Delphi methodology in healthcare research: How to decide its appropriateness

Assessing agreement on Canadian pediatric critical care training objectives in Japan

BACKGROUND

Japan has no accredited learning objectives for pediatric critical care medicine trainees. This study examined the extent of agreement among a panel of Japanese pediatric intensive care unit (PICU) directors regarding the need for the Canadian learning objectives in pediatric critical care knowledge and technical skills training.

METHODS

Using a two-round Delphi survey, we developed consensus among directors of PICUs in Japan on the Canadian training objectives in pediatric critical care medicine. To assess agreement, we applied a four-point Likert scale (1 = unnecessary, 2 = relatively unnecessary, 3 = relatively necessary, 4 = necessary). We conducted a web-based survey and an Excel-based survey over 4 week periods for the first and second rounds, respectively. Consensus was set at ≥80% agreement; items rated 3 or 4 by ≥80% participants in either rounds were included in the final list.

RESULTS

Of the 36 PICU directors invited, 32 (88.9%) completed all survey rounds. In the first round, 164 items were agreed to be necessary, one item was deemed unnecessary, the directors did not reach agreement on 15 items, and these items were included in the second round. In the second round, five items were agreed to be necessary and agreement could not be reached on 10 items. Finally, there was agreement on 169 (94.9%) of the Canadian learning objectives after the two-round Delphi survey. Sixteen participants commented that non-technical skills, such as communication, collaboration, management, and education, were important additional objectives.

CONCLUSIONS

Strong consensus was observed among Japanese pediatric critical care experts concerning the Canadian learning objectives for pediatric critical care knowledge and technical skills training.

A Delphi Consensus Approach for the Management of Chronic Pain during and after the COVID-19 Era

Due to a lack of published evidence on the topic, a modified Delphi approach was used to develop recommendations useful for chronic pain management during and after the COVID-19 pandemic. Focusing on the available literature and personal clinical expertise, an Italian board of nine professionals from different disciplines identified four main topics: prevention of chronic pain, treatment of chronic pain, consequences of inadequate treatment, and perspectives. They elaborated a semi-structured questionnaire. A multidisciplinary panel of experts in the field of pain management was requested to comment on the statements. Based on the answers provided, a structured questionnaire was prepared (Round 1). It included 21 statements divided into three categories (organizational issues; diagnosis and therapies; telemedicine and future perspectives). A five-point Likert scale was adopted. The threshold for consensus was set at a minimum of 70% of the number of respondents (level of agreement ≥ 4, Agree or Strongly Agree). A final questionnaire with rephrasing of the statements that did not reach the consensus threshold was elaborated (Round 2). A total of 29 clinicians were included in the panel. Twenty clinicians (69%) responded in both the first and second round. After two rounds, consensus (≥70%) was achieved in 20 out of 21 statements. The lack of consensus was recorded for the statement regarding the management of post-COVID pain (55%; Median 4; IQR 2.3). Another statement on telemedicine reached the threshold in the first round (70%), but the value was not confirmed in Round 2 (65%; Median 4; IQR 2). Most of the proposed items reached consensus, suggesting the need to make organizational changes, the structuring of careful diagnostic and therapeutic pathways, and the application of new technologies in pain medicine. Long-COVID-19 care is an issue that needs further research. Remote assistance for chronic pain must be regulated.

Information preferences about treatment options in diffuse cutaneous systemic sclerosis: A Delphi consensus study

Objectives:

The aim of this study was to identify and prioritize aspects essential for decision making in patients with diffuse cutaneous systemic sclerosis (dcSSc) and to gain insight into information preferences of treatment options which could guide development of a leaflet for patients.

Methods:

A three-round Delphi study was conducted with a panel of patients with dcSSc. The questionnaire was based on a systematic literature search regarding benefits and harms of four main treatment options in dcSSc: methotrexate, mycophenolate mofetil, cyclophosphamide pulses and stem cell transplantation. Patients were asked to identify information that is essential for making a treatment decision. After the third round, a live, online discussion was held in order to reach consensus on these items and to discuss the content and design of the leaflet. Consensus was defined as ⩾75% agreement among panel members.

Results:

Of the 36 patients invited, 78% (n = 28) participated in one or more rounds, 67% (n = 24) completed the first, 69% (n = 25) the second and 75% (n = 27) the third round. In the last round, median age of participants was 51 years (interquartile range, 18) and median disease duration 4 years (interquartile range, 5); 52% were female. Patients had been treated with mycophenolate mofetil (67%), methotrexate (44%), cyclophosphamide (41%), autologous stem cell transplantation (26%), rituximab (4%) or were treatment-naïve (7%). Eight patients joined the live panel discussion. The panel reached consensus on seven benefits (prolonged progression-free survival, improved quality of life, improved daily functioning, improved pulmonary function, improved skin thickness, improved mobility and reduced fatigue) and four harms (treatment-related mortality, infections, cardiac damage, increased risk of cancer) as essential information for decision making. Also a design of a leaflet was made.

Conclusion:

This study identified information about treatment options in dcSSc that should be addressed with patients. Our results can be used to develop effective patient information.