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PubMed2005

Development of ovarian cancer surgery quality indicators using a modified Delphi approach.

OBJECTIVE: Little performance measurement has been undertaken in the area of oncology, particularly for surgery which is a pivotal event in the continuum of cancer care. This work was conducted to develop indicators of quality ovarian cancer surgery using a modified three-step Delphi approach. METHODS: A multidisciplinary panel, comprised of surgical and methodologic co-chairs, nine surgeons, one medical oncologist, one radiation oncologist, a nurse, and a pathologist, reviewed potential indicators extracted from the medical literature through two consecutive rounds of rating followed by consensus discussion. The panel then prioritized the indicators selected in the previous two rounds. RESULTS: Of 33 possible indicators that emerged from 41 selected articles, 14 were prioritized by the panel as benchmarks for assessing the quality of surgical care. The 14 indicators represent three levels of measurement (provincial/regional, hospital, individual provider) across several phases of care (diagnosis, surgery, pathology, and adjuvant therapy), as well as broad measures of access and outcomes. Some of the indicators selected by the panel were also recommended as standards of care by national initiatives in other countries. CONCLUSIONS: A systematic evidence- and consensus-based approach was used to develop quality indicators of ovarian cancer care, with a focus on pre-, peri-, and postoperative care as well as outcomes, that are applicable in any jurisdiction.

Consensus↗
PubMed1997

"How do you remember you ate...?": a Delphi technique study to identify retrieval categories from fourth-grade children.

OBJECTIVE: To develop and validate a consensus set of retrieval categories for how children remember what they have eaten, and to relate retrieval categories to accuracy of reporting items eaten during school lunch. DESIGN: A Delphi technique study was conducted using 10 psychologists. The subject matter consisted of responses transcribed from interviews conducted with 89 randomly selected fourth graders within 90 minutes of eating. Retrieval categories were evaluated for accuracy by comparing students' self-reported lunch intake with observation. STATISTICAL ANALYSES: For round 1, a centroid hierarchical cluster analysis was used to identify common sets of rating pairs to propose categories for reaching consensus. For rounds 2 and 3, percent of agreement was calculated. Accuracy was tabulated across meal items and student use by retrieval category. RESULTS: After round 3, we found that 23 "near-consensus" categories were used by at least eight raters. Six categories were used 60% of the time, 4 were used 20% of the time, and 5 were used 15% of the time. Less frequently used categories were combined with similar, more frequently used categories for a total of 16 categories. Students used a large variety of retrieval categories when accurately reporting consumption. Of the 16 categories, 12 were used similarly by both accurate and inaccurate students. Where there were differences in accuracy by retrieval category, the more accurate students used "taste/smell/texture" and "visual" in deference to "order items consumed" and "oral cue still present." APPLICATIONS: These categories provide insight into the broad range of retrieval categories that children use and provide direction for researchers to design and study specific cues to enhance the accuracy of children's self-reports of diet.

Child↗
PubMed2005

Global prevalence of dementia: a Delphi consensus study.

BACKGROUND: 100 years after the first description, Alzheimer's disease is one of the most disabling and burdensome health conditions worldwide. We used the Delphi consensus method to determine dementia prevalence for each world region. METHODS: 12 international experts were provided with a systematic review of published studies on dementia and were asked to provide prevalence estimates for every WHO world region, for men and women combined, in 5-year age bands from 60 to 84 years, and for those aged 85 years and older. UN population estimates and projections were used to estimate numbers of people with dementia in 2001, 2020, and 2040. We estimated incidence rates from prevalence, remission, and mortality. FINDINGS: Evidence from well-planned, representative epidemiological surveys is scarce in many regions. We estimate that 24.3 million people have dementia today, with 4.6 million new cases of dementia every year (one new case every 7 seconds). The number of people affected will double every 20 years to 81.1 million by 2040. Most people with dementia live in developing countries (60% in 2001, rising to 71% by 2040). Rates of increase are not uniform; numbers in developed countries are forecast to increase by 100% between 2001 and 2040, but by more than 300% in India, China, and their south Asian and western Pacific neighbours. INTERPRETATION: We believe that the detailed estimates in this paper constitute the best currently available basis for policymaking, planning, and allocation of health and welfare resources.

Aged↗
PubMed1998

Delphi-panel analysis of appropriateness of high-dose therapy and bone marrow transplants in adults with acute lymphoblastic leukemia in first remission.

