Delphi methodology in healthcare research: How to decide its appropriateness

Development of an instrument to measure the attitudes and skills of undergraduate nursing students in caring for family caregivers: An international multi-method study

BACKGROUND

The increasing demands on family caregivers due to the shortage of healthcare professionals and the rising prevalence of chronic conditions underscore the need for adequate nursing support to enhance family caregivers' abilities and reduce their burden. No instrument exists to measure undergraduate nursing students' attitudes and skills in involving family caregivers. This study aimed to develop a questionnaire to evaluate undergraduate nursing students' attitudes and skills in caring for family caregivers.

METHODS

A three-phase multi-method study was conducted involving a consortium of five universities in Italy, Denmark, India, Spain, and Sweden. Theoretical models and literature analysis and review informed initial item generation. Then, a Delphi process with purposefully selected international experts across three rounds refined the item list based on clarity, essentiality, and relevance, achieving consensus on a final set of items. Finally, pilot testing with purposefully selected 25 students assessed face validity and clarity.

RESULTS

The preliminary phase led to 130 items. Delphi rounds reduced the initial 130 items to a refined set of 39 (13 items on attitudes, 26 on skills). Content Validity Index (CVI) scores for clarity and relevance were high (S-CVI/Ave = 0.93 for clarity, 1.0 for relevance). From the pilot test among 25 students, items scored an average clarity of 0.84 (I-CVI). Two items were removed, resulting in a final 37-item questionnaire (12 attitudes, 25 skills).

DISCUSSION

The developed questionnaire bridges a gap in nursing education assessment. Emphasizing attitudes and skills, it addresses key areas such as understanding family dynamics, emotional support, and collaborative planning with caregivers, aligning with nursing education needs across diverse cultural contexts. The use of this instrument will support educational programs in enhancing family-centered care competencies of undergraduate nursing students, ultimately improving support for family caregivers in healthcare settings.

Modification of the Adjustment Disorder New Module20 (ADNM-20) for Use in Military Environments (ADNM-20-MIL): A Delphi and Pilot Study

OBJECTIVES

Despite its high prevalence and strong linkages with dangerous health outcomes, research on Adjustment Disorder (AjD) is hindered by lack of diagnostic clarity. AjD is categorized as a stress-related disorder, highlighting the important role of the stressor(s) on AjD symptom onset and severity. The military community shows increased risk for AjD, and existing tools do not capture the stressors most relevant and appropriate to this unique community. A diagnostic assessment tool developed specifically for this specialized population may provide critical capability to clinical assessment.

METHODS

A Delphi method was used to create a military-specific version of the standard assessment for Adjustment Disorders (ADNM-20), named ADNM-20-MIL. This tool was pilot-tested in a sample of U.S. Active Duty Service Members (ADSMs) with AjD diagnoses.

RESULTS

Throughout the Delphi process, military-specific stressors were identified and integrated into the ADNM-20-MIL, then refined and validated, ensuring their applicability and relevance to the military context.

CONCLUSIONS

The ADNM-20-MIL will enable timely diagnosis and targeted treatment for AjD, which remains a highly prevalent and destabilizing diagnosis in ADSMs.

Refining partial gland ablation for localised prostate cancer: the FALCON project

OBJECTIVES

To provide a contemporary statement on focal therapy (FT) for localised prostate cancer (PCa) from an international and diverse group of physicians treating localised PCa, with the aim of overcoming the limitations of previous consensus statements, which were restricted to early adopters, and to offer direction regarding the various aspects of FT application that are currently not well defined.

MATERIALS AND METHODS

The FocAL therapy CONsensus (FALCON) project began with a 154-item online survey, developed following a steering committee discussion and literature search. Invitations to participate were extended to a large, diverse group of professionals experienced in PCa management. From 2022 to 2023, a Delphi consensus study consisting of three online rounds was conducted using the Modified Delphi method. A 1-9 Likert scale was used for the survey, which was followed by an in-person expert meeting. The threshold for achieving consensus was set at 70% agreement/disagreement. Six main aspects of FT were covered: (i) patient selection; (ii) energy source selection; (iii) treatment approach; (iv) treatment evaluation and follow-up; (v) treatment cost and accessibility; and (vi) future perspectives.

RESULTS

Of 246 initial participants, 148 (60%) completed all three rounds. Based on participant feedback, 27 new statements were added in the second round, and 33 questions related to personal expertise, for which consensus was not necessary, were excluded. After the third and final round, consensus had not been reached for 69 items. These items were discussed at the in-person meeting, resulting in a consensus of 57 additional items. Consensus was finally not reached on 12 items. Given the volume of data, the voting outcomes are summarised in this article, with a detailed breakdown presented in the form of figures and tables.

CONCLUSIONS

The FALCON project delivered a significant consensus on the approach to FT for localised PCa. Additionally, it highlighted gaps in our knowledge that may provide guidance for future research.

Essential competencies of nurses working with AI-driven lifestyle monitoring in long-term care: A modified Delphi study

BACKGROUND

As more and more older adults prefer to stay in their homes as they age, there's a need for technology to support this. A relevant technology is Artificial Intelligence (AI)-driven lifestyle monitoring, utilizing data from sensors placed in the home. This technology is not intended to replace nurses but to serve as a support tool. Understanding the specific competencies that nurses require to effectively use it is crucial. The aim of this study is to identify the essential competencies nurses require to work with AI-driven lifestyle monitoring in long-term care.

METHODS

A three round modified Delphi study was conducted, consisting of two online questionnaires and one focus group. A group of 48 experts participated in the study: nurses, innovators, developers, researchers, managers and educators. In the first two rounds experts assessed clarity and relevance on a proposed list of competencies, with the opportunity to provide suggestions for adjustments or inclusion of new competencies. In the third round the items without consensus were bespoken in a focus group.

FINDINGS

After the first round consensus was reached on relevance and clarity on n = 46 (72 %) of the competencies, after the second round on n = 54 (83 %) of the competencies. After the third round a final list of 10 competency domains and 61 sub-competencies was finalized. The 10 competency domains are: Fundamentals of AI, Participation in AI design, Patient-centered needs assessment, Personalisation of AI to patients' situation, Data reporting, Interpretation of AI output, Integration of AI output into clinical practice, Communication about AI use, Implementation of AI and Evaluation of AI use. These competencies span from basic understanding of AI-driven lifestyle monitoring, to being able to integrate it in daily work, being able to evaluate it and communicate its use to other stakeholders, including patients and informal caregivers.

CONCLUSION

Our study introduces a novel framework highlighting the (sub)competencies, required for nurses to work with AI-driven lifestyle monitoring in long-term care. These findings provide a foundation for developing initial educational programs and lifelong learning activities for nurses in this evolving field. Moreover, the importance that experts attach to AI competencies calls for a broader discussion about a potential shift in nursing responsibilities and tasks as healthcare becomes increasingly technologically advanced and data-driven, possibly leading to new roles within nursing.

Developing a Prototype Home-Based Toothbrushing Support Tool for Families in Scotland: A Mixed-Methods Study With Modified Delphi Survey and Semi-Structured Interviews

BACKGROUND

Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (Uitblinkers) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice.

METHODS

A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (n = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from Uitblinkers, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis.

RESULTS

From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical 'paper' tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are workable; (4) the tool is generally feasible within the operation of Childsmile home visits; (5) the tool is not less applicable for children with additional support needs.

CONCLUSIONS

A card-based conversational intervention to provide targeted home toothbrushing support for families of young children (0-3 years) in the home setting in Scotland, drawing from a template from the Netherlands, has been deemed worthy of further testing based on expert consensus and staff views on barriers faced, appropriate behaviour change techniques to address these and the design of a physical tool.

The participation of lifeworld experts in Delphi processes: A reflection on method and practice

Delphi studies have established themselves in the health sciences as a means to systematically and, ideally, synthesize expert opinions into a consensus on concrete issues. As participatory health research increases in relevance, lifeworld experts (e.g., patients, caregiving relatives) are being included in Delphi surveys and their opinions placed alongside those of professional and scientific experts. Looking at the theory and methodology, we discuss the opportunities and challenges concerning result quality and derive practical implications for conducting Delphi studies involving lifeworld experts alongside scientific and/or professional experts. Delphi techniques are understood here to be social interaction processes whose outcomes are a result of the participating experts' conscious, cognitive judgment processes, and also shaped by individual, situational and cultural factors. The more heterogeneous the expert panel, in particular when lifeworld experts are participating, the more these influences vary. Expert panel composition and how diversity is handled prove significant to Delphi study results. Our argument is based on an in-depth analysis of a systematic review of Delphi studies with lifeworld experts. We found that the inclusion of lifeworld experts in Delphi studies usually occurs relatively unsystematically and, furthermore, that results are not analysed separately according to expert group, although there would be good reasons for this. We have oriented the reporting here on PRISMA. To enhance the outcomes of Delphi studies that incorporate lifeworld experts alongside scientific and/or professional experts, we put forward specific recommendations that address potential biases arising from the participation of lifeworld experts.

Principles of the superior labrum and biceps complex: an expert consensus from the NEER Circle

BACKGROUND

The superior labrum and biceps complex is commonly implicated in shoulder pain and there remains discordance regarding the surgical management of superior labrum anterior to posterior (SLAP) tears. The purpose of this study was to establish an expert consensus regarding the management of superior labrum and biceps complex pathology.

