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PubMed2006

A Delphi-based consensus study into planning for biological incidents.

OBJECTIVE: Biological incidents present a significant threat to health services in the UK. The objective of this study was to achieve consensus in all phases of biological incident planning and response. METHODS: A three-round Delphi study was conducted using a panel of 23 experts from specialities involved in the management of biological incidents. The consensus and non-consensus outcomes from the Delphi study were subsequently presented for discussion in four syndicate groups at a one-day consensus conference funded by the Health Protection Agency. RESULTS: The results of each syndicate group discussion were presented at a subsequent plenary session at the end of the conference. Further iteration of both the consensus and the non-consensus outcomes of the Delphi study resulted in the endorsement, modification, integration or rejection of individual statements. 125 consensus statements were produced. CONCLUSIONS: The 125 synopsis consensus statements that all phases of biological incident planning and response. These can be used to inform policy decisions and translated into practical guidance for emergency planners and first responders at local, regional and national levels.

Accidents, Occupational↗

PubMed1993

The development of a position statement using the Delphi technique.

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."

Delphi Technique↗

PubMedDate not supplied

A Delphi study to determine informatics competencies for nurses at four levels of practice.

BACKGROUND: Despite its obvious need, a current, research-based list of informatics competencies for nurses is not available. OBJECTIVE: To produce a research-based master list of informatics competencies for nurses and differentiate these competencies by level of nursing practice. METHODS: After a comprehensive literature review and item consolidation, an expert panel defined initial competencies. Subsequently, a three round Delphi study was conducted to validate the items. Participants were expert informatics nurse specialists in the United States of America. RESULTS: Of the initial 305 competencies proposed, 281 competencies achieved an 80% or greater agreement for both importance as a competency and appropriateness for the correct practice level. Five competencies were rejected. Six competencies were considered valid competencies but the appropriate level of practice could not be agreed upon. Thirteen competencies did not reach any consensus after the three Delphi rounds. DISCUSSION: The Delphi study had a high rate of participation, demonstrating the great level of interest and need for a list of informatics competencies for nurses. Out of the initial 305 competencies, only 24 items were not validated. Respondents commented during each round about whether computer skills should be considered informatics competencies. The authors propose that computer skills, while not high level, are one set of tools within the larger category of informatics competencies. This sample of experts did not deem programming skills as necessary for informatics nurses. This research study is an initial effort to fill the void of valid and reliable informatics competencies. It is the first study to span four levels of nurses, create competencies for both entry-level and experienced informatics nurse specialists, and examine the categories of computer skills, informatics knowledge and informatics skills.

Attitude of Health Personnel↗

PubMed1994

Using the Delphi survey technique to develop a professional definition of nursing for analysing nursing workload.

This paper describes the use of the Delphi survey technique to develop a professional definition of nursing which is used as a framework for analysing the contribution made to care by learner nurses prior to the introduction of Project 2000. A detailed account is provided of the importance of generating a theoretical nursing perspective to structure the first round of the Delphi survey. The paper goes on to question the validity of developing a consensus about nursing priorities in subsequent rounds of the Delphi survey and argues instead that priorities about nursing care needs can only be determined in the context of practice.

Activities of Daily Living↗

PubMed1994

The Delphi technique: a worthwhile research approach for nursing?

Since its introduction as a research approach in the late 1940s the Delphi technique has had over 1000 published research utilizations. Most of these have been in the field of social policy. However, a review of contemporary nursing literature suggests that it is becoming a popular choice among nurse researchers. With its focus on maximizing participant's judgements and decision-making abilities the Delphi technique is a useful tool in the research armoury of a young profession. However, questions remain about its scientific respectability. This paper gives an overview of what the Delphi technique is, the criteria for selecting it as a research approach, the studies where it has been used and its advantages and disadvantages.

Choice Behavior↗

PubMed1999

Delphi study into planning for care of children in major incidents.

This paper describes a Delphi study used to identify and improve areas of concern in the planning of care for children in major incidents. The Delphi was conducted over three rounds and used a multidisciplinary panel of 22 experts. Experts were selected to include major incident, immediate care, emergency medicine, and paediatric specialists. This paper presents a series of consensus statements that represent the Delphi group's opinion on the management of children in major incidents. The statements cover all phases of major incident planning and response. Paediatric services may play a vital role in the preparation and response to a major incident involving children. This paper represents a consensus view on how best to plan and respond to major incidents involving children. An accompanying paper describes the practical implementation of this guidance.

