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PubMed2006

Paratonia: a Delphi procedure for consensus definition.

BACKGROUND AND PURPOSE: Paratonia is a motor problem that develops during the course of dementia. Definitions of paratonia used in the literature differ considerably, which has clinical implications and may lead to an undesirable heterogeneity in study populations. For this reason, we initiated a Delphi procedure with known experts in the field to establish an operational consensus definition of paratonia. METHODS: The Delphi procedure involved an anonymous and multistage approach presented as a questionnaire, with each stage building on the results of the previous one in order to reach consensus on the definition of paratonia. RESULTS: Eight of 17 experts agreed to participate in the study. After 4 rounds, the participants reached consensus on the following definition: paratonia is a form of hypertonia with an involuntary variable resistance during passive movement. The nature of paratonia may change with progression of dementia (eg, from active assistance (aka Mitgehen) to active resistance). The degree of resistance depends on the speed of movement (eg, slow > low resistance, fast > high resistance). The degree of paratonia is proportional to the amount of force applied and increases with progression of dementia. The resistance to passive movement is in any direction and there is no clasp-knife phenomenon. CONCLUSION: The Delphi procedure resulted in a comprehensive, operational definition of paratonia. Future research should focus on the reliability and validity of this definition.

Delphi Technique↗

PubMed1991

[Practice experience as a resource--the Delphi method in nursing research].

Delphi method in nursing research is unusual but worthy of attention. The foundation of the method is experience-based knowledge and interaction of experts in successive rounds. Usually delphi method does not produce objective, exact facts. Delphi method is applicable to identifying and clarifying new issues and assumptions and producing well-grounded evaluations--often important in young disciplines. However, critical attitude is needed regarding methodological decisions as well as implications.

Delphi Technique↗

PubMedDate not supplied

The committee meeting alternative. Using the Delphi technique.

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.

Administrative Personnel↗

PubMed1996

[Professional profile of primary health care personnel. A Delphi study].

OBJECTIVE: To determine the professional profile of health staff (doctors, paediatricians and nurses) in primary care (PC). DESIGN: Three simultaneous Delphi techniques (consensus method). SETTING: Primary care. PARTICIPANTS: 55 doctors, 45 nurses and 23 paediatricians from the whole of Spain and different fields of activity. INTERVENTION: The filling in of three questionnaires, using the Delphi methodology. RESULTS: The overall percentage of replies was 69.1% (first questionnaire), 70.7% (2nd) and 60.16% (3th). The PC doctor should guide in a suitable way his/her community's health problems, using the relevant diagnostic and therapeutic methods, caring for patients' all-round health, controlling the doctor-patient interview, all in collaboration with other professionals, with a planning, programming and evaluation of his/her activity and a basically community-oriented approach. The nursing professional should provide all-round care for patients, using nursing diagnostic and therapeutic methods, within a multidisciplinary team and carrying out planning, programming and evaluation of the community's health problems. The PC paediatrician should be concerned with the prevention and treatment of the most common pathologies. He/she has a vital role to play in childrens' health education, should have the training to resolve the most common paediatric emergencies and organise his/her work within a multidisciplinary team. CONCLUSIONS: The Delphi method is a useful technique for determining professional profiles. Paediatricians have a more sharply defined profile than doctors and nursing staff.

Delivery of Health Care↗

PubMedDate not supplied

[Avoidable hospitalization using ambulatory surgery in the Community of Valencia: a Delphi study].

BACKGROUND: To estimate the number of hospital admittance's avoidable by means of ambulatory surgery, according to surgeons and anaesthetists who currently work with the National Health System (NHS). METHOD: By means of a Delphi procedure of 25 surgeons or anaesthetists of the Valencia Health Survey (AServei Valencià de la Salut-SVS), a consensus was reached as to the objective criteria for excluding patients that could be treated outside a hospital and the percentage of certain operations that could be performed under day surgery. These criteria were applied to the Minimum Basic Data Set on hospital discharge within the Autonomous Region of Valencia in order to estimate the figure of hospital admittance and stays avoidable by means of ambulatory surgery in a selection of 29 surgery processes. RESULTS: 83% of medical personnel responded to the Delphi questionnaires. The median of the surveyed group's estimation on the proportion of cases that could be treated by means of external surgery varied from 40% for abdomen wall hernias or laparoscopic cholecystectomy and 90% for perianal tissue excision, anastomosis for dialysis or ganglionectomy. Application of the results of the Delphi survey would have meant that the SVS could have avoided 12,558 admittances in 1994, 75% of the operations surveyed, which is almost the same figure resulting from applying the medical personnel's opinion of the CMBD. CONCLUSIONS: SVS professionals consider it feasible to perform a much higher number of ambulatory operations than those currently carried out, and that it is likely that the causes for the lack of such operations lie in SNS financing and incentive criteria, rather than medical issues.