METHODS

The NEER Circle is an organization of shoulder experts recognized for their service to the American Shoulder and Elbow Surgeons (ASES) society. Consensus among 92 identified experts was sought with a series of surveys pertaining to the management of superior labrum and biceps complex (SBC) pathology. The initial survey featured questions crafted to determine the experience of the panel in treating SBC pathology. The second survey was designed to elicit opinions concerning the diagnosis and treatment of SBC pathology. The third survey aimed to establish consensus across 48 scenarios, tasking panelists with categorizing 4 surgical modalities as either preferred, acceptable, or not acceptable. The available options included débridement, SLAP repair, biceps treatment, or a combined repair and biceps treatment. In the final survey, the panelists were tasked with diagnosing SBC pathologies by assessing arthroscopic footage and evaluating treatment options within 45 scenarios. A minimum of 80% agreement was required to attain consensus, designating a treatment as either preferred or unacceptable.

RESULTS

Response rates ranged from 52.2% to 58.7%. Discordance exists regarding aspects of the physical examination, patient history, imaging, nonoperative management, and the surgical approach in SBC injuries. Of the 78 clinical scenarios, 26 reached consensus agreement. Treating the biceps was the favored approach in older, more sedentary patients with evidence of biceps tendinopathy. Performing a SLAP repair was favored in scenarios depicting younger, more active patients with signs of an unstable biceps anchor or mechanical symptoms. A SLAP repair was typically contraindicated in the setting of an older patient, concomitant rotator cuff tear, and/or a prior failed SLAP repair. The management of overhead throwing athletes, particularly those that are professionals, remained controversial, although SLAP repair is generally favored in younger pitchers.

CONCLUSION

The optimal management of superior labrum and biceps complex pathology requires a systematic approach based on the individual's age, occupational demands, and functional requirements. Age was the predominant factor influencing surgical decision making. SLAP repairs are generally favored in younger, active patients, whereas treating the biceps is preferred in lower-demand patients aged >30 years. Little consensus was observed regarding the management of competitive athletes.

Best practice recommendations for physiotherapists providing telerehabilitation to First Nations people: a modified Delphi study

OBJECTIVES

This study aimed to develop best practice recommendations for physiotherapists providing telerehabilitation to First Nations people.

DESIGN

Modified Delphi study.

PARTICIPANTS

Eighteen experts from four groups were selected: (a) physiotherapists who provide telerehabilitation to First Nations people, (b) Carrier Sekani Family Services leaders (CSFS, First Nations-led health organization/research partners), (c) telehealth experts from British Columbia (BC), Canada, and (d) First Nations individuals (end users) with experience in telerehabilitation.

METHODS

Panelists rated recommendations on telehealth best practices in two rounds using an online questionnaire. Recommendations were synthesized from a scoping review and two qualitative studies. Each statement was rated on a four-point Likert scale indicating whether it was essential, useful, not useful, or unnecessary for inclusion in the best practices. Statements endorsed by ≥80% of panel members were considered for inclusion in the final document.

RESULTS

Following the Delphi process, 77 recommendations covering foundational components, information technology utilization, professional expertise, therapeutic relationships, cultural safety, and the telehealth visit were validated for inclusion in the policy document. Participants also validated the methodology.

CONCLUSION

The recommendations offer a valuable resource for continuing education and professional development, empowering physiotherapists to enhance their skills and competencies in delivering culturally competent telerehabilitation to the First Nations population. The adoption of these best practices ensures that First Nations people are getting the best standard of care, potentially enhancing uptake and experiences with telehealth. It also enables healthcare organizations and policymakers to monitor adherence to established standards and identify areas for improvement. CONTRIBUTION OF THE PAPER.

Consensus Recommendations for Sustainable and Equitable Neonatology Staffing: A Delphi Approach

BACKGROUND AND OBJECTIVE

The specialty of neonatology faces significant and growing challenges related to patient safety, physician well-being, and workforce sustainability that highlight the necessity for innovative work models. Our objective was to develop consensus recommendations to improve neonatologist staffing practices in the United States.

METHODS

We used a modified Delphi process with 32 diverse subject-matter expert stakeholders to reach consensus. We derived 60 initial potential recommendations for improved staffing from the literature and our 2 previous studies of physician leaders. We defined consensus as 80% or higher agreement and strong consensus as 90% or higher agreement. We ultimately eliminated statements that achieved less than 80% consensus from the recommendations.

RESULTS

Fifty-one individual statements reached consensus and were grouped into 24 final recommendations to improve neonatology staffing. Topics of focus included clinical allocations (eg, clinic work is counted in hours/year), shift characteristics (eg, clinical work after 24 hours is minimized), allocation of nonclinical work (eg, nonclinical work is accounted for in full-time equivalent), and staffing flexibility (eg, options to restructure clinical work are provided for specific circumstances such as aging and pregnancy). Significant discussion on many statements focused on ensuring that recommendations were both feasible and not overly prescriptive for individual institutions.

CONCLUSIONS

We reached consensus on a set of neonatologist staffing recommendations that emphasize the critical issues related to patient safety and physician well-being. Future work will focus on advocating for widespread implementation of these recommendations and evaluating their effect on patient safety, physician well-being, and sustainability of the neonatal workforce.

Latin American Consensus on Ocular Lubricants and Dry Eye Disease (LUBOS): A Report on Severity Classification, Diagnosis, and Therapy

PURPOSE

This consensus aims to establish a practical severity classification for applying a tailored stepladder treatment algorithm helpful to any clinician.

METHODS

A modified Delphi methodology was used to establish a consensus on the definition, diagnosis, severity classification, and treatment algorithms for dry eye disease (DED) adapted to the needs of Latin America. The consensus focused on promoting the effective use of lubricants and providing straightforward, practical guidance for ophthalmologists treating dry eyes. Twenty-eight corneal specialists from representative Latin American countries reviewed the scientific evidence and drew on their expertise to answer specifically designed open-ended questions.

RESULTS

A simple diagnostic algorithm (clinical history, DED questionnaire, and dry eye clinical tests) identified patients with the disease. A practical severity classification system of four grades: mild, moderate, severe, and LUBOS plus DED was based on four criteria: OSDI, film break-up time, Sjögren International Collaborative Clinical Alliance ocular surface staining score, and international workshop on meibomian gland dysfunction meibomian gland functionality test. For classification, ≥2 criteria of the highest severity grade from the worse eye were considered. A stepladder therapeutic algorithm aligned with disease severity consisted of 5 steps, each with proposed and recommended treatment alternatives. Patient education, lifestyle recommendations, adverse environment avoidance, lubricants, and eyelid therapy were reinforced during the therapy period.

CONCLUSIONS

The LUBOS expert panel consensus considered the diverse geoenvironmental, socioeconomic, cultural, and ethnic factors pertinent to Latin America. This consensus offers an accessible and cost-effective tool, enabling professionals to detect, evaluate, and grade the severity of dry eye disease effectively for planning adequate therapeutic strategies that can be monitored with confidence.

Development of a Core Outcome Set for Intervention Studies in Adults With Laryngotracheal Stenosis

OBJECTIVE

Adult acquired laryngotracheal stenosis (LTS) is a chronic condition with heterogeneous treatment options and a significant symptom burden. Synthesis of data across research studies to guide clinical decision-making is challenging due to inconsistent outcome selection and use of unvalidated measures. Our objective was to establish a core outcome set (COS) for studies of LTS interventions in adults.

METHODS

We conducted a two-round modified e-Delphi study. We reviewed published systematic reviews and qualitative studies to inform the inclusion of 42 outcomes in the first e-Delphi round, with 10 additional outcomes added by participants for the second voting round. The international expert panel included clinicians, researchers, and people living with LTS. We held two consensus meetings and a final voting round.

RESULTS

The first e-Delphi round involved 1067 participants from multiple stakeholder groups, with 575 participants voting in the second. Seventeen participants participated in the consensus meetings. The final COS included seven outcomes: (1) Level of breathlessness, (2) Ability to generate audible voice, (3) Ability to manage/clear mucus, (4) Ability to eat and drink, (5) Health-related quality of life, (6) Emotional and mental health symptoms, and (7) Frequency of treatment.

CONCLUSION

By using a rigorous Delphi process informed by multiple stakeholder groups, we gained consensus on seven core outcomes for inclusion in future research relating to LTS. Use of this COS will standardize outcomes measured in future research studies, ensuring they are comparable. Future work is required to identify the best way to measure these outcomes to fully operationalize this COS.

LEVEL OF EVIDENCE

Level V.

Transition Care for Young Persons with Rare Bone Mineral Conditions: A Consensus Recommendation from the ECTS Rare Bone Disease Action Group

Transition care (TC) is crucial for young persons with rare bone and mineral conditions (RBMCs) as they move from pediatric to adult healthcare. Effective TC prevents care disruptions and supports medical and psychosocial needs. However, gaps in communication, a shortage of adult RBMC specialists, and challenges in navigating adult healthcare necessitate standardized care. This study aimed to develop consensus-based recommendations for TC in RBMCs, focusing on best practices for seamless transition and patient empowerment. A two-round Delphi survey (September 2023-April 2024) was conducted among European RBMC experts, including 3 pediatric and 8 adult clinicians and 3 patient representatives from the European Calcified Tissue Society (ECTS). The panel formulated and refined statements through literature review and iterative scoring. Statements reaching ≥ 70% consensus were retained. A total of 81 statements were finalized across seven domains: initiation and planning, TC requirements, patient empowerment, organization and communication, service infrastructure and funding, and clinical care. Consensus was achieved on 64 out of 81 statements, with strong agreement on general and RBMC-specific recommendations. Key priorities included structured coordination among healthcare providers and a patient-centered approach that fosters self-advocacy and self-management. This Delphi consensus provides a structured framework for TC in young persons with RBMCs, emphasizing multidisciplinary care and patient empowerment. Future studies should assess the feasibility and impact of these guidelines across diverse healthcare systems.