Child↗

PubMed2003

Initiation of biological agents in patients with ankylosing spondylitis: results of a Delphi study by the ASAS Group.

BACKGROUND: There is ample evidence of important symptomatic efficacy of tumour necrosis factor alpha (TNFalpha) inhibition in ankylosing spondylitis (AS). Moreover, studies suggest that anti-TNF could be considered as the first disease controlling antirheumatic treatment (DC-ART) for AS. OBJECTIVE: To determine precisely which patients with AS are most likely to benefit from anti-TNFalpha treatment because of the cost and possible long term side effects of such treatment. METHODS: Assessment in Ankylosing Spondylitis (ASAS) members were asked to use a Delphi technique to name the characteristics of patients with AS for whom they would start DC-ART, in three different clinical presentations (isolated axial involvement, peripheral arthritis, enthesitis). RESULTS: Among the 62 invited ASAS members, more than 50% actively participated in the four phases of definition according to the Delphi technique. For each of the three clinical presentations, a combination of five to six domains was proposed, with an evaluation instrument and a cut off point defining a minimum level of activity for each domain. CONCLUSION: This study provides a profile for a patient with AS for considering initiation of biological agents that reflects the opinion of the ASAS members, using a Delphi exercise. Further studies are required to assess their relevance and their consistency with clinical practice.

Antibodies, Monoclonal↗

PubMed2006

Determination of required anatomical knowledge for clinical practice in emergency medicine: national curriculum planning using a modified Delphi technique.

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.

Anatomy↗

PubMed1999

Consensus for tobacco policy among former state legislators using the policy Delphi method.

OBJECTIVE: To test a novel approach for building consensus about tobacco control policies among legislators. DESIGN: A pilot study was conducted using a two-round, face-to-face policy Delphi method. PARTICIPANTS: Randomly selected sample of 30 former Kentucky legislators (60% participation rate). MAIN OUTCOME MEASURE: Consensus on tobacco control and tobacco farming policies. RESULTS: Former state legislators were more supportive of tobacco control policies than expected, and highly supportive of lessening the state's dependence on tobacco. Former state legislators were in agreement with 43% of the second-round items for which there was no agreement at the first round, demonstrating a striking increase in consensus. With new information from their colleagues, former lawmakers became more supportive of workplace smoking restrictions, limitations on tobacco promotional items, and modest excise tax increases. CONCLUSIONS: The policy Delphi method has the potential for building consensus for tobacco control and tobacco farming policies among state legislators. Tobacco control advocates in other states might consider using the policy Delphi method with policymakers in public and private sectors.

Cooperative Behavior↗

PubMed2002

The impact of the internet on community pharmacy practice: a comparison of a Delphi panel's forecast with emerging trends.

The purpose of this study was to forecast the impact of Internet pharmacy commerce on various stakeholders. A panel of experts assembled from a list of academicians in the social and administrative pharmaceutical sciences participated in a three-iteration Delphi procedure. Feedback from the aggregate responses of the panel was used to construct questionnaires employed in subsequent iterations of the Delphi. The panel converged to form a consensus upon a variety of issues. They forecasted the attainment of a 10-15% share in the market of prescription and over-the-counter pharmaceuticals through on-line purchases, the formation of strategic alliances among stakeholders in the drug distribution process, a shift in marketing strategies by brick-and-mortar stores, an increase in the prevalence of niching among pharmacy service providers and a subsequent growth in the implementation of cognitive services throughout the industry. With few exceptions, the forecast produced by the Delphi panel appears to be coming to fruition.

Consensus↗

PubMedDate not supplied

Use of the Delphi Technique for developing national clinical guidelines for prescription of lower-limb prostheses.

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.

Amputees↗

PubMed2006

Nutrition in primary health care: using a Delphi process to design new interdisciplinary services.

PURPOSE: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. METHODS: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. RESULTS: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers' nutrition services. CONCLUSIONS: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

Delphi Technique↗

PubMed2001

Priorities for paediatric cancer nursing research in Western Australia: a Delphi study.

