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PubMed1996

Conflicts experienced by quality assurance/improvement professionals: A Delphi study.

A Delphi survey was conducted to investigate the frequency and importance of conflicts identified by quality assurance/improvement professionals as well as the actions taken and resources used to deal with the conflicts. Responses to three rounds of the Delphi survey from 86 participants indicated that the predominant conflicts involved intrapersonal concerns, such as worry about the future, interpersonal and political barriers to change in quality work, and, rarely, ethical conflicts. A variety of collaborative and educational strategies were used to deal with conflicts. Results may be useful to examine from the perspective of health care professionals currently involved in quality work.

Adaptation, Psychological↗

PubMed2003

The use of a modified Delphi procedure for the determination of 26 prognostic factors in the sub-acute stage of stroke.

The aim of this study was to reach consensus about the prognostic factors when deciding the discharge destination from a hospital stroke unit, and to construct a prognostic conceptual framework. To realise an optimal integration of knowledge from research findings and from clinical experience by expert opinions we used a 'modified Delphi Technique', which is the most commonly used method for the production of clinical guidelines. The process yielded 26 prognostic factors, which were arranged in clinical and social sub-domains. The sub-domains and the factors within each sub-domain were prioritised according to their assumed predictive value for the decision process. The order of importance of the prognostic factors in the clinical domain was: (1) disabilities, (2) pre-morbid disabilities, (3) impairments and (4) disease/biology; and the order of importance of the factors in the social domain was: (1) home front, (2) social situation and (3) residence. The Delphi procedure is an excellent instrument to determine and prioritise prognostic factors. With this procedure research-based and consensus-based knowledge can be combined. For a valid procedure it is mandatory to state explicitly in advance how the scores will be judged, and to explain the scientific level of the evidence during the whole procedure.

Activities of Daily Living↗

PubMedDate not supplied

Burn nursing Delphi study: pain management.

In 1989 a Delphi study was undertaken to identify the nursing priorities in burn research. The Delphi technique is a series of questionnaires used to reach consensus. Ninety-four nurses involved in burn care completed four rounds of questionnaires containing 101 research questions. This, the seventh and final report, concerns a significant area of burn research, which is pain management. Eleven (10%) of the 101 questions dealt with pain, whereas five were rated among the top 20 priority questions. As a category the questions concerning pain management had a mean score of 5.91 on a 0 to 7 Likert scale. The questions collectively were cited as having the most impact on the welfare of the patient with burns.

Analgesics↗

PubMed2006

Defining the dermatological content of the undergraduate medical curriculum: a modified Delphi study.

BACKGROUND: Dermatological problems are common, but in undergraduate medical courses time for learning dermatology and teaching dermatology is limited. The Delphi technique has been used in other specialties to define undergraduate and postgraduate curricula and to reach consensus on what is important. OBJECTIVES: To identify the core dermatological content of the undergraduate medical curriculum. METHODS: Modified Delphi technique. A questionnaire was designed after review of previous recommendations made by dermatologists. Items were written as explicit learning outcomes. A multidisciplinary panel of 66 individuals responded. Outcomes were rated using a Likert scale (1-5). RESULTS: Fifty-three learning outcomes were rated 'very important'. We recommend that these are included in the content of U.K. undergraduate medical core curricula. CONCLUSIONS: A multidisciplinary panel identified dermatological learning outcomes that should be achieved by all medical graduates. Undergraduate medical curricula must provide sufficient resources for learning, teaching and assessment of dermatology so that graduates achieve these outcomes.

Clinical Competence↗

PubMed1994

The Delphi technique: a methodological discussion.

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.

Clinical Competence↗

PubMed2006

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↗

PubMed2002

The development of indicators to measure the quality of clinical care in emergency departments following a modified-delphi approach.

OBJECTIVE: To develop and apply a systematic approach to identify and define valid, relevant, and feasible measures of emergency department (ED) clinical performance. METHODS: An extensive literature review was conducted to identify clinical conditions frequently treated in most EDs, and clinically relevant outcomes to evaluate these conditions. Based on this review, a set of condition-outcome pairs was defined. An expert panel was convened and a Modified-Delphi process was used to identify specific condition-outcome pairs where the panel felt there was a link between quality of care for the condition and a specific outcome. Next, for highly rated condition-outcome pairs, specific measurable indicators were identified in the literature. The panelists rated these indicators on their relevance to ED performance and need for risk adjustment. The feasibility of calculating these indicators was determined by applying them to a routinely collected data set. RESULTS: Thirteen clinical conditions and eight quality-of-care outcomes (mortality, morbidity, admissions, recurrent visits, follow-up with primary care, length of stay, diagnostics, and resource use) were identified from the literature (104 pairs). The panel selected 21 condition-outcome pairs, representing eight of 13 clinical conditions. Then, the panel selected 29 specific clinical indicators, representing the condition-outcome pairs, to measure ED performance. It was possible to calculate eight of these indicators, covering five clinical conditions, using a routinely collected data set. CONCLUSIONS: Using a Modified-Delphi process, it was possible to identify a series of condition-outcome pairs that panelists felt were potentially related to ED quality of care, then define specific indicators for many of these condition-outcome pairs. Some indicators could be measured using an existing data set. The development of sound clinical performance indicators for the ED is possible, but the feasibility of measuring them will be dependent on the availability and accessibility of high-quality data.