The innovation of traditional handicrafts and cultural identity: A multidimensional value analysis using the DEMATEL-ISM method

This study aims to explore how cultural identity influences the protection and innovation of traditional crafts through multidimensional pathways. Using the examples of macau shipbuilding and portuguese tile painting, 14 influencing factors were extracted from three dimensions-culture and expression, aesthetics and creation, and cognition and emotion-through the Delphi method and expert feedback. The decision-making trial and evaluation laboratory (DEMATEL) method was used to analyze causal relationships, and interpretive structural modelling (ISM) was employed to construct a hierarchical model consisting of core, direct, and indirect factors. The results indicate that historical continuity, knowledge transmission, and the integration of tradition and modernity are core factors, forming the cultural foundation for traditional craft innovation. Direct factors, such as creative expression, local culture, and emotional communication, play a pivotal role in connecting the core and indirect layers, while indirect factors like visual appeal, design originality, and craft education reflect the multidimensional value of traditional crafts. The study provides a clear, hierarchical pathway that explains the systematic process from cultural identity to innovation practice, offering valuable insights for sustainable craft innovation in the context of globalization.

Red flags for remote cognitive diagnostic assessment: A Delphi expert consensus study by the Canadian Consortium on Neurodegeneration in Aging

Despite the potential benefits of remote cognitive assessment for dementia, it is not appropriate for all clinical encounters. Our aim was to develop guidance on determining a patient's suitability for comprehensive remote cognitive diagnostic assessment for dementia. A multidisciplinary expert workgroup was convened under the auspices of the Canadian Consortium on Neurodegeneration in Aging. We applied the Delphi method to determine 'red flags' for remote cognitive assessment of dementia. This resulted in 14 red flags that met the predetermined consensus criteria. We then developed a novel clinical decision-making infographic that integrated these findings to support multidisciplinary clinicians in determining a patient's readiness to undergo comprehensive remote cognitive assessment.

A Proposed Universal "Home Time" Quality of Life Measure for Older Adults

BACKGROUND

Researchers and insurers use "home time," or an individual's time at home compared to time in different health care settings, as a population-level quality of life (QoL) or quality of care measure. With varying definitions, it is unknown which components of a home time measure most closely reflect QoL. Our objective is to develop a person-centered universal home time measure agnostic to condition.

METHODS

We used an iterative, structured approach based on Delphi methods to obtain expert input on what a measure should include, using qualitative and quantitative evidence from prior work. A total of 28 expert panelists, including Veterans Affairs (VA) leaders, clinician researchers, and non-clinician researchers, participated. In the first round, panelists voted on components (settings, weights, timeframes) to include in a home time measure. In the second round, panelists discussed results. The third round was final voting and explanations of choices and caveats.

RESULTS

Qualitative and quantitative data suggested that emergency department, inpatient care, and post-acute care settings all affect older adults' QoL in different ways, supporting inclusion; 75% of the experts endorsed all settings, and discussion suggested that future work should limit ED days to visits resulting in an inpatient admission. Our data did not reveal a clear indication for weighting settings: 56% of the expert panel suggested continuing to explore the use of weights to arrive at values that would reflect qualitative differences in settings, and 44% did not support the use of any weights. Our 6-month models resulted in QoL outcomes for all settings, and 30% of experts endorsed a 6-month timeframe, while 65% said that timeframe would depend on the situation.

CONCLUSION

A "1.0" universal person-centered home time measure that reflects QoL should include days in the emergency department, inpatient care, and post-acute care. Expert input revealed domains of agreement and disagreement. Future validation efforts that incorporate expert input are needed to iterate and arrive at the optimal measure.

Comparing Artificial Intelligence-Generated and Clinician-Created Personalized Self-Management Guidance for Patients With Knee Osteoarthritis: Blinded Observational Study

BACKGROUND

Knee osteoarthritis is a prevalent, chronic musculoskeletal disorder that impairs mobility and quality of life. Personalized patient education aims to improve self-management and adherence; yet, its delivery is often limited by time constraints, clinician workload, and the heterogeneity of patient needs. Recent advances in large language models offer potential solutions. GPT-4 (OpenAI), distinguished by its long-context reasoning and adoption in clinical artificial intelligence research, emerged as a leading candidate for personalized health communication. However, its application in generating condition-specific educational guidance remains underexplored, and concerns about misinformation, personalization limits, and ethical oversight remain.

OBJECTIVE

We evaluated GPT-4's ability to generate individualized self-management guidance for patients with knee osteoarthritis in comparison with clinician-created content.

METHODS

This 2-phase, double-blind, observational study used data from 50 patients previously enrolled in a registered randomized trial. In phase 1, 2 orthopedic clinicians each generated personalized education materials for 25 patient profiles using anonymized clinical data, including history, symptoms, and lifestyle. In phase 2, the same datasets were processed by GPT-4 using standardized prompts. All content was anonymized and evaluated by 2 independent, blinded clinical experts using validated scoring systems. Evaluation criteria included efficiency, readability (Flesch-Kincaid, Gunning Fog, Coleman-Liau, and Simple Measure of Gobbledygook), accuracy, personalization, and comprehensiveness and safety. Disagreements between reviewers were resolved through consensus or third-party adjudication.

RESULTS

GPT-4 outperformed clinicians in content generation speed (530.03 vs 37.29 words per min, P<.001). Readability was better on the Flesch-Kincaid (mean 11.56, SD 1.08 vs mean 12.67 SD 0.95), Gunning Fog (mean 12.47, SD 1.36 vs mean 14.56, SD 0.93), and Simple Measure of Gobbledygook (mean 13.33, SD 1.00 vs mean 13.81 SD 0.69) indices (all P<.001), though GPT-4 scored slightly higher on the Coleman-Liau Index (mean 15.90, SD 1.03 vs mean 15.15, SD 0.91). GPT-4 also outperformed clinicians in accuracy (mean 5.31, SD 1.73 vs mean 4.76, SD 1.10; P=.05, personalization (mean 54.32, SD 6.21 vs mean 33.20, SD 5.40; P<.001), comprehensiveness (mean 51.74, SD 6.47 vs mean 35.26, SD 6.66; P<.001), and safety (median 61, IQR 58-66 vs median 50, IQR 47-55.25; P<.001).

CONCLUSIONS

GPT-4 could generate personalized self-management guidance for knee osteoarthritis with greater efficiency, accuracy, personalization, comprehensiveness, and safety than clinician-generated content, as assessed using standardized, guideline-aligned evaluation frameworks. These findings underscore the potential of large language models to support scalable, high-quality patient education in chronic disease management. The observed lexical complexity suggests the need to refine outputs for populations with limited health literacy. As an exploratory, single-center study, these results warrant confirmation in larger, multicenter cohorts with diverse demographic profiles. Future implementation should be guided by ethical and operational safeguards, including data privacy, transparency, and the delineation of clinical responsibility. Hybrid models integrating artificial intelligence-generated content with clinician oversight may offer a pragmatic path forward.

End-of-Life Care Competency in Long-term Care Facilities for Care Providers in Thailand: A Delphi Study

The global shift toward an aging population, evident in Thailand, highlights the critical need for end-of-life care (EOLC) competencies among care providers in long-term care facilities (LTCFs). As the number of older people requiring complex and compassionate care at the end of life continues to rise, the competencies required for care providers in Thai LTCFs remain underexplored. This study aimed to identify the key competencies required to deliver effective EOLC in Thai LTCFs. A Delphi method was used, engaging a panel of 12 experts, including nurses, academics, and LTCF managers. The study achieved consensus on 7 core competencies, encompassing 32 subcompetencies essential for high-quality EOLC. These competencies include knowledge of EOLC, caregiving skills, communication, leadership, innovation, ethical decision-making, and professional development. This study provides a culturally relevant framework for EOLC competencies in Thai LTCFs, emphasizing the importance of integrating technical and interpersonal skills to enhance the quality of care for older people in their final stages of life. These findings can inform educational programs and policy development, ensuring that care providers are adequately prepared to meet the complex needs of this vulnerable population.

Applying a Modified Version of the Prediction of Alcohol Withdrawal Severity Scale in a Canadian Community Withdrawal Management Setting

INTRODUCTION

Severe alcohol withdrawal syndrome (SAWS) can lead to significant morbidity and mortality. The Prediction of Alcohol Withdrawal Severity Scale (PAWSS) has been validated in general acute care environments, but its efficacy in withdrawal management settings remains underexplored. This study aimed to assess the utility of a modified PAWSS and identify appropriate cutoff scores in a community withdrawal management setting in Vancouver, Canada.

