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PubMed2000

What factors contribute to senior psychiatry residents' interest in geriatric psychiatry? a Delphi study.

OBJECTIVE: To generate hypotheses regarding factors that influence senior psychiatric residents, to consider treating geriatric patients in their future practices. METHOD: Using the Delphi technique, designed to generate ideas and consensus, we asked psychiatry residents at the University of Toronto who had completed, or were completing, their geriatric rotation about the factors they thought might influence residents in devoting some of their practice to geriatric patients. Residents then rated the degree of influence of these factors which had been synthesized into a questionnaire. RESULTS: Twenty-six items were rated according to their degree of influence. The most influential item was positive clinical experiences with seniors. This was followed closely by supervisor characteristics such as enthusiasm, role modeling, competence, and mentoring. Interest in and comfort with the medical psychiatric and neuropsychiatric nature of the field were also felt to be influential. CONCLUSIONS: The factors that influence senior psychiatry resident interest in the practice of geriatric psychiatry are primarily educational and result from exposure to the field under optimal educational circumstances (positive clinical experiences and excellent supervisors). The medical and neuropsychiatric nature of the field also likely exerts a unique influence and should be considered in stimulating interest in this population.

Adult↗

PubMed2002

Canadian geriatric psychiatrists: why do they do it? A Delphi study.

OBJECTIVE: To generate hypotheses regarding influential factors that have contributed to the practice of geriatric psychiatry by geriatric psychiatrists. METHOD: Using the Delphi technique, designed to generate ideas and consensus, a sample of members of the Canadian Academy of Geriatric Psychiatry (CAGP) was asked to provide ideas on what factors were influential in their decision to devote a significant part of their practice to geriatric patients. These items were then synthesized into a questionnaire and rated for their degree of influence by the same group of psychiatrists. RESULTS: A total of 41 items were rated according to their degree of influence. The most influential items were related to geriatric psychiatry residency training experiences that were perceived to be positive or adequate. Supervision characteristics and interest in the medical psychiatric nature of the field were also deemed influential. CONCLUSIONS: This study generates the hypothesis that the nature of the educational experience during psychiatry residency has a significant influence on the practice of geriatric psychiatry.

Adult↗

PubMed1990

Establishing pediatric cancer nursing research priorities: a Delphi study.

The purpose of this study was to have pediatric oncology nurses identify and rate topic priorities for clinical nursing research in the specialty and to determine if nurses in a pediatric cancer center identified different priorities than did nursing colleagues in other settings. The sample consisted of 44 nurses from a comprehensive pediatric cancer center and 43 nurses attending the 12th Annual APON Conference. A decision-making method, the classical Delphi technique, was used. Three rounds of soliciting opinions by questionnaires were completed, and data from each round were reviewed and categorized by a research team of six nurses until group consensus was achieved. The majority of priorities identified by both groups concerned nursing procedures, the pediatric oncology patient, and the specialty itself. The least number of priorities were in the categories of care delivery systems and families. One difference between the two groups was that professional issues dominated the cancer center sample, whereas psychosocial issues were more prominent in the APON sample.

Clinical Nursing Research↗

PubMed1994

The 1992 APON Delphi study to establish research priorities for pediatric oncology nursing. Association of Pediatric Oncology Nurses.

The Association of Pediatric Oncology Nurses (APON) recently sponsored a two-wave Delphi study to identify the most important research priorities for pediatric oncology nursing. Seventy-five research priorities were rated for importance by 227 APON members. The majority of these members were inpatient or ambulatory care nurses who had been in pediatric oncology more than 25 months. The top 10 research priorities were primarily about nursing procedures and psychosocial care needs of patients and families. The top priority was to "measure the quality of life and late effects of treatment in long-term survivors of childhood cancer." Study findings will be used to encourage researchers to conduct research on these priorities and to encourage funding organizations to support research related to these priorities.