Ambulatory Surgical Procedures↗

PubMed2006

Comparison of BMD precision for Prodigy and Delphi spine and femur scans.

INTRODUCTION: Precision error in bone mineral density (BMD) measurement can be affected by patient positioning, variations in scan analysis, automation of software, and both short- and long-term fluctuations of the densitometry equipment. Minimization and characterization of these errors is essential for reliable assessment of BMD change over time. METHODS: We compared the short-term precision error of two dual-energy X-ray absorptiometry (DXA) devices: the Lunar Prodigy (GE Healthcare) and the Delphi (Hologic). Both are fan-beam DXA devices predominantly used to measure BMD of the spine and proximal femur. In this study, 87 women (mean age 61.6+/-8.9 years) were measured in duplicate, with repositioning, on both systems, at one of three clinical centers. The technologists were International Society for Clinical Densitometry (ISCD) certified and followed manufacturer-recommended procedures. All scans were acquired using 30-s scan modes. Precision error was calculated as the root-mean-square standard deviation (RMS-SD) and coefficient of variation (RMS-%CV) for the repeated measurements. Right and left femora were evaluated individually and as a combined dual femur precision. Precision error of Prodigy and Delphi measurements at each measurement region was compared using an F test to determine significance of any observed differences. RESULTS: While precision errors for both systems were low, Prodigy precision errors were significantly lower than Delphi at L1-L4 spine (1.0% vs 1.2%), total femur (0.9% vs 1.3%), femoral neck (1.5% vs 1.9%), and dual total femur (0.6% vs 0.9%). Dual femur modes decreased precision errors by approximately 25% compared with single femur results. CONCLUSIONS: This study suggests that short-term BMD precision errors are skeletal-site and manufacturer specific. In clinical practice, precision should be considered when determining: (a) the minimum time interval between baseline and follow-up scans and (b) whether a statistically significant change in the patient's BMD has occurred.

Absorptiometry, Photon↗

PubMed2001

Delphi panel study of current hypertension treatment patterns.

OBJECTIVE: The purpose of this study was to assess whether, and to what extent, usual practice in the management of patients with mild to moderate hypertension differs from that recommended in the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI). The results were used as input for a clinical decision analytic model to assess the cost-effectiveness of a new treatment for hypertension. METHODS: A Delphi panel survey of general practitioners and cardiologists in the United States was conducted to determine current strategies for the treatment of mild to moderate uncomplicated hypertension. The purpose of the panel survey was to reach consensus on 3 key facets of the JNC-VI guidelines and how they relate to the respondents' clinical practices: (1) the definition of mild to moderate hypertension, (2) the treatment that adult patients with uncomplicated mild to moderate hypertension should receive, and (3) the management of patient follow-up. RESULTS: Of the 20 physicians contacted for the survey, 10 responded to both rounds of the questionnaire. There was considerable variation in the responses for defining the ranges of healthy, acceptable, unacceptable, and serious blood pressure. In general, the Delphi panel respondents cited higher limits than stated in the JNC-VI guidelines. Physicians followed the guidelines approximately 60% of the time. Primary determinants of initial drug choice among the panelists were comorbid conditions and the severity of hypertension; patients' age, race, and sex were secondary determinants. Follow-up typically occurred 1 month after therapy initiation. Panelists reported titrating the dose of new therapies upward once or twice before discontinuing the drug for lack of efficacy. Once adequate blood pressure control was achieved, patient follow-up was reported to occur every 3 to 4 months. CONCLUSIONS: This Delphi panel study highlights the differences between clinical practice and the JNC-VI guidelines in the treatment of hypertension. The results were used as a basis for defining a structure for a cost-effectiveness model and provided the management practice and prescribing practice patterns required by the model.