METHODS

From October 2019 to September 2022, we reviewed charts at Vancouver Detox Centre. Modified PAWSS versions replaced question 9 on the original PAWSS with: (i) breath analysis readings; (ii) alcohol consumption in the previous 24 h; and (iii) clinical assessments. We performed receiver operating characteristic analysis and used Youden's index to determine modified PAWSS' diagnostic accuracy against SAWS presentation, defined by a score of 15 or greater on the Clinical Institute Withdrawal Assessment Alcohol, Revised, seizures or delirium tremens and/or benzodiazepine administration.

RESULTS

Among 228 individuals (165 male, 63 female), 175 (75%) met SAWS criteria during admission. For breath analysis readings, an optimal PAWSS cutoff score had 55% sensitivity (95% confidence interval [CI] 46%-63%) and 74% specificity (95% CI 54%-87%). For alcohol consumption in the last 24 h, a cutoff score of 7 had 44% sensitivity (95% CI 36%-51%) and 85% specificity (95% CI 70%-93%). For clinical assessment, a cutoff score of 6 had 53% sensitivity (95% CI 45%-61%) and 71% specificity (95% CI 58%-85%).

DISCUSSION AND CONCLUSIONS

Within a community withdrawal setting, the prevalence of SAWS was high, rendering the modified PAWSS less valuable. Although higher cutoff scores improved specificity, poor sensitivity hindered identification of low-risk SAWS individuals.

Inducing and measuring positive affective state in domesticated equines: A Delphi consultation

Over the last twenty years the definition of good animal welfare has advanced from the 'absence of negative welfare states' to the aim of identifying the presence of positive welfare states; however, research on positive animal welfare is relatively new. Consequently, through expert consultation, this study aimed to synthesise knowledge regarding domesticated equine emotional state, specifically methods to induce and measure positive affective states, which could be of significant benefit to equine welfare across sectors. A Delphi consultation of experts in the field of equine behaviour, welfare and affective state was undertaken to derive consensus agreement on definitions used when considering positive affective state in equines and methods suitable for inducing and measuring these states within experimental investigations. Ninety-three international experts participated in a robust three-round Delphi consultation with data gathered analysed qualitatively (thematic analysis) and quantitatively (ranking data, consensus benchmarks and Content Validity Index (CVI) / Content Validity Ratio (CVR) analyses). Retention rates were high (78 %), and consensus (minimum 70 % agreement) was reached within Round three of the consultation. Nineteen methods for inducing positive affect reached consensus (provision of high value food, an affiliative companion and a substrate to roll in where the highest ranked), and twelve behavioural (assessment of body language, facial actions and horse-horse interactions were ranked highest) and three physiological (evaluation of heart rate, heart rate variability and respiratory rate) variables for measuring positive affect also reached consensus. This consultation highlights several important considerations surrounding the induction and measurement of positive affective state in equines, including consideration of the individual's personality and individual preference within any measures of affective state. We therefore recommend that establishing individual preference should be a prerequisite of research into positive affective states. It is anticipated that the results of this study can be used to provide new direction for research on positive affective states by providing expert agreed methods and measures for policy and practice through expert agreed approaches to induce positive affect in horses.

Cervical Disc Replacement in Athletes: A Modified Delphi Consensus Survey of Expert Opinion

BACKGROUND CONTEXT

The safety and efficacy of cervical disc replacement (CDR) for spinal disorders in contact sport athletes is not clear. Current research is limited and highlights mixed results regarding return-to-sport (RTS) among athletes with CDR.

PURPOSE

We sought to perform a modified Delphi consensus survey of expert opinion on CDR in athletes.

STUDY DESIGN/SETTING

A cross-sectional, modified Delphi consensus survey of different scenarios regarding RTS for athletes with CDR was conducted among a panel of expert spine surgeons.

PATIENT/RESPONDENT SAMPLE

An international panel of 34 spine surgeons involving both neurosurgeons and orthopaedic surgeons with sport expertise was identified.

OUTCOME MEASURES

Consensus regarding return to any level of sport as defined above was queried as the main outcome measure, with consensus defined a-priori at ≥70%.

METHODS

A 2×2 scheme was used to classify sport risk: 1=low impact/low frequency; 2=low impact/high frequency; 3=high impact/low frequency; 4=high impact/high frequency that also served as the different levels of sport that respondents could recommend returning to for the theoretical athlete. Descriptive statistics were performed with survey respondent data to generate the percentages of respondents recommending return to each level of sport for all scenarios.

RESULTS

Of the 34 sports spine surgeons invited to participate (55.9% neurosurgeons and 44.1% orthopaedic surgeons), all completed 9 questions as part of a larger survey. Regarding radiculopathy, consensus was achieved that CDR is an acceptable treatment for cervical radiculopathy in a high impact/high frequency athlete for 1-level disease (73.5%). However, only 58.8% responded that they would offer a CDR in this scenario. Regarding spinal cord compression, consensus was not achieved that CDR is an acceptable treatment for a high impact/high frequency forces athlete for 1-level disease with cord compression with/without myelopathy (47.1%). The most common reasons behind not offering a CDR included certainty of the anterior cervical discectomy and fusion (ACDF), safety concerns (e.g., adequacy, efficacy, stability), and lack of data/evidence. Postoperatively, following a 1-level CDR for myelopathy or radiculopathy, 57.6% of participants responded that they would advise the athlete may return to high impact/high frequency sport, whereases following a 2-level CDR, only 23.5% of all participants responded they would advise the same. For 1-level CDR, the most endorsed timelines for return to practice were 6 weeks (26.5%) and 3 months (26.5%) and for games was 3 months (41.2%). For 2-level CDR, the most endorsed timeline for return to practice was 3 months (26.5%) and for games was 3 months (41.2%).

CONCLUSIONS

Consensus was achieved that CDR is an acceptable treatment for radiculopathy (74%) but not myelopathy (47%) in high impact/high frequency athletes; however, only 59% of surgeons would offer a CDR for athletes with radiculopathy. Reasons for CDR hesitancy were certainty of outcomes with ACDF, safety concerns, and lack of long-term data. Although consensus was reached for some indications herein, this study highlights ongoing heterogeneity in the use of CDR for contact sport athletes and concerns regarding its safety. Future research should focus on gathering primary data on safety, durability, and long-term efficacy of CDR among athletes of different sports.

Criteria For Agreement When Conducting Local Consensus Discussions: A Qualitative Study

Purpose

Healthcare is a complex, multi-layered team environment where effective change often requires reaching consensus among relatively autonomous stakeholders. Although conducting informal consensus discussions is a frequently used implementation strategy in real-world clinical settings, limited information exists about what defines consensus when using these methods. Specifying the criteria for consensus is important, as it can shape the design of consensus-building strategies. This study aimed to identify and define the key domains of consensus used in local consensus discussions to standardise healthcare practices.

Patients and Methods

A qualitative study was conducted in one private hospital in Australia using a modified, grounded theory methodology. Clinical, non-clinical and leadership staff involved in developing standardised perioperative pathways using informal consensus discussions were recruited. Data were collected via semi-structured interviews and naturalistic participant observations between February 2023 and May 2024. Data collection and analysis occurred concurrently until theoretical saturation was achieved. Data were analysed using open coding with constant comparison, focussed and theoretical coding to develop theoretical concepts.

Results

Sixteen hours of observations with 31 participants and nine semi-structured interviews were conducted. Analysis identified four distinct consensus criteria: i) unanimous consensus, ii) delegated consensus, iii) assumed consensus and iv) concessional consensus. While unanimity was the preferred outcome, other consensus types emerged as viable alternatives when unanimous agreement was challenging to achieve. Each criterion had differing factors and mechanisms which influenced reaching the consensus criterion, underpinning assumptions, and considerations for practice, which formed four domains of consensus.

Conclusion

These domains provide a structured framework for classifying consensus criteria when conducting local consensus discussions in healthcare. The findings broaden our understanding of consensus in local healthcare discussions, moving beyond a singular focus on unanimity. By clearly defining consensus types, organisations can strategically select consensus methods that best support decision-making and intervention implementation.

Defining Clinical Remission in Severe Asthma: Expert Opinion From the Gulf Region Using the Modified Delphi Method

The introduction of biologics into the asthma management landscape and the adoption of patient-centricity and outcomes principles drive the need to revise clinical goals and targets while treating asthma patients. This necessitates a deeper understanding of asthma phenotypes, endotypes, pathophysiology, and clinical cutoff points depicting an operational definition of clinical remission in asthma. This publication represents a step in this direction, through systemically gathering and analyzing insights from experts in pulmonology and immunology from the Gulf Countries. A pre-workshop survey, scientific workshop, and two rounds of Delphi surveys constituted the analysis process and resulted in agreed-upon comprehensive criteria defining clinical remission in severe asthma. While constructing the Delphi expert opinion addressing the concept of on treatment remission, the following factors were agreed to be the main defining criteria: The sustained absence of asthma symptoms, the sustained absence of asthma exacerbations, stable lung function, and zero systemic corticosteroids for the treatment of asthma for at least 12 months.

Off-label drug use in palliative medicine: Delphi study for the consensus of evidence-based treatment recommendations

BACKGROUND

Off-label use of drugs is an integral part of everyday clinical practice in palliative medicine. However, it is associated with many uncertainties, that is, drug therapy safety or legal issues including cost coverage. Healthcare professionals often lack time and resources for comprehensive literature search and patient-specific risk-benefit analyses.

AIM

The aim of this project is to develop, evaluate and rate agreement/disagreement on treatment recommendations for off-label use in adult palliative medicine.

