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The development of the Delphi technique, as a survey method of research, and examples of its use are described. The technique's key characteristics, anonymity, use of experts and controlled feedback, are examined. The method's usefulness in structuring group communication for the discussion of specific issues and as an aid to policy making is discussed in the light of the technique's perceived drawbacks and limitations.
Decision making is an important component of the role of nursing administrators; yet, committee meetings for decision making have limitations. The author describes the characteristics of the Delphi technique and compares the Delphi process to the face-to-face discussions occurring in committee meetings. Specific information about the use of the Delphi technique as well as examples of its use are presented.
The aim of this project was the development of evidence- and consensus-based clinical practice guidelines for lower-limb prosthesis prescription for achieving transparency and consensus among clinicians, manufacturers, and insurance companies. This article describes a modified Delphi Technique, which is based on different methods of collecting evidence, and its role in the development of national clinical guidelines for prosthesis prescription. We used a multimethod approach to develop guidelines for the clinical practice of prosthesis prescription for lower-limb amputees. The Delphi Technique was central in the process, and the panel was made up of experts from three key disciplines on a national level. Our approach involved various methods: a systematic review, a survey of national clinical practice on prosthesis prescription, and interviews with experts. These activities resulted in 45 postulates about prosthesis prescription. The views of the national expert panel were then presented at a consensus development conference. The participants in the Delphi Technique sessions reached a consensus on 37 of the postulates on prosthesis prescription for lower-limb amputees. The postulates were categorized according to amputation level and partitioned into different domains. The total process resulted in the development of draft clinical guidelines comprising guidance for prescribing prostheses for the lower limb. The scope and applicability of these guidelines will have to be measured and evaluated in future work.
A useful addition to any researcher's methodological repertoire is the Delphi technique. This technique facilitates group communication to develop research items that are contextually specific. For the first time this method was utilised to develop a self-reporting triage survey tool that would explore current practice and begin to explore triage decision-making. The triage role is complex, often crisis-driven and demands speed and accuracy on the part of the triage nurse. This role involves patient assessment, initiating investigations, patient referral and management. The study used the Delphi technique to produce a triage survey tool that would assist in broadening our understanding of current triage practice within Australia.
Health service research is best served through the collaboration of researchers and practitioners. This study utilizes a multi-method approach in developing a learning resource in clinical risk management in mental health. Phase one of the project is reported here; using a Delphi Technique to build the learning resource. Using the Delphi enabled a group of 'experts' to explore a complex issue and move towards consensus. In addition, the Delphi technique enabled the researchers to repeatedly access a dispersed group of 'experts' in an economic way. A three round Delphi was undertaken and results were analyzed (medians, means, standard deviations and thematic content analysis) to facilitate consensus building from a range of perspectives. The analytical model chosen is discussed in the context of prior use of the Delphi as a consensus building technique. The researchers conclude that analysis using medians and means to measure the level of agreement/disagreement with the content and structure of the learning pack, standard deviations to measure 'tightening' of the group view and Thematic Content Analysis of qualitative data was an effective approach. They argue that in the education and health fields, group views are particularly important and that this is a central tenet of the Delphi.
The need to develop practice-related documents in an accurate, efficient, and economical manner is the responsibility of the Board of Directors of the Society of Gastroenterology Nurses and Associates (SGNA). When the results of large, randomized, controlled, clinical trials are available, documents can be based on the information published in scientific literature. GI nursing, however, is in a novice phase regarding controlled research trials; thus, other methods of obtaining reliable information are required. The Delphi technique was selected to obtain the consensus of experts. The Delphi technique enables a free and open exchange of ideas while respecting the economics of a deficit budget. This article describes the Delphi process and the manner in which it was used to prepare the SGNA position statement, "Responsibilities of the Gastroenterology Registered Nurse related to Conscious Sedation."
AIM: The aim of this paper was to provide insight into the Delphi technique by outlining our personal experiences during its use over a 10-year period in a variety of applications. BACKGROUND: As a means of achieving consensus on an issue, the Delphi research method has become widely used in healthcare research generally and nursing research in particular. The literature on this technique is expanding, mainly addressing what it is and how it should be used. However, there is still much confusion and uncertainty surrounding it, particularly about issues such as modifications, consensus, anonymity, definition of experts, how 'experts' are selected and how non-respondents are pursued. DISCUSSION: This issues that arise when planning and carrying out a Delphi study include the definition of consensus; the issue of anonymity vs. quasi-anonymity for participants; how to estimate the time needed to collect the data, analyse each 'round', feed back results to participants, and gain their responses to this feedback; how to define and select the 'experts' who will be asked to participate; how to enhance response rates; and how many 'rounds' to conduct. CONCLUSION: Many challenges and questions are raised when using the Delphi technique, but there is no doubt that it is an important method for achieving consensus on issues where none previously existed. Researchers need to adapt the method to suit their particular study.