Cost-Benefit Analysis↗

PubMedDate not supplied

Delphi survey of priorities in clinical nursing research.

Using the Delphi technique, a panel of 433 nurse and nonnurse experts was surveyed regarding priorities for clinical research in nursing. Of these, 341 completed all four Delphi survey rounds. Three questions were studied: 1) Is this an area in which nursing should assume primary research responsibility? 2) How important is research on this topic for the profession of nursing? 3) What is the likelihood of change in patient welfare because of research on the topic? Although the nature and amount of data produced prohibited interpretation of the data or delineation of succinct conclusions about priorities for clinical nursing research, responses to the three questions supported these statements: The majority of research areas identified in the questionnaire are areas in which nursing should take research leadership. Although there is some overlap, priorities for professional significance and social or patient welfare relevance are different. In terms of professional significance, highest priority was given to items regarding measuring the quality of care, role, nursing process, and the research process. In terms of patient welfare, several programs of research are discernible in the items ranked in the top ten percent; these include nursing interventions related to stress, care of the aged, pain, and patient education. The Delphi technique also is described.

Evaluation Studies as Topic↗

PubMedDate not supplied

Toward the development of advocacy training curricula for pediatric residents: a national delphi study.

BACKGROUND: Training in child advocacy is now required in pediatric residency program curricula. No national consensus exists regarding the content of such advocacy training. OBJECTIVE: To identify an operational definition of advocacy, as well as knowledge, skills, and attitude objectives for advocacy training in pediatric residency programs. METHODS: Professionals experienced in pediatric advocacy and training (n = 53) were invited to participate in a sequence of surveys to define the content of a pediatric residency advocacy curriculum that would result in acquisition of appropriate knowledge, skills, and attitudes related to advocacy for children. Three rounds of surveys were distributed, collected, and analyzed using a modified Delphi technique, in which the results from an antecedent survey were used to refine responses in a subsequent survey. RESULTS: Participants (n = 36), comprising a group of experienced leaders with diverse training and experience in child advocacy and resident education, created a consensus definition for advocacy. They initially identified 179 possible objectives for advocacy curricula. Through the iterative process of the Delphi technique, 32 of those objectives were identified as necessary for inclusion in a child advocacy curriculum for pediatric residents. CONCLUSIONS: Using a modified Delphi technique, a group of experienced leaders in pediatric advocacy were able to reach consensus on an operational definition of child advocacy and a set of objectives for a resident advocacy curriculum. Programs may use these findings to assist in developing an advocacy curriculum based on their own faculty assets and community resources.

Adult↗

PubMed2001

Management of spontaneous pneumothorax: an American College of Chest Physicians Delphi consensus statement.

OBJECTIVE: Provide explicit expert-based consensus recommendations for the management of adults with primary and secondary spontaneous pneumothoraces in an emergency department and inpatient hospital setting. The use of opinion was made explicit by employing a structured questionnaire, appropriateness scores, and consensus scores with a Delphi technique. The guideline was designed to be relevant to physicians who make management decisions for the care of patients with pneumothorax. OPTIONS: Decisions for observation, chest tube placement, surgical interventions, and radiographic imaging. OUTCOMES: Effectiveness of pneumothorax resolution, duration of and patient tolerance of care, and pneumothorax recurrence. EVIDENCE: Literature review from 1967 to January 1999 and Delphi questionnaire submitted in three iterations to a multidisciplinary physician panel. VALUES: The guideline development group determined by consensus the relevant outcomes to be considered in developing the Delphi questionnaire. BENEFITS, HARMS, AND COSTS: The type and magnitude of benefits, harms, and costs expected for patients from guideline implementation. RECOMMENDATIONS: Management decisions vary between patients with primary or secondary pneumothoraces, with observation of small pneumothoraces being appropriate only for primary pneumothoraces. The level of consensus varies regarding the specific interventions indicated, but agreement exists for the general principles of care. VALIDATION: Recommendations were peer reviewed by physician experts and were reviewed by the American College of Chest Physicians (ACCP) Health and Science Policy Committee. IMPLEMENTATION: The guideline recommendations will be published in printed and electronic form with distribution of synopses for patients and health care providers. Contents of the guideline will be incorporated into continuing medical education programs. SPONSORS: The ACCP.