DESIGN

Online Delphi study with two rounds each to rate agreement/disagreement with treatment recommendations for off-label use in adult palliative medicine. An international expert panel consisting of physicians, pharmacists and nurses working in palliative care evaluated previously developed recommendations based on the best available evidence.

SETTING

/participants:Professionals (physicians, pharmacists, nursing staff) working in inpatient and home palliative care involved in the medication process were recruited as experts to participate. Between 64 and 75 experts participated in the first two Delphi studies.

RESULTS

A total of 64/68 recommendations on 21 drugs and 14 applications were agreed upon. Topics related to routes of administration as well as indications for sialorrhea, bronchorrhea, xerostomia, pruritus, singultus, fistula, gastroparesis and hot flashes. Recommendations that reached consensus are available to health care professionals via a free of charge database.

CONCLUSION

For many off-label use applications, it is likely that there will be no registration studies and therefore no drug approvals in the future. The consensus-based recommendations are intended to facilitate individual treatment planning for prescribers and to enable a more reflected handling of off-label use.

The Attitude of Nursing Staff Towards Oral Healthcare for Care-Dependent Older Adults (ANOCO) Questionnaire: Development and Validation

AIMS

This study aims to report on the development and validation of the Attitude of Nursing staff towards Oral healthcare for Care-dependent Older adults (ANOCO) questionnaire.

METHODS

The development of the ANOCO questionnaire was performed in three stages between 2008 and 2019. In a first stage, domains related to oral healthcare attitudes were identified. Next, relevant statements per domain were formulated by a Delphi panel in two rounds, resulting in a questionnaire with 32 statements. In a final phase, this questionnaire was subjected to psychometric analysis, including an evaluation of the construct validity, an internal consistency analysis (Cronbachs alpha) and a principal component analysis.

RESULTS

The questionnaire could significantly distinguish between known groups (dentists, nurses' aides, nursing students and nurses). Regarding internal consistency, Cronbach's alpha was 0.863 in the first sample (n = 361) and 0.843 in the second sample (n = 1051). Based on principal component analysis, 22 statements were retained. Four components with an eigenvalue of more than 1 explained 45% of the total variance.

CONCLUSION

The ANOCO-22 questionnaire consists of 22 statements and is a valid tool to assess the changes or differences in the attitude of nursing staff towards oral healthcare for care-dependent older adults.

Strategies to overcome barriers to the statistical representation of femicide data-a technical note

Mortality data systems are upstream determinants of health, providing critical information on causes of death and population health trends and influencing health outcomes by shaping policies, research, and resource allocation. Moreover, the gender-related deaths of women and girls are significantly underrepresented or underrecognized in mortality data across many countries. This paper seeks to identify potential barriers and facilitators to improving the representation of femicide data. The primary barriers affecting data representation of femicide are related to definitions, data collection, coding, comparability, access, and systemic challenges. Key recommendations include establishing a nationwide consensus on the definition of femicide, updating training modules for medicolegal professionals, improving pathology reporting processes, ensuring quality assurance in documentation, refining coding practices, developing new analytic methods, and providing deidentified access to cases still under investigation.

Report on the Development of the Accreditation Council for Education in Nutrition and Dietetics' Academic "Accreditation Standards for Advanced Practice Doctoral Education in Nutrition and Dietetics"

The dietetics profession is facing a shortage of registered dietitian nutritionists (RDNs) with a terminal degree. The need for doctoral-prepared RDNs was augmented with the entry-level RDN requiring a graduate degree and exacerbated by the number of retirees from the baby-boomer generation. Advanced practice doctoral (APD) programs can assist in meeting the increased need for doctoral-prepared RDNs. The Accreditation Council for Education in Nutrition and Dietetics Board established an Expanded Standards Committee to develop the APD academic accreditation standards, which included creating and validating doctoral-level competencies in dietetics practice. The development began with a review of the literature, including a review of advanced practice standards for nondietetic, health-related professional programs and professional-doctorate accreditation standards, and focus groups to investigate the perception and need. A rigorous, iterative, Delphi research process was used to develop the academic standards, competencies, and respective performance indicators. The iterative approach resulted in 8 validated standards with 14 competencies with 34 performance indicators for the academic accreditation APD standards. The APD standards define an advanced practice professional doctorate curriculum that is distinct from the entry-level graduate degree in clinical nutrition programs, as well as the research PhD, as it incorporates advanced didactic coursework, advanced practice residency, and applied practice-based research to achieve specific practice-based competencies. Academic accreditation at the doctoral level ensures quality programs that are educating RDNs who are competent at the advanced-practice level, enhancing not only professional practice, but also advancing research supporting practice, education, and leadership.

Vessel wall MRI in giant cell arteritis: standardized protocol and scoring approach developed by an international working group

OBJECTIVES

There are an increasing number of centres performing research on high-resolution vessel wall magnetic resonance imaging (VW-MRI) in GCA. However, harmonized approaches to VW-MRI in GCA are lacking and are essential to performing multicentre studies. Using a data-driven, consensus-based approach, an international expert group developed a standardized MRI protocol and scoring system to advance multi-centred research in cranial GCA.

METHODS

A targeted literature review of VW-MRI in cranial GCA was conducted. A working group comprised of radiologists, rheumatologists and ophthalmologists with expertise in VW-MRI and GCA reviewed the results of the literature search, presented relevant data and images from their respective centres, and then reached consensus on recommendations related to key MRI structures, MRI sequences, scoring system and other important considerations.

RESULTS

A total of 21 relevant articles were identified and reviewed. Based on published literature, structures to be evaluated on MRI were categorized based on anatomic location (extradural cranial, intradural cranial and orbits) and prioritization (core vs elective). Essential and elective sequences to comprehensively image cranial and orbital structures while minimizing scan time were determined along with scoring systems to grade contrast enhancement.

CONCLUSION

This report describes a standardized approach to facilitate research of VW-MRI in cranial GCA that is the result of a multidisciplinary, international collaboration of experts in VW-MRI and/or GCA.

Clinical-genomic profiling of MDS to inform allo-HCT: recommendations from an international panel on behalf of the EBMT

ABSTRACT

For patients with myelodysplastic neoplasm/syndrome (MDS), allogeneic hematopoietic cell transplantation (allo-HCT) represents the only potentially curative treatment, capable of eradicating disease-related mutant hematopoietic cells and establishing normal donor hematopoiesis. Biologic-assignment clinical trials have indicated that in eligible patients, allo-HCT is associated with superior clinical outcomes compared with nontransplant therapy. However, this therapeutic option is only available to a subset of patients, and the outcome is influenced by multiple factors inherent to the patient, the MDS subtype, and the allo-HCT procedure itself. In 2017, the European Society for Blood and Marrow Transplantation (EBMT) published recommendations for allo-HCT in MDS to guide practical decision making. In the contemporary era, genomic profiling has become routine clinical practice in many centers, and the most recent classification systems include MDS entities that are defined by genetic abnormalities. In particular, the molecular International Prognostic Scoring System offers more precise prognostication across all clinical end points and currently represents the standard tool for estimating patient survival in the absence of disease-modifying treatment. Evidence from multiple sources increasingly indicates that allo-HCT should be considered at the time of diagnosis in all eligible patients with MDS. Therefore, genomic profiling for somatic mutations and testing for germ line predisposition variants are integral to determining a patient's eligibility for transplantation. Although all patients with higher-risk MDS are potential candidates for immediate transplantation, a subset of those with lower-risk MDS may also derive benefit from this procedure at an earlier disease stage. Comprehensive recommendations on behalf of an expert international panel for clinical practice and future clinical studies of relevance are presented.

Translation, Adaptation, and Validation of a Traditional Chinese Version of the Family Caregiver Medication Administration Hassle Scale

Background

The Family Caregiver Medication Administration Hassle Scale (FCMAHS) assesses the stress experienced by family caregivers in managing daily medication regimens for older adults. However, its suitability for the Taiwanese healthcare context has not yet been established.

Objective

To translate, cross-culturally adapt, and evaluate the reliability and validity of a Traditional Chinese version of the FCMAHS (FCMAHS-TC).

Methods

A two-phase cross-sectional study was conducted. In Phase I, the FCMAHS was translated into Traditional Chinese. In Phase II, a convergent mixed-methods study was carried out with a convenience sample of 138 family caregivers who completed the FCMAHS-TC. In parallel, 12 of those participants were interviewed to explore their experiences with medication administration tasks and associated stress. Content validity was assessed using the content validity index (CVI), whereas reliability was evaluated through Cronbach's alpha and intraclass correlation coefficients (ICCs). Exploratory factor analysis (EFA) was performed to investigate the FCMAHS-TC's factor structure. Qualitative data from interviews were analyzed using content analysis to provide triangulated evidence of scale adaptability.

Results

The FCMAHS-TC demonstrated strong internal consistency (Cronbach's alpha = 0.94) and test-retest reliability (ICC = 0.78). Expert evaluation indicated strong content validity, with the item- and scale-CVI value reaching 1.0. The EFA identified four key factors: information seeking and sharing, scheduling logistics, medication filling and prescription management, and safety issues, accounting for 59.57% of the total variance. Qualitative findings supported the factor structure identified and further highlighted care coordination among caregivers as an additional challenge.