Consensus↗

PubMed1998

Essential components of schizophrenia care: a Delphi approach.

Other than medication and access to in-patient care, there is little published consensus on the essential components of schizophrenia care. This paper reports a Delphi approach to the identification of these components. This approach identifies and measures the degree of consensus, using a structured iterative series of questionnaires by a group of experienced UK and Irish psychiatrists (n = 15) on the essential components. Pharmacotherapy, in-patient care and community mental health team (CMHT) staffing were explicitly excluded from the study. In total, 106 components were identified and their importance was rated twice. There was consensus on 92% of the components and strong consensus on 64%. The Delphi results were refined by the participants to produce 10 essential components of care.

Delphi Technique↗

PubMed2002

Expert consensus in the development of a European health-related quality of life measure for children and adolescents: a Delphi study.

AIM: To determine the level of consensus among experts regarding content, structure and sources of content for a new European measure of health-related quality of life in children and adolescents. METHODS: A three-round Delphi questionnaire was sent by e-mail to 24 experts in quality of life measurement in 9 European countries. Consensus was considered reached when > 90% of experts either agreed or disagreed with a given statement, or where median scores were over 6 on a scale of 1-10, and score dispersion was within predefined limits. RESULTS: Completed questionnaires were received from 20 panellists in each round. It was agreed that the new instrument should be a multidimensional, profile measure with 30-49 items covering 5-8 dimensions, which should take no more than 10-15 min to complete. Agreement was also reached on 8 specific dimensions to include in the questionnaire (psychological well-being, self-esteem, body image, cognitive functioning, mobility, energy/vitality, social relations, family/home function). Consensus was against the use of individualized questionnaires. Focus groups with children, parents and workers in the field, literature and instrument reviews were considered appropriate sources for content. CONCLUSION: Using a Delphi method in this way for the first time showed it to be a feasible and useful method for establishing a conceptual and operational framework for the Kidscreen questionnaire.

Adolescent↗

PubMed2004

The changing role of the emergency department in the Northern Territory: a Delphi study.

OBJECTIVE: To explore the changing role of EDs in Northern Territory hospitals. METHODS: A two-round Delphi study was undertaken by recruiting a panel of health professionals from the EDs of the five Northern Territory public hospitals. Participants in round one were asked to list changes they have encountered and how these changes have affected health service delivery, as well as five factors that were responsible for the changes. During the second round they prioritized the factors identified in order of importance. RESULTS: Twenty-four ED staff returned their questionnaire. Global changes identified were more verbal/physical abuse from patients, followed by increase in acuity of patient presentations. The most important factor perceived as responsible for the changes was budget cuts, resulting in fewer inpatient beds, an increase in access block and sicker patients being discharged too early. CONCLUSION: The Delphi evaluation provided insights into the problems facing the ED from the staff perspective and offered some suggestions to deal with the emerging issues.

Adult↗

PubMed2004

Defining the sports medicine specialist in the United Kingdom: a Delphi study.

OBJECTIVE: To define the role and responsibilities of the sports medicine specialist using a recognised research technique. METHODS: A Delphi technique was employed using anonymous postal questionnaires sent to a random sample of 300 members of the British Association of Sport and Exercise Medicine. The questionnaire of 300 putative attributes was developed in a pilot study and the Delphi technique used allowed participants to modify their responses according to the responses of other participants. RESULTS: There was a 53% response to both rounds of the study with 75.6% of the respondents being male, 39% having a higher qualification in sports medicine, and 45.6% being general practitioners. Some 86.3% strongly agreed that sport and exercise medicine should be a recognised speciality and 90% strongly agreed that it should be available on the National Health Service (NHS). The most important specialist attributes were orthopaedic and soft tissue medicine (83.6% strongly agreed) and emergency medical management (79.7% strongly agreed). More than 75% of respondents did not agree that either research or personal playing experience were relevant. CONCLUSION: Sports and exercise medicine is an evolving speciality in the United Kingdom. We believe this is the first systematic attempt to define the role and responsibilities of the sports medicine specialist and the findings are of relevance to the future development of a career pathway.

