Abstract

BackgroundMethods for developing a core outcome or information set require involvement of key stakeholders to prioritise many items and achieve agreement as to the core set. The Delphi technique requires participants to rate the importance of items in sequential questionnaires (or rounds) with feedback provided in each subsequent round such that participants are able to consider the views of others. This study examines the impact of receiving feedback from different stakeholder groups, on the subsequent rating of items and the level of agreement between stakeholders.MethodsRandomized controlled trials were nested within the development of three core sets each including a Delphi process with two rounds of questionnaires, completed by patients and health professionals. Participants rated items from 1 (not essential) to 9 (absolutely essential). For round 2, participants were randomized to receive feedback from their peer stakeholder group only (peer) or both stakeholder groups separately (multiple). Decisions as to which items to retain following each round were determined by pre-specified criteria.ResultsWhilst type of feedback did not impact on the percentage of items for which a participant subsequently changed their rating, or the magnitude of change, it did impact on items retained at the end of round 2. Each core set contained discordant items retained by one feedback group but not the other (3–22 % discordant items). Consensus between patients and professionals in items to retain was greater amongst those receiving multiple group feedback in each core set (65–82 % agreement for peer-only feedback versus 74–94 % for multiple feedback). In addition, differences in round 2 scores were smaller between stakeholder groups receiving multiple feedback than between those receiving peer group feedback only. Variability in item scores across stakeholders was reduced following any feedback but this reduction was consistently greater amongst the multiple feedback group.ConclusionsIn the development of a core outcome or information set, providing feedback within Delphi questionnaires from all stakeholder groups separately may influence the final core set and improve consensus between the groups. Further work is needed to better understand how participants rate and re-rate items within a Delphi process.Trial registrationThe three randomized controlled trials reported here were each nested within the development of a core information or outcome set to investigate processes in core outcome and information set development. Outcomes were not health-related and therefore trial registration was not applicable.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1479-x) contains supplementary material, which is available to authorized users.

Highlights

  • Methods for developing a core outcome or information set require involvement of key stakeholders to prioritise many items and achieve agreement as to the core set

  • Responses for each item are summarized and fed back within the subsequent questionnaire, enabling participants to consider the views of others before re-rating the item and can change their initial responses based on the feedback from the previous rounds

  • All participants were recruited from the UK with the exception of the oesophageal set in which approximately 50 % of patients and 20 % of health professionals were recruited from the Netherlands

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Summary

Introduction

Methods for developing a core outcome or information set require involvement of key stakeholders to prioritise many items and achieve agreement as to the core set. The Delphi technique requires participants to rate the importance of items in sequential questionnaires (or rounds) with feedback provided in each subsequent round such that participants are able to consider the views of others. The methods for developing CISs and COSs are very similar and both involve working with key stakeholders to prioritise large numbers of items (outcomes or information) and achieve agreement as to the core set. Responses for each item are summarized and fed back (anonymously) within the subsequent questionnaire (the round), enabling participants to consider the views of others before re-rating the item and can change their initial responses based on the feedback from the previous rounds. Whilst accuracy cannot be assessed in the context of a core set, since there is no ‘correct’ result, ensuring some degree of consensus is paramount

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