The Delphi Technique: a possible tool for predicting future events in nursing education.
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Canada↗
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The Delphi technique in a psychiatric hospital.
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Hospital Administration↗
Problem solving with the Delphi technique.
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Hospital Administration↗
Use of the Delphi research technique to test a decision model in foodservice systems: a case study in food production.
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Decision Making, Organizational↗
Contributors to initial success on the national athletic trainers' association board of certification examination as perceived by candidate sponsors: a delphi study.
OBJECTIVE: To determine the factors that are perceived to contribute to first-time success on the National Athletic Trainers' Association (NATA) Board of Certification Examination. DESIGN AND SETTING: We surveyed a panel of athletic training educators who sponsor candidates for the examination by means of the Delphi technique. The Delphi technique is a method of structuring the collective judgments of a group of experts, conducted through a series of sequential questionnaires, each containing summarized information from earlier responses. SUBJECTS: A total of 29 athletic training program directors whose programs are accredited by the Commission on Accreditation of Allied Health Education Programs or approved by the NATA. MEASUREMENTS: We used 3 questionnaires to solicit the opinions of experts and ultimately reach consensus. Each questionnaire was generated from the results of the previous questionnaire. The initial questionnaire asked respondents to list items that they perceived as contributing to first-time success. The second was generated from the results of the first and asked respondents to rate items using a Likert scale. The third questionnaire allowed respondents to change their answers based on the information presented. The study concluded with a consensus confirmation report that asked respondents to concur with the results of the study. RESULTS: The panel reached consensus on items that reflected clinical experiences, teaching qualities and practices of the clinical instructors, student knowledge, test-taking skills, and student characteristics. Of these consensus items, the items contributing significantly to initial examination success were "ability to interpret the question," "knowledge of theories and techniques in rehabilitation and modalities," "clinical assessment skills," "clinical settings that allow students to take an active role," and "instructors committed to providing a positive learning environment." CONCLUSIONS: We noted 5 different areas perceived as contributing to a student's passing the examination on the first trial. These results can be used by program directors to enhance their curricular, didactic, and clinical structures to better prepare students for the examination. The results can also be used by the NATA Education Council in the development of educational programs for certified athletic trainers to become effective clinical instructors.
Journal Article↗
Research guidelines for the Delphi survey technique.
Consensus methods such as the Delphi survey technique are being employed to help enhance effective decision-making in health and social care. The Delphi survey is a group facilitation technique, which is an iterative multistage process, designed to transform opinion into group consensus. It is a flexible approach, that is used commonly within the health and social sciences, yet little guidance exists to help researchers undertake this method of data collection. This paper aims to provide an understanding of the preparation, action steps and difficulties that are inherent within the Delphi. Used systematically and rigorously, the Delphi can contribute significantly to broadening knowledge within the nursing profession. However, careful thought must be given before using the method; there are key issues surrounding problem identification, researcher skills and data presentation that must be addressed. The paper does not claim to be definitive; it purports to act as a guide for those researchers who wish to exploit the Delphi methodology.
Attitude of Health Personnel↗
Performance measures for early psychosis treatment services.
OBJECTIVE: This study examined the feasibility of identifying performance measures for early psychosis treatment services and obtaining consensus for these measures. The requirements of the study were that the processes used to identify measures and gain consensus should be comprehensive, be reproducible, and reflect the perspective of multiple stakeholders in Canada. METHODS: The study was conducted in two stages. First a literature review was performed to gather articles published from 1995 to July 2002, and experts were consulted to determine performance measures. Second, a consensus-building technique, the Delphi process, was used with nominated participants from seven groups of stakeholders. Twenty stakeholders participated in three rounds of questionnaires. The degree of consensus achieved by the Delphi process was assessed by calculating the semi-interquartile range for each measure. RESULTS: Seventy-three performance measures were identified from the literature review and consultation with experts. The Delphi method reduced the list to 24 measures rated as essential. This approach proved to be both feasible and cost-effective. CONCLUSIONS: Despite the diversity in the backgrounds of the stakeholder groups, the Delphi technique was effective in moving participants' ratings toward consensus through successive questionnaire rounds. The resulting measures reflected the interests of all stakeholders.
Canada↗
A study of skill mix issues in midwifery: a multimethod approach.