Conclusion

The FCMAHS-TC is a valid and reliable tool for healthcare professionals in Taiwan to assess the challenges and stress associated with medication administration among family caregivers. Future research should explore social and demographic determinants of medication-related caregiving stress and develop targeted interventions to support caregivers in Taiwan.

Consensus of Expert Opinion for the Diagnosis and Management of Hypermanganesaemia With Dystonia 1 and 2

Hypermanganesaemia with Dystonia 1 and 2 (HMNDYT1 and 2) are inherited, autosomal recessive disorders caused by pathogenic variants in the genes encoding the manganese transporters SLC30A10 and SLC39A14, respectively. Impaired hepatic and enterocytic manganese uptake (SLC39A14) and excretion (SLC30A10) lead to deposition of manganese in the basal ganglia resulting in childhood-onset dystonia-parkinsonism. HMNDYT1 is characterized by additional features due to manganese accumulation in the liver causing cirrhosis, polycythaemia, and depleted iron stores. High blood manganese levels and pathognomonic MRI brain appearances of manganese deposition resulting in T1 hyperintensity of the basal ganglia are diagnostic clues. Treatment is limited to chelation therapy and iron supplementation that can prevent disease progression. Due to their rarity, the awareness of the inherited manganese transporter defects is limited. Here, we provide consensus expert recommendations for the diagnosis and treatment of patients with HMNDYT1 and 2 in order to facilitate early diagnosis and optimize clinical outcome. These recommendations were developed through an evidence and consensus-based process led by a group of 13 international experts across the disciplines of metabolic medicine, neurology, hematology, genetics, and radiology, and address the clinical presentation, diagnostic investigations, principles of treatment, and monitoring of patients with HMNDYT1 and 2.

Development and validation of the national High-Risk Medicine Classification using the Delphi method

BACKGROUND

High-risk medicines (HRMs) are medicines that have a higher risk of causing severe consequences for the patient when used in error.

OBJECTIVE

This study aimed to develop a Finnish High-risk Medicine Classification (FIN-RiskMeds) to support healthcare professionals in HRM risk management.

METHODS

The development of FIN-RiskMeds was coordinated by the Finnish Medicines Agency (Fimea) using the Delphi consensus method. The preliminary list of HRMs was based on an inventory of existing HRM lists, literature, and the expertise of the working group (WG). A three-round Delphi survey with 60 panelists and a public hearing were used to achieve consensus on the content of the classification. The consensus threshold was set at 70 %.

RESULTS

The expert panel agreed on 42 medicines or medicine classes (later 'items') to be included in the FIN-RiskMeds. A 70 % consensus was reached on 30 out of 60 items in Round 1 and on 13 out of 31 items in Round 2a. The strongest consensus was reached for warfarin, methotrexate, and opioids. The serious consequences and key risks of medicines and the medication process were described for all items after Rounds 2b and 3. Based on the WG's decision after a public hearing, the final classification consists of 38 items.

CONCLUSION

This study produced expert consensus-based classifications of HRMs and a comprehensive list of their key risks. HRMs and their risks should be identified across health and social care to prevent potential medication errors. It is necessary to develop medication processes to minimize the risks associated with HRMs.

Research themes and key data points for child and adolescent emergency department mental health presentations: A national Delphi study

OBJECTIVE

The objective was to identify a prioritized list of research themes and key data points (baseline data and research outcomes) for future studies regarding child and adolescent emergency department (ED) mental health presentations.

METHODS

A prospective survey-based Delphi process was undertaken in Australia within the Pediatric Research in Emergency Departments International Collaborative (PREDICT) network. Hospital-based and community-based clinicians, researchers, police, ambulance paramedics, pediatric patients, and their carers were recruited to generate research themes and key data points for future pediatric ED mental health research. Responses were collated and analyzed by a steering group consisting of pediatric mental health, medical, and research/academic experts. Participants then prioritized the items through three survey rounds using a 9-point Likert-type scale to generate a final prioritized list.

RESULTS

184 participants (36 patients/carers and 148 clinicians/researchers) were recruited and generated 267 items for initial prioritization; 23 completed all survey rounds. The surveys identified a consensus of 71 items: 35 research themes and 36 key data points (11 baseline data points and 25 research outcomes) for future research. The top-rated research themes included patient/staff safety within the ED, the efficacy of dedicated mental health spaces, and the importance of patient follow-up. Important baseline data points included risk factors for mental health presentations and history of child abuse and/or family violence. Top-rated research outcomes included the occurrence of severe behavioral disturbance in the ED, the use of parenteral sedation, and ED re-presentation and/or suicide attempt postdischarge.

CONCLUSIONS

The Delphi process identified a prioritized list of research themes and key data points that will inform future research on child and adolescent mental health-related ED presentations.

Questionnaire for Clinical Diagnosis of House Dust Mite's Allergy Approved by Delphi Consensus

Despite house dust mite (HDM)-allergy is the most frequent in the world, no standard questionnaire exists to help physicians in their clinical practice for screening patients with this possible diagnosis. The objective of this survey was to develop a questionnaire that could be used to identify patients with suspicion of HDM-allergy. The survey was conducted using the Delphi methodology. Nineteen international experts in allergology constituted the scientific board who established the items included in the first version of the questionnaire, defined the criteria of the selection for the next steps, and validated the final questionnaire and its interpretation. The initial version of the questionnaire included 15 items. For each item, five answers were suggested graduated by scores from "no importance" to "very high importance." The predefined conditions for the item selection after each round were a median score ≥ 7 and > 50% of responses according "high importance" and "very high importance." The electronic survey circulated within the Interasma Scientific Network platform. Eight questions based on the occurrence/worsening of symptoms induced by HDM-allergen exposure meet the survey criteria after the second and the third rounds and were included in the final questionnaire. Binomial answers for each question with 1 point accorded for "Yes" and none for "No" were suggested for the final version with a score ≥ 5 points associated with a high probability for HDM-allergy. By applying the Delphi process, we generated a brief questionnaire with binomial answers, easy to use in clinical practice for screening patients with HDM-allergy.

A network approach to addressing the needs of patients with incurable head and neck cancer and their families

Background

Patients with incurable head and neck cancer have considerable unmet needs and complex symptom burden, with evidence of substantial geographical and/or socioeconomic inequalities. Accurate information on healthcare needs, resource utilisation and service provision in the last year of life is lacking. This places limits on service delivery planning and the development and testing of interventions to better meet needs. Our partnership spans three regions, which nationally have some of the highest rates of incurable head and neck cancer.

Aims

The overall aims were to (1) establish a palliative head and neck cancer partnership, (2) identify and evaluate routine incurable head and neck cancer data sources and utilise these to develop and address research priorities.

Objectives

O1. Develop a palliative head and neck cancer network within the North of England, representing a geographical area with high incidence of incurable head and neck cancer and palliative care needs. O2. Develop and refine research questions and priorities. O3. Engage with data providers to identify relevant data sets and specific data fields to understand the potential quality and utility of these to inform research priorities.

Methods

There were three interconnected work packages: WP1: A 'snowballing' approach to establish a network of clinicians, researchers, patient and public representatives, data architects and key stakeholders with an interest in head and neck cancer palliative care. WP2: A Delphi consensus process to develop and refine research questions and priorities, based on national guidance and systematic reviews of evidence gaps. WP3: Identification of national and local data sets and exploration of the potential data quality and utility, and associated information governance processes for access.

Results

WP1: A diverse network was established, encompassing members from a wide range of professions and patient/carer groups. WP2: The Delphi consisted of two rounds involving up to 66 participants. Consensus was reached on 12 research questions representing 4 key areas of prioritisation: service provision, symptom management, psychosocial support and information provision and communication. WP3: A range of national and local data sources were identified as having the potential to address the research priorities. A directory of data sources was developed. Working in an iterative way, data sets and relevant data fields were mapped to the 12 potential research priority areas to assess the applicability of using routine data to address these priorities.

Limitations

Approximately, one-third of participants in the Delphi process dropped out in round 2. Despite attempts to be flexible in our approach, retaining participants, particularly for patients and their families on a palliative care pathway, is challenging.

Future work

The established network and consensus exercise form the basis for future service evaluations and collaborative research. These will be based on gaps and priorities agreed by patients, their families and a range of other stakeholders.

Conclusions

The network has established a cross-sectoral collaboration for improving incurable head and neck cancer and a platform to identify 12 research priority areas. Utilising routine data to address these priorities remains a challenging area, and a range of methodological research approaches will be required to take this forward.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR135361.

Expert-Reviewed Nutritional Guidance for Adults with Spinal Cord Injury: A Delphi Study

Background/Objectives: Nutritional needs for people with chronic spinal cord injury (SCI) are inadequately addressed due to the lack of comprehensive evidence and scattered research. We established a consensus-based framework for addressing the nutritional needs of community-dwelling adults with chronic SCI who can ingest food orally. Methods: A web-based Delphi design was employed to ascertain an expert consensus. The Delphi panel consisted of physicians, registered dietitians (RDs), and researchers knowledgeable in SCI and nutrition. Informed by a literature review, 18 nutrition statements were rated by 15 panelists. The survey included statements about SCI-specific dietary energy assessments and macro- and micronutrients. Results: The response rate for the panel (N = 15) was 100%. Consensus levels, scores, stability levels, and response numbers were documented for each statement. The statements received consensus scores ranging from 4.14 to 8.13 on a 9-point Likert scale. Alternative expert comments and suggestions were also provided for each statement. Conclusion: Engaging a diverse panel of experts, the real-time Delphi process yielded expert-reviewed nutrition statements based on an extensive literature review and expert opinions. The rated statements contribute to the ongoing dialogue in SCI-specific nutrition, providing a practical resource for healthcare professionals working with adults with chronic SCI.

