Consensus about cardiac patients and families’ competencies in emergency situations: use of a multi-partite Delphi method

Abstract

Background: Cardiovascular diseases (CVD) are a real public health issue in France. CVDs are generally chronic diseases, punctuated by emergency situation. When a cardiac crisis occurs, the patient and his family are confronted with complex situations that they must manage in priority. The primary aim of this pilot study was to characterise the decision-making competencies that the patient and his close relations must mobilise in such situations, by clarifying diverging and converging opinions among a panel of experts. The objective is to obtain a unique and convergent final opinion of a group of experts. Methods: We conducted a Classical Delphi method during 18-month with 196 members of “Heart and Health” clubs and 82 CVD specialists in one area of France. The Delphi process consist of five rounds of questionnaires (Q) administrated by post to an expert panel. The first questionnaire asks the experts about their opinions on a topic in an open-ended manner: Q1 defined the concept of crisis. These responses are then analysed by the researchers and sent back to the expert panel in the form of statements or new questions. The expert panel rate or rank the questions within the second questionnaire according to their expert opinion on the subject: Q2 identified the emergency situations (frequency and severity); Round continue until a consensus is reached on some or all of the items as required: Q3 ranked the competencies required and the actions likely to be implemented in those situations (feasibility and limitations); and Q4 determined the conditions in which they are mobilised. The Wilcoxon-test was used to compare how the choices regarding these competencies in emergency situations changed from before (Q3) to after (Q4) the responses were submitted to the entire panel (p The panellists reported, clarified and prioritised 20 competencies. Competencies C2 (Recognising the warning signs) and C3 (Calling emergency medical) services ) got a very strong consensus immediately (agreement ≥ 90%) and acquiring them is a high priority. The decision-making competencies C20 (Making emergency decisions ) and organisational competencies C10 (Preparing the medical record ) take precedence over the emotional competencies C14 (Articulating one’s experience) and C15 (Articulating one’s emotions) . Sharing opinions among the panellists led to a significant change in scores for 16 competencies between Q3 and Q4. Conclusions: Using a formal approach, our study produced a solid expert consensus on the competencies needed by CVD patients (and their families) for managing crises, which can help guide clinicians in their practice. Our study helps shift the balance in the care relationship, where, traditionally, health care professionals (HCP) develop the educational programsand define the competencies to be acquired by patients.