BACKGROUND: While skill mix studies are quite commonplace in health care, most have focused on the most effective use of staff and skill distribution in the field of nursing; few relate specifically to the midwifery profession. In Ireland there is no recognized midwifery assistant grade. AIMS: This paper describes a study that investigated the skill mix requirements of a midwifery service based in the Republic of Ireland. The project was built on previous research, which showed that due to undertaking a number of 'nonmidwifery duties', midwives were unable to undertake fully the work for which they were trained. RESEARCH METHODS: Data were collected using a variety of methods. These included postal questionnaires and the Delphi technique. The 'Delphi' was used to gain a level of consensus from hospital midwives (all grades) (n=194) and student midwives (n=79) on what are and what are not nonmidwifery duties. Analysis of secondary data (duty rotas and staff turnover data) was also undertaken. RESULTS: Findings indicate that the respondents spent a large proportion of their time undertaking clerical, domestic, portering and stock duties. They would welcome the introduction of midwifery assistants into the ward team and were able to identify those duties that such persons could undertake. CONCLUSIONS: Skill mix requirements and organizational strategies to deal with the workforce changes are highlighted. Due to the current shortage of midwives in many countries and the dearth of extant research in this area, the results and recommendations have implications for midwives nationally and internationally.
Delphi Technique↗
Evidence-based clinical guidelines: a new system to better determine true strength of recommendation.
RATIONALE, AIMS AND OBJECTIVES: Clinical practice guidelines often grade the 'strength' of their recommendations according to the robustness of the supporting research evidence. The existing methodology does not allow the strength of recommendation (SOR) to be upgraded for recommendations for which randomized controlled trials are impractical or unethical. The purpose of this study was to develop a new method of determining SOR, incorporating both research evidence and expert opinion. METHODS: A Delphi technique was employed to produce 10 recommendations for the role of exercise therapy in the management of osteoarthritis of the hip or knee. The SOR for each recommendation was determined by the traditional method, closely linked to the category of research evidence found on a systematic literature search, and on a visual analogue scale (VAS). Recommendations were grouped A-D according to the traditional SOR allocated and the mean VAS calculated. Difference across the groups was assessed by one-way ANOVA variance analysis. RESULTS: Mean VAS scores for the traditional SOR groups A-D and one proposition which was 'not recommended' showed significant linearity on one-way ANOVA. However, certain recommendations which, for practical reasons, could not assessed in randomized controlled trials and therefore could not be recommended strongly by the traditional methodology, were allocated a strong recommendation by VAS. CONCLUSIONS: This new system of grading strength of SOR is less constrained than the traditional methodology and offers the advantage of allowing SOR for procedures which cannot be assessed in RCTs for practical or ethical reasons to be upgraded according to expert opinion.
Analysis of Variance↗
Does this patient need a narcotic injection? A descriptive analysis of decision making.
Thirty six nurses divided into three groups were asked in a series of three questionnaires to evaluate patients' needs for post-operative narcotic pain relief. Using a decision-analytic procedure, which combined a version of the Delphi technique and the multi-attribute utility approach, the six most salient criteria in order of priority were identified. These criteria were then tested in the clinical situation using a series of scenarios. A difference between how nurses purportedly evaluated patients' needs for narcotic pain relief and what they actually did in hypothetical clinical situations was found. The theoretical implications of these results are discussed.
Decision Support Techniques↗
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↗
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↗
Consensus methods: a bridge between clinical reasoning and clinical research?
Evidence-Based Practice does head the "hierarchy of evidence" upon which developments in clinical practice should be based. There are, however, situations where evidence is either unavailable, unclear, or results between studies are at variance. Consensus is a reliable contingency, and approaches to reaching consensus have acceptable construct validity (Nominal Group Technique, Delphi, and Consensus Development Conference). Consensus is reached when: (i) the method of investigation tightly controls communication to reduce the obscuring "noise" of divergent discussion; (ii) statistical measures of agreement or dissent screen out the bias that would otherwise be produced by the dictate of vociferous minorities or coalitions that may represent vested interests; (iii) all participants contribute equally to the product of the investigation.
Biomedical Research↗
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↗
Histologic changes in prostate carcinomas treated with leuprolide (luteinizing hormone-releasing hormone effect). Distinction from poor tumor differentiation.