BACKGROUND: There is controversy over whether high-dose therapy and a bone marrow transplant is better than conventional-dose chemotherapy in adults with acute lymphoblastic leukemia (ALL) in first remission. This decision may depend on which type of donor is available: an HLA-identical sibling, an alternative donor transplant (HLA-matched related or unrelated people other than HLA-identical siblings), or autotransplant. OBJECTIVE: To determine the appropriate use of high-dose therapy and bone marrow transplants in ALL in first remission. Develop a treatment algorithm. PANELISTS: Nine leukemia experts from diverse geographic sites and practice settings. EVIDENCE: Boolean MEDLINE searches of acute lymphoblastic leukemia and chemotherapy and/or transplants. CONSENSUS PROCESS: We used a modified Delphi-panel group judgment process. Age, white blood cell (WBC) count, cytogenetics and immune type were permuted to define 48 clinical settings. Each panelist rated appropriateness of high-dose therapy and a transplant versus conventional-dose chemotherapy on a 9-point ordinal scale (1, most inappropriate; 9, most appropriate) considering three types of donors: (1) HLA-identical siblings; (2) alternative donors; and (3) autotransplants. An appropriateness index was developed based on median rating and amount of disagreement. Relationship of appropriateness indices to the permuted clinical variables was considered by analysis of variance and recursive partitioning. Preference between donor types was analyzed by comparing mean appropriateness indices of comparable settings and a treatment algorithm was developed. CONCLUSIONS: In people with an HLA-identical sibling donor, transplants were rated appropriate in those with unfavorable cytogenetics and uncertain in all other settings. An HLA-identical sibling donor was always preferred to an alternative donor or autotransplant. In people without an HLA-identical sibling but with an alternative donor, this type of transplant was rated appropriate in those with unfavorable cytogenetics. However, an autotransplant was preferred over an alternative donor transplant in all other settings where a transplant was rated uncertain. In people without an HLA-identical sibling or alternative donor, autotransplants were rated uncertain in all settings except in those with not unfavorable cytogenetics, WBC < 100 x 10(9) l(-1) and T- or pre-B-cell type where they were rated inappropriate.

Adolescent↗
PubMed1999

Delphi-panel analysis of appropriateness of high-dose therapy and bone marrow transplants in chronic myelogenous leukemia in chronic phase.

BACKGROUND: It is uncertain which people with chronic myelogenous leukemia (CML) in chronic phase should receive conventional treatment (interferon and/or chemotherapy) versus high-dose therapy and a bone marrow transplant. There are no randomized trials comparing these approaches and analyses of data from non-randomized studies are complex, contradictory without sufficient detail to allow subject-level treatment decisions. OBJECTIVE: Determine appropriateness of high-dose therapy and bone marrow transplants in persons with CML in chronic phase with specific features. Develop a treatment algorithm. PANELISTS: nine leukemia experts from diverse geographic sites and practice settings. EVIDENCE: Boolean MEDLINE searches of chronic myelogenous leukemia and chemotherapy and/or transplants. CONSENSUS PROCESS: We used a modified Delphi-panel group judgment process. Age, prognostic score, disease duration, and type of conventional therapy and response were permuted to define 90 clinical settings. Each panelist rated appropriateness of high-dose therapy and a transplant versus conventional therapy on a 9-point ordinal scale (1, most inappropriate, 9, most appropriate) considering three types of donors: (1) HLA-identical siblings; (2) alternative donors (HLA-matched related or unrelated people other than an HLA-identical sibling); and (3) autotransplants. An appropriateness index was developed based on median rating and amount of disagreement. Relationship of appropriateness indices to permuted clinical variables was considered by analysis of variance and recursive partitioning. Preference between donor types was analyzed by comparing mean appropriateness indices of similar settings and a treatment algorithm developed. CONCLUSIONS: In people with CML in chronic phase and an HLA-identical sibling donor and in those with an alternative donor (but no HLA-identical sibling), a transplant was rated appropriate in those with a < or = partial cytogenetic response to interferon and uncertain or inappropriate in all other settings. Autotransplants were rated uncertain or inappropriate in all settings. Most of the variance in appropriateness ratings between different clinical settings was accounted for by response to interferon: complete versus < or = partial response. An HLA-identical sibling donor, when available, was always preferred to an alternative donor or autotransplant. In people without an HLA-identical sibling, an alternative donor was favored over an autotransplant at higher appropriateness indices and the converse at lower appropriateness indices.

Adolescent↗
PubMed2002

[Factors that affect the prescription of benzodiazepines and actions to improve their use: a Delphi study of primary care doctors].