Adult↗

PubMed2026

Solutions for engaging priority populations in HIV cure research: a hybrid Delphi consensus-building process.

BACKGROUND: To achieve consensus on barriers and strategies to improve the engagement of three priority populations - Black and Latino/a/x individuals, cisgender women, and transgender women in HIV cure research. METHODS: We assembled a panel of 54 experts assigned to six groups in a hybrid Delphi process: (1) HIV community members, (2) biomedical researchers, (3) medical providers, (4) funders and private industry members, (5) bioethicists and regulators, and (6) social scientists. Over 18 months, we conducted four iterative survey rounds and three group discussions to identify barriers and strategies to arrive at a consensus on how to engage these priority populations in HIV cure research. RESULTS: For Black and Latino/a/x populations, the panellists identified inadequate outreach and a lack of accessible educational information as primary barriers and emphasised community-driven engagement and partnerships with trusted leaders as key strategies. For cisgender women, logistical hurdles, caregiving responsibilities and time constraints were identified as major barriers, with flexible trial designs and equitable compensation proposed as solutions. For transgender women, the lack of transgender-focused research design, including misrepresentation and exclusion, was identified as a key barrier, while centring transgender-specific needs in study design achieved consensus as the most effective strategy. CONCLUSION: Among all four priority populations, investment in outreach, engagement along the research process, better integration of health needs with research, and enhanced incentives are not novel ideas, but remain obviously ignored in a way that has led to underrepresentation of people in HIV cure research, who carry the greatest burden of HIV in the U.S. SUMMARY: This paper uses a hybrid Delphi process to identify and reach consensus on key barriers and strategies to engage underrepresented groups: Black and Latino/a/x individuals, cisgender women, and transgender women in HIV cure research across the United States.

Humans↗

PubMed2001

Environmental initiative prioritization with a Delphi approach: a case study.

India is fast finding its place in the industrialized world and that is beginning to raise its environmental consciousness. The Delphi technique was used to prioritize specific needs and articulate a sustainable urban improvement strategy for the city of Mumbai (formerly Bombay). The Delphi technique is a means of achieving consensual validity among raters by providing them feedback regarding other raters' responses. Mumbai has several indigenous environmental groups that were tapped for activists and leaders; the study was conducted using ten environmentalists. In the initial phases the responses resulted in a range of possible program alternatives. The last two stages helped to seek out information that generated a consensus on the part of the respondent group. Statistical analysis methods included a hierarchical cluster analysis, mean, median, mode, and percent of agreement calculations using SPSS software. The face-to-face discussion in phase 4 clarified some issues and helped the group as a whole to outline the strategy for putting in place the essential elements of a framework to improve the quality of life in an urban environment.

Adult↗

PubMed2026

Time to subsequent therapy (TTST) as an endpoint in clinical studies: development of standardized documentation of subsequent therapy through systematic literature review, expert interviews, and Delphi survey.

BACKGROUND: The endpoint Time to Subsequent Therapy (TTST) is an intermediate endpoint used in research and regulatory assessments. TTST denotes initiation of subsequent therapy and is a clearly definable, clinically relevant event for healthcare professionals. However, it has not been systematically established to which extent TTST is subjectively meaningful to patients. The objective of this study was to define TTST as a patient-relevant intermediate endpoint. METHODS: The study examined five oncological indications (breast cancer, prostate cancer, melanoma, multiple myeloma, and non-small cell lung cancer) using a systematic literature review, analysis of case report forms used in international randomized controlled trials, review of German Federal Joint Committee (G-BA) documents, semi-structured interviews and a two-stage Delphi survey with healthcare professionals, patients, and relatives. RESULTS: A total of 35 individuals participated in qualitative interviews. Most of them rated TTST as particularly significant. The Delphi Survey included 264 interviewees in round one, and 117 in round two. Patient-relevance of TTST was confirmed by 81% of respondents (95% confidence interval 76%, 85%). Nine treatment scenarios that justify TTST were identified. To capture patient-relevance, prospective collection of reasons for and consequences of therapy change are required. A checklist with standardized response formats plus free-text fields was developed: a comprehensive master checklist for flexible, complete documentation and a short version focused on therapy change-specific items. CONCLUSIONS: TTST is an intermediate endpoint whose systematic documentation of characteristics demonstrating patient-relevance can be standardized in research and clinical practice using the developed checklists.

