Delphi Process Research Articles

Defining an Undergraduate Radiation Oncology Microclerkship Using the Delphi Method.

Defining an Undergraduate Radiation Oncology Microclerkship Using the Delphi Method.

Current status of adjuvant immunotherapy and relapse management in renal cell carcinoma: Insights from a European delphi study.

Current status of adjuvant immunotherapy and relapse management in renal cell carcinoma: Insights from a European delphi study.

Appropriate use criteria for neoplastic compression fractures.

Appropriate use criteria for neoplastic compression fractures.

International Consensus Guidelines on the Delineation of Radiation Therapy Target Volumes for Nasopharyngeal Carcinoma After Induction Chemotherapy Using a 2-Round Modified Delphi Survey.

International Consensus Guidelines on the Delineation of Radiation Therapy Target Volumes for Nasopharyngeal Carcinoma After Induction Chemotherapy Using a 2-Round Modified Delphi Survey.

International Expert Consensus on Development of a State of the Art Male Perineal Anatomy Simulation Model for Urethroplasty and Artificial Urinary Sphincter Insertion.

International Expert Consensus on Development of a State of the Art Male Perineal Anatomy Simulation Model for Urethroplasty and Artificial Urinary Sphincter Insertion.

'We're All (Cauliflower) Ears': A Delphi Study Including Staff and Players to Co-Construct Sports Science and Medicine (Performance and Wellbeing) Research Priorities for Premiership Rugby.

Sports invest in research to optimise performance and enhance athlete wellbeing. Involving stakeholders allows research priorities to be determined, maximising the adoption and relevance of research findings. A three-round modified Delphi process was used to establish wellbeing and performance research priorities for Premiership Rugby (Professional men's rugby union competition in England). Up to 10 research priorities were provided during Round 1 (grouped into higher-order categories and themes via content analysis). In Rounds 2 and 3, participants ranked higher-order categories on a one to five Likert scale. Consensus was defined as ≥70% agreement. Sixty-five participants responded in Round 1 (41 and 32 in Rounds 2 and 3). Staff and player experience of working or playing in the Premiership was 11.0 (4.5-16.5) and 7.0 (6.0-8.5) years. Following Round 1, 393 research priorities were provided and 53 higher-order research priorities and 26 categories were identified, within three themes: performance, wellbeing and injury. Following Round 3, 21 research priorities reached consensus within performance (n=7), wellbeing (n=6) and injury (n=8). Research priorities for a professional sports league, were established by the application of a pragmatic research lens, to ensure priorities were practically minded and also developed with minimal resource requirements, minimal burden for participants and in a short amount of time, which can be applied in other leagues. Research priorities deemed feasible and lacking a relevant evidence base can be addressed in future studies to maximise impact and compliment the ongoing research programmes already established by the professional league and governing body.

Prevention Decalogue for Dependency-Related Skin Lesions in Neonates: A Consensus-Based Delphi Study

Introduction. The extreme fragility of neonatal skin, particularly in extremely preterm infants, underscores the need for effective preventive measures. This study aims to validate and design a decalogue for the prevention of dependency-related skin lesions (DRSL) in the neonatal population, based on existing consensus documents. Methods. The Delphi method was employed to validate the content of the decalogue through expert consultation across Spain. Key criteria—including relevance, clarity, ambiguity, simplicity, satisfaction, and applicability—were assessed using a 4-point Likert scale and a 10-point scale, with a 75% agreement threshold for validation. Descriptive statistics were used to analyze responses. Items not meeting the threshold were revised based on qualitative feedback and re-evaluated. The final list of interventions was established through consensus in the second round. Results. A total of 23 experts participated in the first round, and 20 in the second. Across both rounds, all items were validated with a high level of agreement. In the second round, all items exceeded 85% agreement for relevance, clarity, ambiguity, and simplicity. The average satisfaction (9.36–9.47) and applicability (9.09–9.42) revealed a high level of agreement concerning the clinical applicability of the Decalogue. The decalogue outlines essential measures for preventing DRSL in neonates, including risk assessment, postural changes, the use of specialized pressure-relieving surfaces, and monitoring of device-related pressure points. It also highlights the importance of tailored skin care based on neonatal maturity and the need for thorough documentation of preventive interventions. Discussion. Consensus achieved via the Delphi process substantiates the Decalogue’s capacity to effectively articulate key preventive strategies with clarity and brevity. Moreover, its implementation will foster evidence-based care practices, ultimately enhancing the quality of care in neonatal units. However, ongoing efforts are required to further improve DRSL prevention and continuously update strategies in light of emerging evidence.