OBJECTIVES: To identify the factors that affect the prescription of benzodiazepines and similar drugs and the actions that can be taken to reduce their prescription.Design. Consensus method. Delphi technique. SETTING: Four primary care areas in Asturias. Participants. 39 doctors from primary care teams agreed voluntarily to take part in the study, and 32 completed the study. They belonged to 20 health centres. METHOD: They were sent by mail three questionnaires one after the other. The second and third questionnaires were worked out on the basis of the analysis of the information from the replies to the preceding questionnaire. Those who did not send in a reply were reminded by phone. RESULTS: The 5 most influential factors in benzodiazepine prescription were agreed: reduction in the threshold of tolerance of emotional discomfort; increase of the prevalence of pathologies; lack of time in the consulting-room; social and economic conditioning factors; properties of the benzodiazepine family. The 5 most important actions that could reduce prescription of these drugs were agreed: general health education; reduction in case loads; making doctors more conscious of prescribing correctly; strengthening the social support network; doctors fomenting use of effective alternative treatments. CONCLUSIONS: The prescription of benzodiazepines and their analogues is a multi-factorial action with social and psychological roots. The action most voted on to reduce their prescription was general health education.

Adult↗
PubMedDate not supplied

[Factors related with the family physician work's effectiveness and efficiency: a Delphi study in the province of Alicante].

OBJECTIVE: [corrected] To detect factors that more directly restrict effectiveness and efficiency of the family physician's work in the health center. Made proposals for change which will contribute to increase this efficiency and effectiveness. METHOD AND PARTICIPANTS: Consensus method by Delphi technique. Thirty experts, from different settings of the National Health System at the province of Alicante, were requested for participate in this study: 15 health center co-ordinators, 7 directors of district primary care services and 8 chairmen of internal medicine hospital services. Twenty-four experts maintained their participation in all phases of the project, that means 80% of participation. RESULTS: The factors identified with a larger consensus (supported by at least 83% of the participants) were: difficulties in the relationship and communication between primary and secondary care levels; lack of incentives or motivation in manpower policy; vertical health programs not realistic and not well co-ordinated; a society each time more medicalized; deficiencies in the makeup of the general practitioners patients listś; political influences in management; excessive bureaucracy on consultations; deficiencies in continuing medical education; lack of prefixed aims and previously set criteria of standards; different training and involvement levels among professionals; limited access to diagnostic tests and a limited health education level among the population. The solutions proposed with a larger consensus (supported by at least 92% of the participants) were: to improve and increase communication between primary and secondary care levels; to makeup the patient list of every general practitioner and to adjust the staff of the health centers according to sociodemographic population variables and professional duties (practice, management, teaching, research,.); to design programs of continuing medical education with obligatory attendance for professionals; to incentive and to motivate professionals; to professionalize and depoliticize management; reduction of unnecessary bureaucracy on consultations by computing some tasks; to establish guidelines in practice; to introduce the Individual Health Card; self-management in health centers; to increase the primary care capacity in solving health problems; freedom of choice of the specialist consultant by the general practitioner; to release the access for the general practitioners to certain diagnostic tests; to improve certain social services and to increase the time that health center co-ordinators devote to managerial tasks. CONCLUSIONS: Most of the problems identified and the solutions proposed were linked either with organisational or managerial factors or with human resources management. The essences of the new primary care model are not questioned. Other Spanish publications which investigated the opinion of health professional as well, have identified similar problems and proposed similar solutions. This coincidence and the high degree of agreement reached by the participants in designing problems and in proposing solutions, may indicate that factors that most restrict the effectiveness and the efficiency of the family physicians work in health centers are clearly explained and it is necessary to deal with the solutions resolutely.

Delphi Technique↗
PubMed2003

Why do student nurses leave? Suggestions from a Delphi study.

The high dropout rate of nursing students is a major concern. However, there is little research available about the reasons why students leave. Universities collect some information from 'exit' interviews but, due to ethical sensitivities, it is not made available for research analysis. The purpose of this study was to establish a consensus view of the reasons why student nurses leave their pre-registration education programme. The study was undertaken in two phases. Initially, an exploratory phase using focus groups and one-to-one interviews was used to gather multi-professional views about the reasons why students leave. In the second phase a questionnaire was developed from the themes arising from the data analysis in phase one. The questionnaire was administered to an expert panel of student nurses in the form of a three-round Delphi Study. The consensus level was set at 75%. It is important to clarify that, for reasons stated above, the views expressed in this paper are those of current students about others who had left the programme. From this study, it is apparent that, with the exception of academic failure, there was no single contributing factor that was thought to make students leave. However, there were a number of important issues identified as factors that may result in student nurses leaving. These include communication and operational factors between the university and clinical areas, feelings of not being valued, unmet expectations, and stress. These issues were of concern to students and appeared to have a cumulative effect that led them to question whether they should continue their education programme. On the basis of these findings, several recommendations are made to improve the student nurse experience.