Child↗

PubMed2006

Exploring consensus in practice with youth who are sexually abusive: findings from a Delphi study of practitioner views in the United Kingdom and the Republic of Ireland.

This article presents the findings of a study exploring current levels of consensus among practitioners in the United Kingdom (UK) and the Republic of Ireland (ROI) about good practice in relation to youth who are sexually abusive. A three-stage Delphi procedure was used to survey the views of 78 practitioners, experienced in this field, on a range of matters relating to preferred responses to this population. The exercise indicated high levels of agreement that youth who are sexually abusive should be seen as a group clinically distinct from adult sex offenders and that all of their developmental needs, and their problematic behavior, should be targeted in intervention. A strong level of consensus was found among respondents about the goals and content of ideal practice with this user group, although there was less consensus about the theoretical models that should underpin practice.

Adolescent↗

PubMed2006

Identification of pain indicators for infants at risk for neurological impairment: a Delphi consensus study.

BACKGROUND: A number of infant pain measures have been developed over the past 15 years incorporating behavioural and physiologic indicators; however, no reliable or valid measure exists for infants who are at risk for neurological impairments (NI). The objective of this study was to establish consensus about which behavioural, physiologic and contextual indicators best characterize pain in infants at high, moderate and low levels of risk for NI. METHODS: A 39- item, self-administered electronic survey that included infant physiologic, behavioral and contextual pain indicators was used in a two round Delphi consensus exercise. Fourteen pediatric pain experts were polled individually and anonymously on the importance and usefulness of the pain indicators for the 3 differing levels of risk for NI. RESULTS: The strength of agreement between expert raters was moderate in Round 1 and fair in Round 2. In general, pain indicators with the highest concordance for all three groups were brow bulge, facial grimace, eye squeeze, and inconsolability. Increased heart rate from baseline in the moderate and severe groups demonstrated high concordance. In the severe risk group, fluctuations in heart rate and reduced oxygen saturation were also highly rated. CONCLUSION: These data constitute the first step in contributing to the development and validation of a pain measure for infants at risk for NI. In future research, we will integrate these findings with the opinions of (a) health care providers about the importance and usefulness of infant pain indicators and (b) the pain responses of infants at mild, moderate and high risk for NI.

Attitude of Health Personnel↗

PubMed2006

Rationale and design of The Delphi Trial--I(RCT)2: international randomized clinical trial of rheumatoid craniocervical treatment, an intervention-prognostic trial comparing 'early' surgery with conservative treatment [ISRCTN65076841].

BACKGROUND: Rheumatoid arthritis is a chronic inflammatory disease, which affects 1% of the population. Hands and feet are most commonly involved followed by the cervical spine. The spinal column consists of vertebrae stabilized by an intricate network of ligaments. Especially in the upper cervical spine, rheumatoid arthritis can cause degeneration of these ligaments, causing laxity, instability and subluxation of the vertebral bodies. Subsequent compression of the spinal cord and medulla oblongata can cause severe neurological deficits and even sudden death. Once neurological deficits occur, progression is inevitable although the rapidity of progression is highly variable. The first signs and symptoms are pain at the back of the head caused by compression of the major occipital nerve, followed by loss of strength of arms and legs. The severity of the subluxation can be observed with radiological investigations (MRI, CT) with a high sensitivity. The authors have sent a Delphi Questionnaire about the current treatment strategies of craniocervical involvement by rheumatoid arthritis to an international forum of expert rheumatologists and surgeons. The timing of surgery in patients with radiographic instability without evidence of neurological deficit is an area of considerable controversy. If signs and symptoms of myelopathy are present there is little chance of recovery to normal levels after surgery. DESIGN: In this international multicenter randomized clinical trial, early surgical atlantoaxial fixation in patients with rheumatoid arthritis and radiological abnormalities without neurological deficits will be compared with prolonged conservative treatment. The main research question is whether early surgery can prevent radiological and neurological progression. A cost-effectivity analysis will be performed. 250 patients are needed to answer the research question. DISCUSSION: Early surgery could prevent serious neurological deficits, but may have peri-operative morbidity and loss of rotation of the head and neck. The objective of this study is to identify the best timing of surgery for patients at risk for the development of neurological signs and symptoms.