The Italian national consensus conference on the diagnosis and treatment of Rectus Abdominis diastasis in Post-gravidic Women.

Rectus Abdominis diastasis (RAD) is a prevalent condition, particularly in post-gravidic women, with functional and esthetic impact. This Delphi consensus, led by general surgeons, aimed to establish evidence-based recommendations for the diagnosis and management of RAD in post-gravidic women. A Delphi process was conducted under the auspices of the Italian Society of Hernia and Abdominal Wall Surgery (ISHAWS), the national chapter of the European Hernia Society (EHS). A steering committee supervised systematic literature reviews to evaluate the quality of evidence and formulate recommendations. Iterative rounds of voting involving 105 expert panellists were conducted, with Consensus defined as ≥ 70% agreement. Non-consensual recommendations were revised and discussed in a plenary session during the Italian Society of Surgery (SIC) Congress, 2024. Consensus was achieved on 12 recommendations covering RAD diagnosis, classification, and treatment. Key findings included the endorsement of radiological methods for accurate RAD assessment, the establishment of surgical thresholds (> 2.5cm inter-recti distance for symptom improvement), and the recommendation of minimally invasive linea alba plication for surgical management. Non-operative treatments, such as targeted exercise programs, were emphasized as first-line approaches. For RAD with concomitant hernias of the linea alba with defects > 1cm, mesh reinforcement was strongly recommended, with extraperitoneal placement preferred. The importance of tailoring approaches based on patient-specific factors and fostering shared decision-making was highlighted. This consensus provides a structured framework for RAD management, emphasizing accurate diagnosis, tailored treatments, and patient-centered care. Future multicenter studies are required to address remaining evidence gaps and refine these recommendations.

A Delphi-consensus of US vascular surgeons on "OPioid prescripTION in VASCular surgery".

A Delphi-consensus of US vascular surgeons on "OPioid prescripTION in VASCular surgery".

Precision-medicine management recommendations for advanced non-small cell lung cancer: expert consensus.

Lung cancer is the leading cause of cancer-related death and the second most common cancer worldwide. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all lung cancer cases. In the Middle East and North Africa (MENA) region, lung cancer ranks second in incidence and cancer mortality, with a five-year survival rate of about 8%. To address this pressing health challenge, this expert consensus aims to provide regionally tailored recommendations to improve outcomes for patients with advanced NSCLC in the MENA region. A panel of 15 regional experts convened to develop evidence-informed guidance using a modified Delphi process. Through this structured and collaborative approach, the panel formulated 40 consensus statements covering key areas such as epidemiology, diagnostic workup, molecular testing, and the use of targeted therapies in advanced NSCLC. These statements reflect both global best practices and region-specific considerations, including access to testing and treatment. The resulting recommendations offer the first regionally adapted framework for the management of advanced NSCLC in the MENA region. By unifying clinical practice and promoting precision medicine, these guidelines aim to support clinicians in improving patient care and outcomes across the region.

A Consensus Study on the Competencies of Nurse Specialists Providing Care for Craniofacial and Cleft Lip and Palate Patients.

