| | - Aanand D Naik
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, USA; Alkek Department of Medicine, Baylor College of Medicine, Houston, USA
| | - David H Berger
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Health Services Research and Development Center of Innovation, Houston, USA
| | - James W Suliburk
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, USA.
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