A Delphi study was undertaken to identify paediatric cancer nursing research priorities at the sole paediatric tertiary referral centre in Western Australia. Thirty one responses were received from the first Delphi round and 22 from the second round. The top 10 priorities identified were different from those identified in prior North American Delphi studies. The top ranked research topic was 'To effective methods of communication in a multi-disciplinary identify health care team'. The findings will provide a research agenda for cancer nursing at the study setting and may stimulate discussion and re-assessment of research priorities in other paediatric cancer settings.

Adult↗

PubMed2005

Delphi survey research and older people.

Delphi survey or Delphi technique has been described as an effective way of gathering information on a subject where there is currently scant evidence available. It provides an opportunity for participants to offer an expert opinion on the subject in question and helps to clarify what individuals consider to be most important about the topic under consideration. In this article the practical steps needed to construct a Delphi survey are reviewed in the context of the special circumstances associated with older adult participants.

Age Factors↗

PubMed2006

How expert are the experts? An exploration of the concept of 'expert' within Delphi panel techniques.

The use of the term 'expert' occurs widely in healthcare research, in the context of national guidelines and consensus methods for the development of clinical protocols. Within consensus methods of research, especially Delphi panel techniques, the use of 'experts' is fundamental to reliability. Yet literature fails to debate the practicalities of defining 'experts' for use within Delphi panel research. This paper, by John Baker and colleagues, draws on methodological literature and discusses the concepts and elements of 'experts'. It concludes with recommendations for researchers to ensure experts for future Delphi research.

Delphi Technique↗

PubMedDate not supplied

The use of the Delphi panel for consensus development on indicators of laboratory performance.

The objective of this research study is to identify laboratory performance areas and indicators of performance from the perspective of key laboratory constituencies. A specific technique, the Delphi panel, is used to achieve consensus on a system of indicators that can be used by laboratory service managers to build information pathways, increase efficiency, and improve outcomes. Individual panels represented the five highest ranked stakeholder groups: hospital executives, managed care executives, referring physicians, laboratory regulators, and laboratory managers. The instruments used for the Delphi panels were developed and validated in a pilot study. After three rounds, each panel had identified a set of priority performance areas and indicators for each area. Although concurring that the Delphi was valuable and effective in identifying performance areas, participants indicated that it was less useful in developing specific indicators enabling monitoring of laboratory performance over time or cross-laboratory comparisons.

Consensus Statements as Topic↗

PubMed2001

[Practical clinical skills in medical education 1--undergraduate education. A Delphi survey].

INTRODUCTION: The necessity of defining standards in medical education is increasingly recognised. The aim of the present study was to adapt the Delphi method in establishing a consensus about competence levels of basic clinical skills in the undergraduate medical curriculum. METHOD: We used a Delphi design with two postal rounds. An expert panel of 52 physicians was selected on the criteria of knowledge and practical engagement in medical education. Questionnaires were set up with lists of 213 practical skills based on literature studies. Six levels of competence were identified. The task of the panel was to select the competence level for each skill. RESULTS: The panel reached a 75% level of consensus in 212 of the 213 skills. A core curriculum of basic clinical skills in the medical education of Danish undergraduates is proposed. DISCUSSION: The Delphi method was found applicable to qualify the process of identifying goals in a medical curriculum design.

Clinical Competence↗

PubMed2001

Using the Delphi technique to identify the cancer education requirements of general practitioners.

UNLABELLED: Continuing education for the general practitioner (GP) is in need of revision. Much of today's continuing education is based upon a traditional didactic approach, which is believed to be inappropriate and inefficient for the learning needs of the increasingly stretched GP. OBJECTIVE: To investigate the educational needs of a group of GPs, using the response to cancer to construct an appropriate model for the provision of care in general practice. METHOD: The Delphi technique was adopted to reach "expert" consensus. PARTICIPANTS: 49 GPs currently practising within two health authorities within the north-west region of England. DESIGN: Three waves of data collection were employed, with the same sample and the inclusion of an additional reference group. RESULTS: Many issues relating to the difficulties experienced by GPs regarding care of cancer patients were identified, along with associated training needs. Successive rounds of this Delphi survey enabled consensus to be reached about the level of importance to be assigned to these issues. This technique avoided some of the problems associated with a conventional committee approach (e.g. time, expense and potential bias in decision-making process). CONCLUSIONS: First, the Delphi technique provided a relatively quick means of gaining a consensus on the complex task set for participants. Second, continuing training for GPs would benefit from the adoption of a problem-based learning approach rather than traditional didactic methods.

Adult↗