Attitude of Health Personnel↗
PubMed2002

Current trends in restorative dentistry in the UK: a Delphi approach.

OBJECTIVES: The purpose of the study was to obtain insight into current trends in restorative dentistry in the UK by means of a Delphi technique. METHODS: A panel of nine experts was convened to define areas where changes were thought to occur in contemporary restorative dentistry. The defining statements obtained were circulated amongst the Panel to reach consensus on the content and wording, and then formatted into a questionnaire which was distributed amongst 407 clinical academic staff in Restorative Dentistry in UK dental schools. Good agreement with a statement was defined as a score of > or =70%, statements that received such scores were taken as indicating possible trends. RESULTS: The Expert Panel reached consensus on the wording of 21 defining statements, which were formatted into a 23-item questionnaire. The questionnaire achieved a useable response rate of 70%, and the academic respondents reached good agreement on 15 (65%) of the statements. CONCLUSIONS: The 15 statements which received scores of 70% or greater were considered to be possible indicators of trends in aspects of the clinical practice of restorative dentistry in the UK.

Consensus↗
PubMed2002

Planning for major burns incidents by implementing an accelerated Delphi technique.

OBJECTIVE: This paper presents a series of practical guides for use in planning and responding to a major incident involving large numbers of burns casualties. METHOD: The guidance is based on the findings of an expert Delphi study published as an accompanying paper. RESULTS: The guidance covers preparation and all aspects of the response from prehospital care and hospital care to resolution recovery. Emphasis is placed on the management of the secondary/tertiary care interface as this is the point at which significant difficulties may arise. The importance of local interpretation of guidelines is emphasised. CONCLUSION: This practical guide for emergency planners will improve the preparation and response to a major incident involving burns.

Burn Units↗
PubMed2002

Planning for major burns incidents in the UK using an accelerated Delphi technique.

BACKGROUND: Major incidents require careful planning if they are to be managed well. Although a generic plan to deal with all major incidents is essential, a number of "special incidents" deserve special consideration because of their potential to impact on specialist services. This paper examines the problems of managing a major incident involving large numbers of burns casualties. METHOD: A three-round Delphi study was conducted using a multidisciplinary panel of experts from prehospital care, emergency medicine, burns surgery, intensive care and emergency planning. RESULTS: A series of consensus statements on the management of burns incidents are presented. An accompanying paper describes the practical implementation of this guidance. CONCLUSION: Specific consideration should be given to the problems of managing a major incident involving burns casualties.

Burn Units↗
PubMed1996

Research priorities for the nursing of children and their families: a Delphi study.

To most effectively address the issues influencing the health care of children while using limited resources, some priorities for research must be established. To date, there has not been a focused effort to systematically identify and describe critical areas of inquiry needed to provide quality pediatric care in the next decade. The purpose of this study was to systematically survey a cross-section of pediatric nurse experts in a variety of settings across the nation. A three-round Delphi technique was used. In the first round, participants responded to three open-ended questions asking them to identify (a) threats affecting children's health, (b) major societal factors that would positively influence children's health in the future, and (c) important research questions in the field. In rounds two and three, respondents rated the importance of those topics. Of two hundred fifty respondents, 75% or more reached consensus on the importance of 35 researchable topics across five categories of research in nursing of children and their families. The focus was on patient-centered research.

Child↗
PubMed1997

Determining research priorities in pediatric nursing: a Delphi study.

A two-round Delphi study was performed in Pediatric Nursing at a large midwestern teaching hospital. The purpose of the study was to identify research priorities for the Pediatric Research committee for future projects. The initial survey was sent to all pediatric nursing staff. Sixty-two staff (19%) responded to the first round. Forty-five separate research topics/themes of interest were identified. The second round survey was sent to the 62 staff who responded to Round 1. Forty-eight staff (76%) responded. Participants were given a list of the 45 topics identified in Round 1, and asked to identify their top five priorities. Results were analyzed by unit and by Division. The identified priorities for the Division are described here.

Clinical Nursing Research↗
PubMed1998

Needs of the critically ill child: a review of the literature and report of a modified Delphi study.