Risk Factors for Thyroid Function Test Abnormalities During Pregnancy: A Systematic Review of the Literature to Validate Current Risk Factors and Identify Novel Ones

Background: International guidelines recommend that the indication to perform thyroid function testing during pregnancy is based on the presence of risk factors for thyroid function test abnormalities. However, the discriminative ability of currently recommended risk factors is questionable. To inform on an update of the American Thyroid Association Guidelines for the Diagnosis and Management of Thyroid Disease in Preconception, Pregnancy, and the Postpartum, we aimed to systematically review the literature to evaluate evidence for current risk factors and potential novel ones for thyroid function test abnormalities in pregnancy. Methods: A systematic literature search was performed on Embase, Medline Ovid, and the Cochrane Library from inception to October 17, 2024, to identify articles on the associations of any candidate variables with thyroid function test abnormalities, thyroid antibody positivity, or results of continuous thyroid function tests in pregnancy. Additional records were identified through citation searching. Study quality was assessed using the Newcastle-Ottawa Scale. We summarized the results using a narrative synthesis. Results: A total of 81 articles were included, describing 36 candidate variables. Thyroid antibody positivity was associated with a higher risk of overt or subclinical hypothyroidism compared with antibody negativity (absolute risks: 2.4-7.0% vs. 0.1-0.2% for overt hypothyroidism and 1.9-29.0% vs. 2.0-5.7% for subclinical hypothyroidism). In cases of iodine deficiency, sufficiency, and intake above pregnancy requirements or excess, the absolute risks for subclinical hypothyroidism were 2.2-42.6%, 1.42-16.0%, and 3.8-24.3%, respectively. A limited number of studies were available for history of autoimmune diseases, family history of thyroid disease, symptoms of hypothyroidism, and history of pregnancy loss, preterm delivery, or infertility. There was little or no association of current risk factors with isolated hypothyroxinemia or (subclinical) hyperthyroidism. We did not identify novel risk factors for thyroid function test abnormalities. Conclusions: Evidence for most currently recommended risk factors remains limited and heterogeneous, and no novel risk factor was identified. While risk factors can help guide thyroid function testing in pregnancy, a clinical risk assessment cannot be replaced. Future studies are needed to detect novel risk factors that can improve the accuracy and efficiency of identifying pregnant women at high risk of thyroid function test abnormalities, in particular, overt hypothyroidism.

Acne scarring: protocol for development of a core outcome set for clinical trials

INTRODUCTION

Acne scarring is one of the primary sequelae that affect patients with acne, with facial scarring occurring to some extent in 95% of patients with active acne. Subtypes include atrophic, hypertrophic and keloid scarring. Treatment options include topical and surgical approaches. Despite numerous clinical trials focusing on acne scarring treatments, the absence of standardised outcome reporting across these trials raises concerns in evaluating treatment methods. To address this issue, this project aims to develop a core set of outcomes which should be uniformly assessed in all clinical trials involving acne scarring.

METHODS AND ANALYSIS

Outcomes will be extracted from four sources: a systematic literature review, patient interviews, printed and electronic sources and stakeholder involvement. The steering committee will assess the potential outcomes, adding or removing outcomes if needed. The Delphi process will be performed to understand the importance of outcomes. Two rounds of Delphi surveys will be completed by physicians, researchers and patients. Following this, a consensus meeting involving stakeholders will be held to refine the outcomes based on participant scores. The meeting will end in a voting process to determine a final recommended core outcome set (COS). This study will be conducted in collaboration with the Core Outcome Measures in Effectiveness Trials (COMET) initiative and the CHORD COUSIN Collaboration (C3). This study aims to develop a global COS to standardise assessment approaches in clinical trials of acne scarring. The final goal is to enhance uniformity of outcome reporting.

ETHICS AND DISSEMINATION

Ethical approval and consent to participate for the study have been granted by Northwestern University Institutional Review Board protocol ID: STU00097285. On completion of the COS, we plan to publish our results in peer-reviewed journals and send participants the finalised COS.

PROSPERO REGISTRATION DETAILS

This study is registered with PROSPERO (CRD42023460964), COMET (754) and C3 (https://www.c3outcomes.org/improved-acne-scarring).

Defining and subphenotyping ARDS: insights from an international Delphi expert panel

Although the definition of acute respiratory distress syndrome (ARDS) has undergone numerous revisions aimed at enhancing its diagnostic accuracy and clinical practicality, the usefulness and precision of these definitions remain matters of ongoing discussion. In this Position Paper, we report on a Delphi study to reach a consensus on the conceptual model of ARDS, specifically identifying its defining components within clinical, research, and educational contexts as well as exploring the potential role of subphenotyping. We did a four-round Delphi study, involving experts in ARDS research and management from a diverse range of geoeconomic regions and professional backgrounds. Consensus was achieved for the conceptual model of ARDS; key components to be included for an ARDS definition in the context of research, education, and patient management; and the need for further research in subphenotyping ARDS. Additionally, we highlight knowledge gaps and research priorities that could guide future investigations in this area. Our study builds on previous non-Delphi-based consensus processes (eg, the new global definition of ARDS and recent society-based guidelines) by using a rigorous Delphi method that ensured panellist anonymity and used clear quantitative criteria to mitigate potential peer pressure and group conformity. The findings underscore the need to refine the ARDS definition to better account for the heterogeneity of clinical presentations and underlying pathophysiology, and to improve diagnostic precision, including the use of subphenotyping where appropriate.

Use of the Delphi method as an instrument of community participation in health needs assessment

We conducted a comprehensive analysis of the usefulness of the Delphi technique for facilitating community participation in local health needs assessments within the Andalusian Local Health Action Network, Spain. We developed an ad hoc online questionnaire based on the Social Determinants of Health model and applied it to a panel of experts in two municipalities in the province of Seville (Andalusia, Spain) between May and June 2021. Our results reflected good panelist participation. The questionnaire successfully enabled the prioritization of both new and original items, some of which were incorporated into local health policies. We concluded that the Delphi method was effective for facilitating participation in local health needs assessments offering a replicable, cost-effective approach that accelerated local policy development and supported the implementation of Health in All Policies within local government.

Workplace Strategies to Reduce Burnout in Veterinary Nurses and Technicians: A Delphi Study

Veterinary nurses and technicians are at risk of burnout, which negatively impacts mental and physical health, turnover, and patient care. Workplace contributors to burnout have been identified in this population, but little is known about best practice management strategies. This study used the Delphi method to explore barriers to addressing burnout and develop expert recommendations for workplace management strategies. Forty participants with a minimum of 5 years' industry experience in leadership, or wellbeing, were recruited via purposive sampling from the USA, UK, Australia, New Zealand, and Canada. Participants completed two anonymous, online, mixed-methods surveys between October 2024 and January 2025. Qualitative survey data were analysed using content analysis to identify codes and categorise solutions. Quantitative data were analysed using descriptive statistics. Barriers to addressing burnout included industry-wide barriers, such as lack of, or unclear, regulation and lack of leadership knowledge, and clinic-specific barriers, such as poor team culture, unwillingness for change, and existing burnout. Thirty-nine solutions were developed and rated as being highly, or very highly effective. These focused on themes such as improving communication, developing progression pathways, and providing leadership training and support. Existing workplace barriers must be evaluated prior to selecting strategies, to maximise effectiveness in specific contexts.

Optimizing safety in conservative physical management of the cervical spine: A modified Delphi study

BACKGROUND

Conservative cervical spine treatment is generally safe, but serious adverse events (SAEs) still occur despite various available clinical guidelines. There have been several challenges in understanding the specific circumstances of these events to direct prevention such as inconsistent reporting, misuse of professional titles, and incomplete data. There are also differences in opinions between professions. It is now important to understand expert views and consensus across professions regarding prevention strategies and minimum requirements for reporting standards for future SAEs.

METHODS

A modified Delphi method was used, involving 28 international experts from various allied health professions, including chiropractic, physiotherapy, osteopathy, and medicolegal fields. The experts took part in three rounds of online surveys to reach a consensus on reporting, characteristics, risk factors, and prevention of SAEs associated with neck treatments. An agreement of >74 % was required before consensus was reached.

RESULTS

Consensus was reached for more standardised reporting of SAEs across different types of treatments and professions. Addressing underlying health conditions and improving the recognition of potential risks, precautions, and contraindications during treatment were highlighted. Recommendations for strategies to improve safety, including early identification of risk factors and careful application of techniques, especially in vulnerable populations were also provided.

CONCLUSION

Experts called for the development of universally accepted clinician friendly clinical guidelines that focus on improving SAE reporting, early identification of SAEs, and safer technique application, particularly in special populations. Implementing these recommendations will help reduce the occurrence of SAEs and improve the safety of conservative cervical spine management across professions.

Defining terminology and outcome measures for evaluating overdose response technology: An international Delphi study

INTRODUCTION

Various novel harm reduction services leverage technology to reduce the rising number of drug poisoning deaths, particularly among those who use drugs alone. There is significant variability in terminology and outcome measures in reporting these interventions, complicating efforts to build a comprehensive knowledge base. Thus, we conducted a Delphi study to establish consensus and heterogeneity in these metrics.