Adolescent↗

PubMed2004

Delphi survey of nursing research priorities.

PURPOSE/OBJECTIVES: To identify oncology nurses priorities for topics and issues to be addressed by developing a clinical nursing research program at a large comprehensive cancer center. DESIGN: Delphi survey, completed in two rounds. SETTING: A large comprehensive cancer center in the southern United States. SAMPLE: All 1,500 RNs employed at the cancer center. Round I asked nurses to identify topics they believed needed to be studied, and 642 nurses responded. In round II, 567 nurses ranked these priorities. METHODS: Surveys were distributed to all nurses who work in a variety of settings at the cancer center. Open-ended responses from round I were content analyzed, round II rankings of importance were described, and factor analysis was performed. MAIN RESEARCH VARIABLES: 120 topics were identified from a content analysis of research areas described by nurses in the cancer center. FINDINGS: 120 research priorities were identified. Factor analysis revealed three factors: clinical care, nurses and skills, and administrative aspects. CONCLUSIONS: The top five research priorities identified at the cancer center were, in rank order, acute and chronic pain, infection rates and control, job satisfaction, nurse-patient ratios and staffing, and nurse retention. This study's survey included items similar to those on the recently conducted Oncology Nursing Society research priority survey. Pain and issues with infection were among the top five priorities in both surveys. IMPLICATIONS FOR NURSING: Conducting a survey to identify nurses perceptions of research was useful in involving nurses in the conduct of research, and the results were useful guides to beginning a coordinated program of nursing research.

Adult↗

PubMed1985

Probable future funding priorities in maternal and child health: a modified Delphi National Survey.

Recent enactment of program consolidation block grants proposed by the Reagan administration has left many observers of public health services wondering about the impact of such a change on categorical programs in maternal and child health (MCH). This study first presents predictions about the future of 23 specific MCH services, derived from a modified Delphi Survey of MCH experts, and then examines the implications of these predictions for future public health.

Adult↗

PubMed2002

Rationing hospital services in Hong Kong: priority setting by clinicians using the Delphi method.

This article presents the results of a demonstration project of priority setting by clinicians in Hong Kong's public hospitals. Thirty-five chiefs-of-service of public hospitals in Hong Kong participated in a three-round Delphi exercise on identifying interventions that should be charged in public hospitals on the basis of questionable effectiveness and other reasons. A total of 246 interventions were identified in the first round, 126 of which received a positive score (indicating a high degree of consensus amongst the participants) at the end of the final round. The interventions that received higher scores tend to be preventive services, treatment of an elective nature, and procedures for sex-related conditions. As the number of interventions with positive scores in the final round are relatively small, the amount of money to be recovered from charging these interventions is not likely to be substantial. Such results suggest that rationing by itself cannot be a solution to the problems of healthcare financing in Hong Kong.

Cost-Benefit Analysis↗

PubMed2006

Use of the Delphi sorting technique to establish a core sexual history.

The objective of this study was to develop a core sexual history to be used as a supplementary tool to assist sexual health physicians assess new clients attending a sexual health centre. Eight experts in sexual health medicine employed the Delphi technique and sexual history items from a previous study to generate a core sexual history. The core history contained 15 questions for men and women, with three additional specific questions for men and five for women. The current state of the clients' sexual health was explored (rather than a client's history of sexual behaviour) and three months (compared with 12 months and lifetime) came out strongly as the preferred timeframe for asking clients' behavioural questions. This core history may be useful in many clinics in Australia and New Zealand as its development was based on expert clinical experience of respected authorities within the field of sexual health medicine.