Attitude of Health Personnel↗

PubMed2006

A procedure based alternative to the injury severity score for major incident triage of children: results of a Delphi consensus process.

BACKGROUND: Triage at the site of a major incident is key to effective scene management. A number of triage algorithms have been suggested to assist the triage officer to determine triage priorities. However, many advocated scores were not specifically developed for use in major incidents, nor are they designed for multiple age groups. Many of these algorithms have not been validated: those that have were validated against the Injury Severity Score, which is of little relevance in a major incident--it is the urgency of medical intervention that is of importance in this setting. OBJECTIVES: To develop a set of criteria against which major incident triage algorithms can be tested. METHODS: Sixteen experts from the UK and South Africa took part in a three round Delphi consensus method in order to develop clinical criteria against which major incident triage algorithms may be tested. RESULTS: Thirty nine statements were initially identified as possible determinants of triage priority: 29 statements reached consensus. These associate specific clinical interventions with triage priority. CONCLUSION: Delphi may be used to identify which clinical criteria define triage priority in a major incident setting. These criteria and the associated triage categories may be used as for the validation of specific major incident triage algorithms. This method may be used to develop specific criteria for other triage algorithms.

Algorithms↗

PubMed1997

Priorities in occupational health research: a Delphi study in The Netherlands.

OBJECTIVES: To achieve a coherent programme of topics for research in occupational health and safety, with well founded priorities and to relate them to perceived gaps and needs in The Netherlands. METHODS: In the first phase of the study 33 key informants were interviewed. In the second phase questionnaires were sent to 150 Dutch experts (including the key informants). Four groups were recruited, originating from: occupational health and safety services; scientific research institutes; governmental and other administrative bodies; and companies. Using the Delphi technique, the experts were asked to prioritize several topics, which were placed under different headings. In the third phase five workshops were organised to elaborate on the highly prioritized topics. RESULTS: The response rates were 86% for the first and 81% for the second questionnaire. In the second round consistency was reached and consensus proved to be satisfactory; so that the Delphi process was stopped. There were surprisingly few differences in opinion between the four groups. The most important heading was "design/implementation/evaluation of measures", in which the topic cost-benefit analysis of measures had the highest score. "Assessment of relations between exposure and effect" was the second most important heading. Under this heading, topics on work stress were generally judged to be more important than topics on safety and biological, chemical, and physical hazards. The headings "occupational rehabilitation/sociomedical guidance" and "occupational health care/occupational health services" had about the sam priority, closely following the heading "assessment of relations between exposure and effect". CONCLUSIONS: The general agreement on priorities should provide a sufficiently broad basis for decision makers to initiate a long term programme for occupational health research and development in The Netherlands.

Delphi Technique↗

PubMed2001

Occupational health research priorities in Malaysia: a Delphi study.

OBJECTIVES: As part of a consultancy project on occupational health, the Delphi method was used to identify research priorities in occupational health in Malaysia. METHODS: Participation was sought from government ministries, industry, and professional organisations, and university departments with an interest in occupational and public health. Two rounds of questionnaires resulted in a final list of priorities, with noticeable differences between participants depending on whether they worked in industry or were from government organisations. RESULTS: The participation rate of 71% (55 of 78) was obtained for the first questionnaire and 76% (72 of 95) for the second questionnaire. The participants identified occupational health problems for specific groups and industries as the top research priority area (ranked as top priority by 25% of participants). Ministry of Health participants placed emphasis on healthcare workers (52% ranking it as top priority), whereas those from industry identified construction and plantation workers as groups, which should be accorded the highest priority. Evaluation of research and services was given a low priority. CONCLUSIONS: The priorities for occupational health determined with the Delphi approach showed differences between Malaysia, a developing country, and findings from similar European studies. This may be expected, as differences exist in stages of economic development, types of industries, occupational activities, and cultural attitudes to occupational health and safety. Chemical poisonings and workplace accidents were accorded a high priority. By contrast with findings from western countries, workplace psychosocial problems and musculoskeletal injuries were deemed less important. There also seemed to be greater emphasis on adopting interventions for identified problems based on experience in other countries rather than the need to evaluate local occupational health provisions.

Delphi Technique↗

PubMed2004

How do stakeholder groups vary in a Delphi technique about primary mental health care and what factors influence their ratings?