The objective of this study was to develop a European competence-based colposcopy core curriculum using the Delphi technique. Thirty expert colposcopists from 21 countries participated. A four-round iterative questionnaire was used. Competencies were rated using a five-point Likert scale. Competences rated as 4 or more by at least 90% of the respondents were regarded as necessary for the core curriculum. Eighteen participants took part in all four rounds, and 27 were active in each of the last three rounds. Fifty-one core competences were selected from a list of 76 competences collated by the group as a whole. The majority (n = 44) of the selected core competences received a score of 4 or greater in each round. Overall, there was some evidence of increasing consensus but the individual shift in opinion was slight. The Delphi technique was an effective tool for obtaining an expert consensus and enabled group "ownership" of the identified core curriculum.
As in nursing, recent curriculum reform in radiographer education has resulted in the development of undergraduate programmes, and a study referred to in this paper investigated the activities of supervising radiographers in support of the undergraduate curriculum. Following on from 'ward learning environments' research in nursing, the most important activities which assist radiography students' clinical learning were investigated by means of the Delphi technique. At the design stage, a deficiency in previous work using the technique was identified, in that decisions relating to consensus among research respondents appeared to be based on arbitrary or post hoc rationales rather than predetermined or objective criteria. As the Delphi technique is being increasingly employed in nursing and similar research, it is important to explore issues of consensus, validity and reliability. The paper makes recommendations for improving these aspects in future studies.
The University of Kentucky College of Dentistry has been awarded a $500,000 grant to develop and test a university-based educational program leading to a graduate certificate in Advanced General Dentistry, by the use of "extended campus" and distance learning methods. As an aid in developing this curriculum, dentists in general practice in non-urban Kentucky were asked about their educational needs. A Delphi Technique approach to this assessment was adopted. Forty dentists in general practice in non-urban areas in eastern and southern Kentucky were sent four mailings in which they rated or re-rated 65 topics for inclusion in the curriculum. A total of 59 topics were voted to be essential or desirable for the curriculum, 40 of them by a 2/3 majority. The Delphi Technique was workable for involving students in curriculum design. The curriculum produced by this method has also proven to be attractive to the dentists and their colleagues.
AIMS: To outline the key concepts and principles of the Delphi technique. METHODS: Reference is made to a selection of studies that illustrate a variety of methodological interpretations. Drawing on Heshusius's concept of 'goodness criteria', particular emphasis is given to the question of scientific merit and means of evaluation. CONCLUSIONS: Although the technique should be used with caution, it appears to be an established method of harnessing the opinions of an often diverse group of experts on practice-related problems.
OBJECTIVES: To identify the tasks that should constitute the work of preregistration house officers to provide the basis for the development of a self evaluation instrument. DESIGN: Literature review and modified Delphi technique. SETTING: Northern Deanery within the Northern and Yorkshire office NHS executive. SUBJECTS: 67 educational supervisors of preregistration house officers. MAIN OUTCOME MEASURES: Percentage of agreement by educational supervisors to tasks identified from the literature. RESULTS: Over 61% of communication items, 70% of on call patient care items, 75% of routine patient care items, 45% of practical procedure items, and over 63% of self management items achieved over 95% agreement that they should be part of the house job of preregistration house officers. Poor agreement was found for the laboratory and clinical investigations that house officers could perform with or without supervision. CONCLUSIONS: The tasks of house officers were identified but issues in using this method and in devising a universally acceptable list of tasks for preregistration house officers were apparent.
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.
OBJECTIVE: To establish the discriminatory items of the clinical examination of non-specific low back pain, important to physiotherapists. DESIGN: A focus group and Delphi technique with UK physiotherapists. SUBJECTS: A purposive sample of 30 physiotherapists attended a focus group and completed 3 rounds of Delphi questionnaires. METHODS: Data were analysed using mixed qualitative and quantitative approaches. A frequency content analysis identified commonly identified tests and questions, whilst the Delphi consensus technique assumed consensus had been reached with greater than 80% agreement on item inclusion or exclusion. RESULTS: The focus group established the structure of the clinical examination with 15 domains of questioning or physical testing. Three rounds of Delphi questionnaires established the important items of the clinical examination. The list of tests and questions included items evaluating both the psychosocial and biomedical status of the patient as well as questions screening for red flags. CONCLUSION: This is the first work to establish discriminatory tests in the clinical examination of non-specific low back pain, important to physiotherapists. The clinical examination will subsequently be evaluated for item validity and data will undergo cluster analysis. The items of this clinical examination may provide evidence for the existence of homogenous sub-groups within the heterogeneous non-specific low back pain diagnosis.