Delphi Technique↗

PubMed2003

Identifying nurse and health visitor priorities in a PCT using the Delphi technique.

A three-stage Delphi investigation was undertaken over a 4-month period in a primary care trust to identify the perceived clinical needs of nurses. Practice nurses, district nurses, health visitors and community hospital nurses all participated. In round 1, there were 28 replies from these groups of nurses, in round 2 there were 31, and in round 3 there were 25 replies. In round 1, 77 issues (excluding duplications) were identified. These were separated into three themes according to the most appropriate method for addressing the issue: education (29 issues), research (16 issues) and management (32). In round 2, the issues were redistributed in the three areas and staff were asked to choose the ten most important issues from education, research and management. Finally, in round 3 the ten issues in education, research and management were prioritized in terms of the "most pressing". The most pressing education need was recognizing accountability; the most pressing research need was caseload/dependency scoring--matching staff levels to workload, and the most pressing management need was risk management, e.g. staff safety. The results have identified locally that there is a gap between the modernization agenda and what nursing staff consider to be the issues that need addressing locally. If measures are not put in place to address these local issues, there is a danger that nurses will not take a full and active role in the modernization of the NHS.

Community Health Nursing↗

PubMed1994

Preventive therapy for contacts of multidrug-resistant tuberculosis. A Delphi survey.

OBJECTIVE: Several outbreaks of multidrug resistant tuberculosis (MDR-TB) have recently occurred in which healthcare workers and others have become infected. Given the lack of clinical data to guide preventive therapy for such contacts, a Delphi survey of a panel of 31 TB therapy experts was undertaken to identify a consensus regimen. DESIGN: An initial questionnaire presented three scenarios describing persons with significant exposure to MDR-TB and with new tuberculin skin test reactions > 15 mm (except one anergic patient) without evidence of disease. Panelists were asked to suggest possible preventive therapy regimens. METHODS: During a second round survey, the panel members were asked to review the suggested regimens provided for each scenario and to rank them from one to nine as extremely inappropriate to extremely appropriate. Results of this second survey were tabulated and shared with the members of the panel who were then asked to rerank each regimen in light of the previous cumulative panel responses. RESULTS: No specific regimen achieved initial positive consensus by predefined criteria. In two of the three scenarios the no treatment option, however, was deemed clearly inappropriate. The data were also analyzed by what percentage of respondents who ranked a regimen as at all appropriate (ie, six or more on the nine point scale). For scenarios involving a nurse, an HIV-positive tuberculin reactor, and a patient who was anergic HIV-positive, treatment with pyrazinamide 1,500 mg daily with ciprofloxacin 750 mg twice a day for 4 months received a somewhat appropriate rating from more than 50 percent of respondents. CONCLUSIONS: The management of persons exposed to and infected by patients with MDR-TB has become a serious problem in the context of MDR-TB outbreaks. This panel of experts agreed that some form of preventive therapy was warranted; however, they were not able to reach defined consensus on what regimen should be used, although a regimen of pyrazinamide 1,500 mg daily with ciprofloxacin 750 mg twice a day for 4 months was considered somewhat appropriate. Clinical data on the efficacy of alternative preventive therapy regimens for such contacts are urgently needed.

Adult↗

PubMed2005

Identifying and establishing consensus on the most important safety features of GP computer systems: e-Delphi study.

Our objective was to identify and establish consensus on the most important safety features of GP computer systems, with a particular emphasis on medicines management. We used a two-round electronic Delphi survey, completed by a 21-member multidisciplinary expert panel, all from the UK. The main outcome measure was percentage agreement of the panel members on the importance of the presence of a number of different safety features (presented as clinical statements) on GP computer systems. We found 90% or greater agreement on the importance of 32 (58%) statements. These statements, indicating issues considered to be of considerable importance (rated as important or very important), related to: computerised alerts; the need to avoid spurious alerts; making it difficult to override critical alerts; having audit trails of such overrides; support for safe repeat prescribing; effective computer-user interface; importance of call and recall management; and the need to be able to run safety reports. The high level of agreement among the expert panel members indicates clear themes and priorities that need to be addressed in any further improvement of safety features in primary care computing systems.