Humans↗

PubMed1997

Economic evaluation in schistosomiasis: using the Delphi technique to assess effectiveness.

The limited resources allocated to Schistosomiasis Control Programme in Kenya are not adequate to implement and sustain all technically efficacious interventions simultaneously. This fact has dawned upon both policy-makers and medical personnel who hitherto advocated a multi-faceted approach to 'eradicate' schistosomiasis. Given that Kenya cannot afford to implement all interventions that might conceivably be of some benefit, it is necessary to establish priorities based on considerations of both costs and benefits. An important part of the benefit of any health intervention is its effect on health (quality and quantity of life) of potential beneficiaries. The objectives of this study were to: identify relevant types of data needed in estimating impacts of schistosomiasis interventions on health status; develop an instrument which can be used to obtain subjective probabilistic impacts of interventions; test its operational feasibility; develop a conceptual framework within which impacts of interventions can be estimated; illustrate how the probabilities could be used in calculating the 'expected quality adjusted life years' (EQALY); and identify obstacles that need to be overcome within a developing country context. In this study, a 'modified Delphi' approach was used to elicit expert subjective judgements on the effectiveness of ten schistosomiasis interventions. The paper compares and contrasts the expected quality adjusted life years estimated using values obtained from two local schistosomiasis experts with those obtained from a foreign expert. The panelists appeared to be consistent in their ranking of the effectiveness of treatment vs. non-treatment options. However, there were large differences in the magnitudes of estimates obtained from the local and the foreign experts. Given that the Delphi technique has been widely and fruitfully used in industry and commerce (among other areas) in developed countries, African countries health policy-makers cannot possibly do worse (than the current practice where decisions to commit resources are based on 'what we did last time' and 'gut feelings') by using systematic decision analyses based on data from such a technique.

Cost-Benefit Analysis↗

PubMed1997

Construction of a clinical implant performance scale for implant systems with overdentures with the Delphi method.

STATEMENT OF PROBLEM: The success of an implant system is often judged on the survival rate of the separate implants. This does not give a complete view of the "real" success of a system. To make that possible the total clinical performance, surgical and prosthetic, has to be considered. PURPOSE: This study aimed to set up a clinical performance scale for different implant systems retaining mandibular overdentures. MATERIAL AND METHODS: All data regarding surgical and prosthetic complications incurred and treatment procedures needed after implant placement were collected from a group of 90 patients who were treated either with two root form implants connected with a bar and supporting a mandibular overdenture or with a transmandibular implant system that supported an overdenture. All items were scored into five categories on the scale, defined as the "clinical implant performance" scale. The Delphi method was applied to categorize each item. A panel of experts assessed the items. RESULTS: After three rounds there was complete consensus between the experts for 65% of the items for the root form implant systems, and for 87% of the items at least five out of six experts gave the same score. For 55% of the items for the transmandibular implants systems there was complete consensus, and for 85% of the items at least five out of six experts scored in the same way. CONCLUSIONS: The Delphi method provides a useful scale for evaluating the clinical performance of implant systems retaining mandibular overdentures. The presented scale makes it possible to compare the overall performance of different implant systems for overdentures.

Delphi Technique↗

PubMed1999

Professional attitudes toward denture adhesives: A Delphi technique survey of academic prosthodontists.