METHODS

Panellists from three stakeholder groups (people who use drugs, virtual harm reduction service operators and academics) participated in a multi-round Delphi study. The first round included open-ended questions to propose items in three categories: terminology, demographic information and outcomes. Subsequent rounds included options from a previously conducted scoping review for consideration. Likert ratings were used to achieve consensus, with a 70% threshold. Final rounds involved ranking terminology that reached a consensus.

RESULTS

Of 23 initial participants, 14 completed the fourth survey round. "Overdose response technology" was identified as the most appropriate term for these harm reduction technologies. This definition includes drug contamination alerts, overdose response hotlines and applications, wearable overdose detection technology and overdose detection tools. Fourteen demographic outcomes reached a consensus for data collection, including name or handle, neighbourhood, age, gender, past overdose experience, substance used, amount and route of use. Six service use outcomes were recommended: response type, service outcomes, morbidity and mortality, overdose events, responder arrival time and post-rescue care.

DISCUSSION AND CONCLUSIONS

The study results are recommended to standardise terminology and guide future research and knowledge dissemination in the field, ensuring clear communication with a shared language.

Development of a Trauma-Informed, Culturally Sensitive Eating-Disorder-Specific Nutrition-Focused Physical Examination Tool: A Modified Delphi Study

Objective: This study aimed to identify components of a trauma-informed, culturally sensitive eating-disorder-specific nutrition-focused physical examination (ED-NFPE) tool. Method: The modified Delphi methodology was used to develop a consensus on the clinical relevance of nine evidence-informed ED-specific nutrition examination domains and 46 components within those domains. Purposive sampling was used to recruit a panel of registered dietitian nutritionist (RDN) experts in the ED field. The panelists responded to survey statements on a five-point Likert scale. The panelists also provided qualitative feedback on domain and component additions, exclusions, modifications, and trauma-informed culturally sensitive examination practice techniques. Results: Twenty-two RDN expert panelists completed Round One of the study, and eighteen panelists completed Round Two (82% retention). Twenty-one were female. Fifteen panelists had ten or more years of experience in ED dietetics. Fifty percent held an advanced practice credential from the International Association of Eating Disorders Professionals (IAEDP). After the two survey rounds, the nine ED-NFPE domains and 46 of the 48 components achieved a consensus for clinical relevance. The panelists proposed two new examination components and provided qualitative feedback for trauma-informed culturally sensitive practice techniques in all nine domains. Conclusions: This modified Delphi study design was chosen to reach a consensus on developing an ED-NFPE tool, as there are few current evidence-based guidelines for nutrition examinations in ED care. An NFPE tool specifically designed to detect the nutrition-related findings of individuals with EDs would strengthen the overall nutrition assessment. RDNs at every level of care and with all degrees of experience could use an ED-NFPE to inform patient treatment goals.

Entrustable professional activities for physiotherapists to demonstrate digital health competency: an international delphi study

BACKGROUND

The physiotherapy workforce is going through a staggering period of change, amidst an evolving technological landscape. Whilst the profession has cautiously begun to embrace digital physiotherapy practice, there remains a lack of clear, evidence-based standardized guidance regarding tangible activities that demonstrate relevant clinical competence with digital health technologies in practice.

OBJECTIVE

Establish the world's first international consensus on entrustable professional activities (EPAs) for digital physiotherapy practice.

METHODS

International Delphi study of experts over three rounds, to establish consensus on digital physiotherapy practice EPAs and associated specifications.

RESULTS

Fifty-five participants completed the study (which was an 83.3% retention rate from round 1). Participants represented 16 countries. Over 50% were academics, and over 30% were clinicians. The final framework consisted of nine EPAs and 56 specifications for digital physiotherapy practice. The highest percentage rated specification was for "obtaining informed consent" for using digital health.

CONCLUSIONS

This Delphi study is a seminal international consensus on the core EPAs for digital physiotherapy practice. These EPAs materialize competency. As global attention to digital health continues to increase, our workforce will need to continue to mature in this space. This international consensus will support employers, universities, peak bodies, and individual physiotherapists alike to develop alongside technology. With greater evidence and the establishment of international standards, confidence in the outcomes of digital physiotherapy practice will increase.

Key strategies to reduce the global burden of myopia: consensus from the international myopia summit

In this paper, we describe key strategies to guide global collaborative efforts to further reduce the burden of myopia and myopia-related visual impairment. A modified Delphi method was applied as an iterative multistage process to collect expert and stakeholders' opinions and extract consensus strategies regarding myopia diagnosis, prevention and control. Anonymous pre-meeting preparation rounds, structured discussions for prioritisation and the development of key consensus areas were performed. Consensus was reached on three key areas to collaborate and complement existing frameworks: (1) Myopia defined not only as a refractive error but also as a disease with phenotypic features allowing for risk stratification of significant visual impairment. (2) In addition to preventive strategies, a focus is needed on preventing progression to high myopia (HM). (3) A focus on preventing and treating pathologic myopia (PM), that is, end-stage of myopia disease with irreversible visual impairment. In conclusion, the workgroup suggests a global, collaborative strategy that is needed across public health, healthcare and advocacy sectors to support efforts in reducing visual impairment from myopia. Complementary to existing preventive public health efforts, additional focus on defining myopia as a disease with risk stratification for visual impairment and an emphasis on reducing visual impairment associated with HM and PM should be considered.

Operating Department Practitioner's research priorities: A Delphi study

With the 2022 Allied Health Professions' Research and Innovation Strategy and the College of Operating Department Practitioners joining the Council for Allied Health Professions Research, understanding the Operating Department Practitioner profession's vision for research and innovation and identifying its research priorities has become important. This Delphi study aimed to establish research priorities for the Operating Department Practitioner profession. Questionnaires were distributed to Operating Department Practitioners using College of Operating Department Practitioners and social media networks. Round 1 saw 49 eligible responses; this reduced to 21 in Round 2 and 17 in Round 3. Thirty-one research priorities were identified by consensus. Priority rank was determined by mean score, percentage agreement, and coefficient of variance. By reaching a consensus, Operating Department Practitioners co-created research priorities and identified several themes that will contribute to professional development and patient care and support funding opportunities. The five key themes were Workforce Transformation, Education, Patient Safety and Experience, Innovation and Technology, and Theatre Culture.

Consensus recommendations on multiple sclerosis management in Australia and New Zealand: part 1

INTRODUCTION

Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system. There were 33 335 people with MS in Australia in 2021 and 2917 in New Zealand in 2006 and the prevalence and incidence are increasing with time. Although new treatments have substantially improved outcomes in recent decades, the treatment landscape has become increasingly complex due to the expanding number of disease-modifying therapies (DMTs) and associated safety considerations.

MAIN RECOMMENDATIONS

A total of 80 consensus recommendations were developed on the current best-practice management of MS in Australia and New Zealand. Part 1 of these guidelines outlines the consensus recommendations covering domains including DMT counselling and selection, pre-DMT assessments, monitoring disease activity on DMT, switching DMT, and discontinuing DMT. The remaining recommendations are outlined in Part 2, encompassing risk mitigation strategies during treatment with DMT, managing DMT in special situations (including pregnancy, postpartum, breastfeeding, active infection including COVID-19, and malignancy), general lifestyle measures, acute MS relapses, and symptomatic treatments for MS.

CHANGES IN MANAGEMENT AS A RESULT OF THE GUIDELINES

This two-part position statement provides a practical resource for clinicians on current best-practice consensus recommendations for managing adults (≥ 18 years old) with MS in the Australian and New Zealand health care settings. It outlines the 14 DMTs currently available through the Australian Pharmaceutical Benefits Scheme and eight through the New Zealand Pharmaceutical Schedule, including the unique efficacy, safety and monitoring considerations of each. Through these guidelines, we aim to support safe, timely and effective management of patients with MS in Australia and New Zealand.

Long COVID clinical evaluation, research and impact on society: a global expert consensus

BACKGROUND

Long COVID is a complex, heterogeneous syndrome affecting over four hundred million people globally. There are few recommendations, and no formal training exists for medical professionals to assist with clinical evaluation and management of patients with Long COVID. More research into the pathology, cellular, and molecular mechanisms of Long COVID, and treatments is needed. The goal of this work is to disseminate essential information about Long COVID and recommendations about definition, diagnosis, treatment, research and social issues to physicians, researchers, and policy makers to address this escalating global health crisis.

METHODS

A 3-round modified Delphi consensus methodology was distributed internationally to 179 healthcare professionals, researchers, and persons with lived experience of Long COVID in 28 countries. Statements were combined into specific areas: definition, diagnosis, treatment, research, and society.

RESULTS

The survey resulted in 187 comprehensive statements reaching consensus with the strongest areas being diagnosis and clinical assessment, and general research. We establish conditions for diagnosis of different subgroups within the Long COVID umbrella. Clear consensus was reached that the impacts of COVID-19 infection on children should be a research priority, and additionally on the need to determine the effects of Long COVID on societies and economies. The consensus on COVID and Long COVID is that it affects the nervous system and other organs and is not likely to be observed with initial symptoms. We note, biomarkers are critically needed to address these issues.

CONCLUSIONS

This work forms initial guidance to address the spectrum of Long COVID as a disease and reinforces the need for translational research and large-scale treatment trials for treatment protocols.