There has been a wealth of guidance from both policy-makers (Department of Health, (DoH) 1991, DoH 1997a, DoH 1997b) and other interested parties (Audit Commission 1993, British Paediatric Association 1993, Paediatric Intensive Care Society 1992) regarding how and where care should be provided for critically ill children. Latest recommendations indicate that designated general ICUs will continue to provide care for children requiring life support and that all general ICUs will need to initiate such care (DoH 1997a). The literature relating to how nurses identify and act on the needs of the critically ill child has been anecdotal in nature (Green 1991, Purcell 1993), whilst published studies focus on comparing outcomes (Pollock et al 1991) and addressing the needs of parents (Farrell & Frost 1992, Kasper & Nyamathi 1988). This paper explores the literature regarding the needs of the critically ill child, incorporating the role of parents and previous studies exploring needs. The findings of a modified Delphi study exploring the needs of the critically ill child are also outlined.

Child↗
PubMed2002

Modified Delphi survey for decision analysis for prophylaxis of post-radiation osteonecrosis.

OBJECTIVES: to augment epidemiological data from the literature, assist Bayesian perspectives and a decision analytic framework for the minimization of post-radiation osteonecrosis (PRON; osteoradionecrosis) and its impacts in irradiated head and neck cancer patients. MATERIALS AND METHODS: a modified Delphi process survey of 15 international clinical experts was used to identify and assess outcome data and factors related to PRON risk, extraction, and factor suitability for formal decision analysis. Clinimetric pain and function outcome scales were created and assessed for relevance to quality of life. RESULTS AND CONCLUSIONS: expert opinion qualitative assessments were generally adequate and consistent between open- and close-ended items, but many quantitative (e.g. PRON risk rate) estimates were not. A research agenda advocated to validate the epidemiological database for minimization of PRON and decision analysis includes: adoption of a uniform definition of PRON, and ICD code for non-experimental databases; more detailed, consistent data reporting in articles; and quality of life studies.

Decision Support Techniques↗
PubMed2001

Indicators of organizational readiness for clinical information technology/systems innovation: a Delphi study.

The study presented in this article represents the second phase in a multi-phased research program focused on health care organization readiness for clinical information technology/system (IT/S) innovation. The overall purposes of this exploratory study were to: (1) validate the seven IT/S innovation readiness sub-dimensions of a heuristic organizational information technology/systems innovation model (OITIM) developed in phase one of the research program, and (2) identify indicators to assess the validated sub-dimensions. The study was conducted with an expert panel using a two-round modified Delphi technique. In Round #1, panelists supported retention of the OITIMs' seven theoretical IT/S innovation readiness sub-dimensions with an interrater agreement level range of 82-100%. Their sub-dimension importance ratings ranged from 3.27 to 3.72 (1=not important to 4=critically important) with the resources sub-dimension receiving the highest rating of 3.72. Panelists recommended that two sub-dimensions, 'Staffing and Skills' and 'Operations', be renamed to 'End-Users' and 'Management Structures', respectively, and that one sub-dimension, 'Administrative Support' be added. In Round #2, panelists identified a total of 316 indicators to assess the eight sub-dimensions. A two-step thematic analysis process was done with these indicators to reduce duplication and overlap. In Step 1, the investigator created ten preliminary theme categories per sub-dimension. In Step 2, a coding team categorized 279 (88%) of the 316 indicators into preliminary sub-dimension themes to create an organizational IT/S innovation readiness assessment taxonomy. This preliminary taxonomy was used to develop an organizational information technology/systems innovation readiness scale that is currently being pilot tested in phase three of the research program.

Delphi Technique↗
PubMedDate not supplied

A model of exemplary midwifery practice: results of a Delphi study.

What is unique and exemplary about the midwifery model of care? Does exemplary midwifery care result in improved outcomes for the recipient(s) of that care? These are the questions that the profession of midwifery grapples with today within the context of a changing health care arena. Exemplary midwives, and women who had received their care, came to consensus about these issues in a Delphi study. A model of exemplary midwifery care is presented based on the identification of essential elements aligned within three dimensions: therapeutics, caring, and the profession of midwifery. Supporting the normalcy of pregnancy and birth, vigilance and attention to detail, and respecting the uniqueness of the woman, were several of many processes of care identified. The critical difference that emerged was the art of doing "nothing" well. By ensuring that normalcy continued through vigilant and attentive care, the midwives were content to foster the normal processes of labor and birth, intervening and using technology only when the individual situation required. Health care, whether in the gynecologic setting or during pregnancy, was geared to help the woman achieve a level of control of the process and outcome. The ultimate outcomes were optimal health in the given situation, and the experience of health care that is both respectful and empowering. The model provides structure for future research on the unique aspects of midwifery care to support its correlation with excellent outcomes and value in health care economics.

Delphi Technique↗