Decision Support Systems, Clinical↗

PubMed1999

[Delphi technique: identifying the generic competence required for doctors and nurses working in a primary health care].

This study aims to identify the generic competence required of doctors and nurses working in a primary health care. It was based on a series of 3 round of the Delphi technique which identified 8 generic competencies: ability to communicate, ability to be community oriented, ability in teamwork, management skills, educational skills, ability to problem solving, professional skills, ability to make-decision. Only the competence management skills there was not consensus by doctors. They disagree that this competence is required by them working in primary health care.

Attitude of Health Personnel↗

PubMed2003

Using the Delphi technique to select items for use in assessing patients' satisfaction with dysphagia services.

Items for potential use in a survey for the assessment of patients' satisfaction with dysphagia services was developed using the Delphi technique. A panel of speech-language pathologists was provided with 105 potential survey items. They were asked to rate the items with respect to perceived importance in assessing patients' satisfaction. 45 items were rated as "very important." Items concerning the issues of information giving and the conduct and characteristics of the clinician were most common among the selected items. No items focusing on accessibility of services or quality of the treatment environment were in the "very important" group.

Choice Behavior↗

PubMedDate not supplied

A Delphi study to determine defining characteristics of interdependence and dysfunctional independence as potential nursing diagnoses.

Nurses deal with human behavior and are often responsible, not only for their own interpersonal behavior but also for assessment, analysis, and interventions relative to the behavior of clients. This exploratory study was designed to elicit responses from certified psychiatric-mental health clinical nurse specialists relative to the defining characteristics of interdependence and dysfunctional independence. A Delphi methodology was used to obtain a total of 10 defining characteristics for interdependence and 13 defining characteristics for dysfunctional independence. Three operational definitions were obtained for each of the characteristics from the ratings of nurses who contributed information based on the behaviors of their own clients. These characteristics are the basis for future studies relating to dependence, independence, and interdependence.

Delphi Technique↗

PubMed1998

Delphi-panel analysis of appropriateness of high-dose chemotherapy and blood cell or bone marrow autotransplants in diffuse large-cell lymphoma.

Although high-dose chemotherapy and a blood cell or bone marrow autotransplant are commonly used to treat people with diffuse large-cell lymphoma, there is controversy whether this is better than conventional-dose chemotherapy. Subject-selection and time-to-treatment biases preclude comparison of data from uncontrolled trials and there are few date from randomized trials. We used a Delphi-panel group judgment process to determine appropriateness of high-dose chemotherapy and a blood cell or bone marrow transplant. Results were compared to those of randomized trials. Nine lymphoma experts from diverse geographic sites and practice settings were panelists. Boolean MEDLINE searches of lymphoma and chemotherapy and an autotransplant formed the dataset. Panelists were asked to rate appropriateness of high-dose chemotherapy and an autotransplant compared to conventional-dose chemotherapy. Clinical variables were permuted to define 80 clinical settings rated by the panelists on a 9-point ordinal scale. Results were used to determine an appropriateness index reflecting the mean and distribution of ratings. The relationship of appropriateness indices to permuted clinical variables was considered by analysis of variance and recursive partitioning. In people with initial diffuse large-cell lymphoma, autotransplants were never rated appropriate. They were rated uncertain in all settings except in people never receiving chemotherapy and in those with a complete response to chemotherapy and an international prognostic index < 3, where they were rated inappropriate. In people with recurrent lymphoma, autotransplants were rated appropriate in those with a complete or partial response to chemotherapy, uncertain in those with a less than partial response and in those not receiving re-induction chemotherapy and inappropriate in people with CNS lymphoma. These conclusions agree with results of randomized trials.

Aged↗