BACKGROUND: Treatment of patients with prostate carcinoma using drugs with antiandrogenic effects is increasingly common. One of the most popular agents is leuprolide (with or without flutamide), an agonist of luteinizing hormone-releasing hormone (LH-RH). Prostates exposed to antiandrogenic agents develop distinctive pathologic changes. The ability of a group of 18 pathologists to recognize these LH-RH effects on prostate cancers and to distinguish them from poor tumor differentiation was tested using a Delphi technique. METHODS: The Delphi method maximizes the opportunity for individual contributions by eliminating opportunities for group dynamics and confrontational interaction. In this study, participants were provided with a set of duplicate transparencies and a list of written definitions of both poor tumor differentiation and LH-RH effect. They were instructed to examine the cases privately using the definitions provided and to distinguish poor tumor differentiation from LH-RH effect. Responses of the participants were shared anonymously, and each was asked to reexamine the cases in light of this knowledge. RESULTS: After a learning experience accomplished by one round of examination and feedback, LH-RH effect could be correctly distinguished from poor tumor differentiation in greater than 90% of cases by 83% of the participants. A small percentage of cases confounded complete consensus, although every case was correctly identified by most participants. CONCLUSIONS: The pathologic effects associated with androgen deprivation with leuprolide (plus flutamide) are sufficiently distinctive to be recognized by knowledgeable pathologists. In most cases, the tissue shrinkage representing a favorable response to the drug can be distinguished from solid or infiltrating patterns of poorly differentiated carcinoma.
Cell Differentiation↗
Categorization of major and minor complications in the treatment of patients with resectable rectal cancer using short-term pre-operative radiotherapy and total mesorectal excision: a Delphi round.
BACKGROUND: To properly balance the benefit (reduction of local recurrence) of short-term pre-operative radiotherapy for resectable rectal cancer against its harm (complications), a consensus concerning the severity of complications is required. The aim of this study was to reach consensus regarding major and minor complications after short-term radiotherapy followed by total mesorectal excision in the treatment of rectal carcinoma, using the Delphi technique. METHODS: A Delphi round was performed in cooperation with 21 colo-rectal surgeons from the Netherlands, United Kingdom and Sweden. The key-question was: 'Which of the predefined complications, caused or substantially aggravated by radiotherapy, are so important (major) that they might lead to the decision to abandon short-term pre-operative radiotherapy (5 x 5Gy) when treating patients with resectable rectal cancer (T1-3N0-2M0)?' RESULTS: After three rounds, consensus was reached for 37 (68%) of 54 complications of which 13 were considered major and 24 considered minor. The following complications were considered to be major: mortality, anastomotic leakage managed by relaparotomy, anastomotic leakage resulting in persisting fistula, postoperative haemorrhage managed by relaparotomy, intra-abdominal abscess without healing tendency, sepsis, pulmonary embolism, myocardial infarction, compartment syndrome of the lower legs, long-term incontinence for solid stool, long-term problems with voiding, pelvic fracture with persisting pain, and neuropathy with persisting pain (legs). Three of 17 complications without consensus showed a tendency to be considered as major: perineal wound dehiscence managed by surgical treatment, small bowel obstruction leading to relaparotomy and long-term incontinence for liquid stool. CONCLUSION: The 13 major and three 'accepted as major' complications can be used to properly balance the benefit and harm of short-term pre-operative radiotherapy in resectable rectal cancer. This may eventually lead to improved treatment strategies for these patients.
Belgium↗
Canadian therapists' priorities for clinical research: a Delphi study.
Clinically relevant physical therapy research questions were developed by a Delphi technique among 55 teaching hospital physical therapists. The Delphi technique used in this study involved three rounds of questionnaires that included characteristics of anonymity, feedback, ranking with statistical scoring, and use of informed respondents. Fifty-eight initial research questions were narrowed to 11 according to their potential benefit for the patient, for the practice of physical therapy, and for decreasing health care costs. A literature review revealed that each of the 11 questions were as yet unanswered. The use of the survey results to guide and plan for clinical research in physical therapy is discussed.
Canada↗
Defining collegiality within the academic setting.
Faculty development and performance are important issues within colleges of nursing. Collegiality is a performance requirement for promotion and tenure, but the behaviors synonymous with collegiality are frequently unwritten within the academic community as well as being poorly defined in the literature. The ambiguity that this situation produces is often experienced by faculty seeking tenure and promotion. Faculty at a midwestern university used the Delphi technique to determine behaviors synonymous with collegiality. Results of the Delphi rounds yielded specific behavioral indicators for the four broad statements that describe collegiality in the governance document of the university. Those statements include willingness to serve on committees and perform work necessary to departmental operations, willingness to provide guidance and help colleagues in their professional duties, respect for the ideas of others, and conduct of one's professional life without prejudice toward others. Findings revealed that while the area of collegiality is ambiguous, indicators of collegial behavior can be identified. Limitations and benefits of using the Delphi technique are discussed.
Career Mobility↗