STATEMENT OF PROBLEM: The use of denture adhesives and their role in prosthodontics has been an intriguing and conflicted topic, both in clinical practice and dental education. PURPOSE: This study generated discussion, and if possible, obtained a consensus on a series of issues related to denture adhesives among a group of leading academic prosthodontists. MATERIAL AND METHODS: The Delphi Technique survey method was used. It consists of a series of survey questionnaire rounds to a panel of experts to either develop a consensus (>70% agreement) or to clarify the reasons for multiple schools of thought on a topic. A 24-item Delphi questionnaire was sent to an expert panel that consisted of a 33% regionally stratified random sample of program directors of undergraduate complete denture courses in US dental schools. The 5 major topic areas on denture adhesives addressed by the questionnaire items were (1) general perceptions, (2) specific clinical uses/misuses, (3) patient education, (4) inclusion in dental curricula, and (5) overall opinions of utility. RESULTS: Of the 18 randomly selected panelists, 94% (n = 17) agreed to participate, with either 16 or 17 fully participating in each of the 3 survey rounds. The panel achieved consensus and clearly concluded that denture adhesives: (1) are a useful adjunct in denture prosthesis services, having specific roles in both the fabrication and postinsertion phases; (2) had the potential for misuse, both by dentists and by patients; and (3) should be an integral part of patient education for all denture patients and of the undergraduate dental curriculum. However, the panel was unable to achieve consensus on whether denture adhesives should be used at the postinsertion phase for immediate denture patients and whether, on the whole, they were a beneficial adjunct in denture patient management (59% agreed they were). The panelists also clearly expressed their concerns that neither dentists nor patients should use denture adhesives as a substitute for either good clinical practices or proper denture maintenance routines. CONCLUSIONS: This panel of leading academic prosthodontists concluded that denture adhesives are a useful adjunct in denture prosthesis services, with specific roles in both fabrication and postinsertion phases. They also indicated that only through education, for dentists and patients, would the dual goals of maximizing the beneficial aspects of denture adhesive use while minimizing the misuse of denture adhesives be achieved.

Adhesives↗

PubMed1994

Day surgery--how much is possible? A Delphi consensus among surgeons.

Although day surgery (DS) has been performed for many years, it has only relatively recently become a popular and acceptable method of treating many common surgical conditions. With considerable pressure to maximise resource usage DS has been seized upon as a way of stretching scarce resources further. A review of the amount of DS undertaken within the West Midlands region revealed that the current workload showed considerable variation both between districts and between consultants. In an effort to gain clinical commitment to increasing generally the amount of DS undertaken, and obtaining more uniform coverage of DS across the region, a consensus conference was held. The two aims of the conference were to set targets as to the amount of DS considered feasible at a procedural level, and to seek clinicians' views as to the obstacles to developing the service. Targets for 43 procedures at one and/or five years were obtained by the use of a modified Delphi consensus. The groups showed a high level of consensus in the targets reached. A variety of obstacles were discussed. We have shown that it is possible to involve a large number of doctors in the decision-making/target-setting process by using a modified Delphi technique. It remains to be seen whether those targets are met in clinical practice. Surprisingly, obstacles to development were mainly concerned with management and personnel issues rather than capital investment.

Ambulatory Surgical Procedures↗

PubMed2000

When providers and community leaders define health priorities: the results of a Delphi survey in the canton of Geneva.

The Delphi method was used to determine the health priorities in one Swiss canton. The opinion of various groups concerned, either as health professionals or as representatives of the general population, was gathered to identify the health determinants and health problems perceived as most important, to clarify the reasons for these choices, and to recommend interventions to be undertaken in order to improve the situation in the identified priority areas. Five panels, including health professionals as well as selected leaders of community groups with no direct involvement in health, were given the opportunity to reply to two rounds of questionnaires. There was a high convergence of opinion on health determinants and problems to be given priority between panels and between the first and second round. Priorities identified are mainly physical problems (cardiovascular disease, respiratory and breast cancer, AIDS, injuries due to road accidents, chronic back pain), psychosocial disorders (depression, suicide, violence in the family, stress), and problems of substance abuse (alcohol and tobacco). Unemployment and social isolation were chosen because of their perceived impact on health. Very few interventions were proposed in the medical technical or research areas. This may be due partly to the fact that good quality care is widely available and accessible in Geneva, whereas preventive programmes have not received enough attention in the past. Through the identified priorities and the proposed activities, a new vision of health emerges which gives more importance to psychosocial problems and the social environment. In this context, health promotion is seen as essential, acknowledging that sustained change in individual behaviours can only occur if the social and cultural context is taken into consideration. In conclusion, the results of this survey show that the Delphi method is a useful tool to reach consensus on health priorities and corresponding activities among a variety of actors.

Delphi Technique↗