BACKGROUND: While mental health is a core part of primary care, there are few validated quality measures and little relevant internationally published research. Consensus panel methods are a useful means of developing quality measures where evidence is sparse and/or opinions are diverse. However, little is known about the dynamics of consensus techniques and the factors that influence the judgements and ratings of panels and individual panelists. OBJECTIVES: (1) To describe differences in panel ratings on the quality of primary mental health care services by patient, carer, professional and managerial panels within a Delphi procedure; and (2) to explore why different panels and panelists rate quality indicators of primary mental health care differently. DESIGN: Two round postal Delphi technique and exploratory semi-structured interviews. PARTICIPANTS: 115 panelists across 11 panels. Eleven panelists were subsequently interviewed. RESULTS: 87 of 334 indicators (26%) were rated face valid by all 11 panels. There was little disagreement within panel ratings but significant differences between panels. The GP panel rated the least number of indicators valid (n = 138, 41%) and carers the most (n = 304, 91%). The way in which panelists interpreted and conceptualised the indicators and their definition of quality of mental health care affected the way in which participants made their ratings. CONCLUSIONS: Stakeholders in primary mental health care have diverse views of quality of care and these differences translate into how they rate quality indicators. Exploratory interviews suggest that ratings are influenced by past experience, expectations, definitions of quality of care, and perceived power relationships between stakeholders.

Attitude of Health Personnel↗

PubMed1996

Policy priorities in diabetes care: a Delphi study.

OBJECTIVES: To produce policy priorities for improving care of diabetes based on the findings of original research into patient and professional opinions of diabetes care in South Tyneside. To judge the feasibility of implementing these priorities as policy. DESIGN: A two round Delphi survey with a panel of 28 ¿experts.¿ In the first round each respondent produced a list of recommendations based on the findings of a report of patients' and professionals' opinions of diabetes care. 20 respondents produced a total of 180 recommendations, reviewed by a monitoring panel to produce a summary list of 28 recommendations. In the second round respondents rated each recommendation on two 5 point Likert scales. SETTING: Mainly Tyneside but also other parts of England. SUBJECTS: 28 healthcare professionals, including patients and patients' representatives. MAIN MEASURES: Voting by experts on how important each recommendation was to improving diabetes care service, and how likely the recommendation was to be implemented in the next five years. RESULTS: There was a high degree of consensus among respondents about recommendations considered important and likely to be implemented--namely, those concerned with improving communications between doctors in hospital and in general practice, and improving communications with patients. Respondents were more pessimistic about the prospects of implementing the recommendations than about their importance. Respondents thought that standards were important for improving care, and half would stop payments to general practice diabetic clinics that did not keep to district standards for diabetes care. For two recommendations a mismatch occurred between the importance of the recommendations and likelihood of implementation. This may reflect the practical problems of implementing recommendations. 18 of the 22 respondents thought that the study was useful in generating recommendations. CONCLUSIONS: The Delphi technique is a useful method for determining priorities for diabetes care and in assessing the feasibility of implementing recommendations.

Attitude of Health Personnel↗

PubMed2000

A Delphi approach to describing service models of community mental health practice.

OBJECTIVE: The activities of mental health practitioners are poorly understood and described because of a lack of generally accepted and understandable categories. Greater precision is needed for accountability, planning, and evaluation. The objective of this study was to identify a valid and reliable set of categories to describe the clinical work practices of intensive case managers in the United Kingdom. METHODS: Eight intensive case managers participated in a Delphi process to produce a set of categories that described their clinical work practices. They each completed three questionnaires and participated in a final group discussion. RESULTS: The initial open questionnaire generated 38 potential categories after exact duplicates were removed. In round 2, the intensive case managers each rated the 38 categories from 1 to 5 (essential to unimportant). A high degree of consensus on the relative importance of the 38 suggested practice categories was rapidly achieved. In round 3, they re-rated the categories in the light of group medians and their own round 2 ratings. In a structured face-to-face discussion group, the intensive case managers then reduced the 38 potential categories to ten comprehensive and mutually exclusive categories that were judged to adequately and accurately reflect work practices. They were housing, finance, daily living skills, criminal justice system, occupation and leisure, engagement, physical health, caregivers and significant others, specific mental health intervention or assessment, and medication. CONCLUSIONS: Delphi methods were effective and relatively straightforward in producing an agreed-on set of categories with which to record clinical activity and inform care planning.

Case Management↗

PubMed1994

A Delphi study of the basic principles and corresponding care goals of holistic nursing practice.

This descriptive, non-experimental study using the Delphi survey process identified basic holistic health principles for which holistic nurse practitioners agreed guide their healing practice. Seventeen expert holistic nurse practitioners (and AHNA leaders) comprised the respondent group. On the average these practitioners have been nurses for 25 years and holistic practitioners for 11 years. Seventy percent of the group completed all three Delphi rounds indicating their agreement regarding 25 principles of holistic health, their applicability to practice, and care goals related to each principle. A high level of consensus was reached regarding 17 principles. In addition to affirming principles related to unity, interdependence, evolution, energy fields, and interactions, the AHNA expert nurse practitioners strongly emphasized spirituality. The group addressed reality as a unified whole, not limited by the material universe, supporting a practice model based on holographic perspectives.

Delphi Technique↗