OBJECTIVE: To identify the content of a psoriasis curriculum for medical students. DESIGN: Literature review and modified Delphi technique. SETTING: Primary and secondary care in Oxfordshire and Buckinghamshire. SUBJECTS: 19 dermatologists (7 teaching hospital consultants; 6 consultants in district general hospitals; 6 registrars); 2 general practitioner senior house officers working in dermatology, 5 dermatology nurses, 7 rheumatologists, 25 general practitioner tutors, and 25 patients with chronic psoriasis. MAIN OUTCOME MEASURES: Percentage of agreement by participants to items derived from literature and our existing psoriasis syllabus. RESULTS: 71 (84.5%) of 84 questionnaires were returned. A 75% level of consensus was reached on key items that focused on the common presentations of psoriasis, impact, management, and communication skills. Students should be aware of the psychosocial impact of psoriasis, examine the skin while showing sensitivity, and be able to explain psoriasis to patients in a way that enables patients to explain the condition to others. CONCLUSIONS: The panels identified the important items for a psoriasis curriculum. The views of patients were particularly helpful, and we encourage educators to involve patients with chronic diseases in developing curriculums in the future. The method and results could be generalised to curriculum development in chronic disease.
OBJECTIVES: To identify the content of the postgraduate anatomy curriculum for trainees in emergency medicine (EM) in the UK. METHODS: Modified Delphi technique involving 160 randomly sampled consultants in EM. The outcome measure was percentage agreement, based upon a three round iterated Delphi process, of participants to items derived from a standard anatomy text being core knowledge for postgraduate clinical practice in the specialty. A national curriculum document was derived as a result of the data obtained. RESULTS: Response rates ranged from 61% to 70% after three Delphi rounds. From an initial overall questionnaire content of 808 discrete items, 64% was retained as core required knowledge following iteration. This formed the basis of a national consensus anatomy curriculum both to inform question development in postgraduate EM examinations and to benchmark anatomical knowledge requirements for safe clinical practice. CONCLUSIONS: Application of a national consensus methodology allows for determination of curricular content in anatomy. The principles can be applied to all aspects of training and curricular policy at national collegiate level to guide the development of robust documentation.
An attempt to achieve an agreed set of priorities for research in occupational medicine was undertaken by the Delphi technique. Fifty three senior practitioners of occupational medicine in academe (25) and industry or government (28) were canvassed about their views and choices for priority activity. Forty six (86%) responded to the initial enquiry and 48 (91%) provided rank order choices from a second, more detailed questionnaire. The first priority for more research on the natural history of work related ill health identified musculoskeletal disorders of the back and upper limbs followed by asthma, accidents, skin disorders, vibration induced disease, suicide and depression, and finally hearing loss. The second priority area was audit and particularly the need for its use in occupational health screening procedures. Environmental impact of industrial activity was third with the community health effects being more important than individual health effects. Stress related disease was fourth with emphasis on risk factors. The fifth area was neuropsychological effects of work exposures particularly the need for more research on diagnostic tests. Other assorted areas of concern were the cost effectiveness of occupational health, risk assessment, reproductive hazards, the effects of pharmacological agents, and the development of biomarkers as early evidence of an exposure effect. The remarkable degree of unanimity on the issues and choices and the general agreement between physicians from academe and industry on what constitute the priorities warrants further discussion and positive action.
PURPOSE: The objective of this study is to describe the implementation of formal consensus techniques in the development of a clinical definition for acute respiratory distress syndrome. MATERIALS AND METHODS: A Delphi consensus process was conducted using e-mail. Sixteen panelists who were both researchers and opinion leaders were systematically recruited. The Delphi technique was performed over 4 rounds on the background of an explicit definition framework. Item generation was performed in round 1, item reduction in rounds 2 and 3, and definition evaluation in round 4. Explicit consensus thresholds were used throughout. RESULTS: Of the 16 panelists, 11 actually participated in developing a definition that met a priori consensus rules on the third iteration. New incorporations in the Delphi definition include the use of a standardized oxygenation assessment and the documentation of either a predisposing factor or decreased thoracic compliance. The panelists rated the Delphi definition as acceptable to highly acceptable (median score, 6; range, 5-7 on a 7-point Likert scale). CONCLUSIONS: We conclude that it is feasible to consider using formal consensus in the development of future definitions of acute respiratory distress syndrome. Testing of sensibility, reliability, and validity are needed for this preliminary definition; these test results should be incorporated into future iterations of this definition.