Currently, it is unclear which tasks and competencies nurse specialists provide within the European Reference Network for Craniofacial Anomalies and Ear, Nose, Throat Disorders (ERN CRANIO). This study aims to establish an expert consensus on the needed competencies for this nursing role. A narrative literature search on the role of nurses within cleft and craniofacial care was conducted. Statements on competencies and tasks were formed based on literature and expert opinion and categorized according to the Canadian Medical Education Directives for Specialists roles. A Delphi consensus process was conducted with nurse specialists from ERN CRANIO centers. A 9-point Likert Scale was used to measure consensus, which was defined as a mean score of ≥7 and ≤1 outliers. In total, 31 nurse specialists from 19 centers in 12 countries participated in the Delphi process. Overall, 105 statements on competencies and tasks achieved consensus. The domain "communicator" reached consensus on all items, while the domains "manager" and "scholar" perceived lesser and slower consensus. The nursing title, education, and nursing scope of practice revealed a great variety. This study provides valuable insight into the utilization of nursing roles with ERN CRANIO centers. Apart from demonstrating similarities, it also shows that national health care regulations and education pathways lead to different positions and (clinical) responsibilities of nurses. A European unification of nursing education and titles could ensure easier communication and collaboration between health professionals and might support a greater establishment of well-defined nurse specialist roles in ERN CRANIO centers.

Design of a Consensus Derived Synoptic Operative Report for Thyroid Surgery.

The aim of this study was to develop a template for a synoptic operative report (SOR), for thyroid surgical data, and improve interdisciplinary communication and collaboration. Twenty-five expert endocrine surgeons, endocrinologists, surgical oncology, and ear-nose-and-throat surgeons were invited to participate in a modified Delphi process. Initial domains for consideration were determined from literature review and were compatible with domains previously endorsed by the American Thyroid Association. Consensus for individual variables was predefined as mean>70th percentile and a low disagreement index (<1.0). An academic working party reviewed the indeterminate domains to reach a final consensus. Of 25 invited, 24 participated in the study. Two rounds of questionnaires were conducted. Consensus was reached for 39 data elements across five domains and were included in the final SOR template. A further eight data elements were shortlisted for inclusion in a secondary list of desirable but optional data elements. We developed a consensus-derived SOR for thyroid surgery. Future studies are required to review the uptake and utility of this template in a clinical setting. There is a literary void regarding the role of SOR for parathyroid and adrenal surgery and this could be approached with similar methodology.

Consensus on the Management of Anesthetic Agents During Digestive Motility Measurements and Proposal of a Standardized Protocol for Anesthesia (French Neuro Gastroenterology Group GFNG and Committee of Anesthetic French Experts).

Techniques for measuring digestive motility are becoming increasingly precise and enable therapeutic interventions. However, while most of these interventions require general anesthesia, there is limited data on the impact of anesthetic agents on these measurements, and no standardized anesthesia protocol currently exists to guide such procedures. Our working group carried out two Delphi processes involving experts in neurogastroenterology and anesthesiology to reach a consensus on which drugs affect these measurements and to establish an anesthesia protocol. Two expert groups were formed, comprising 13 neurogastroenterology experts from the French Neuro-Gastroenterology Group (GFNG) and 15 full- or associate professors in anesthesia and intensive care. The first Delphi process involved the neurogastroenterologists and aimed to identify which anesthetic drugs influenced digestive pressure measurements. The second Delphi process, involving anesthetists, sought to develop an anesthesia protocol. Each expert indicated their level of agreement with each statement using a 6-point Likert scale. A statement was endorsed when at least 80% of experts agreed with it. The strength of evidence for each statement was evaluated using the GRADE system. The Delphi process with neurogastroenterologists was conducted over three rounds and ultimately resulted in 91 amendments. The second Delphi process with anesthetists took place over two rounds and included 28 amendments, leading to the development of an anesthesia protocol. To our knowledge, this work is the first to establish an expert consensus on anesthetic agents that can affect digestive motility measurements and to propose an anesthesia protocol that accounts for the needs of neurogastroenterologists.

Theatre etiquette Delphi: the development of a guide on professional conduct and best practices in operating environments.

The importance of non-technical skills (NTS) to surgical performance and patient safety has been increasingly recognised by surgical teams. Inductions for new surgical team members in theatre often provide insufficient, non-standard and 'ad hoc' training in theatre behaviour and etiquette. We conducted a Delphi consensus study among senior surgeons to develop standardised guidance on theatre etiquette for those unfamiliar with the theatre environment, including resident surgical trainees and medical students. An international Delphi process of two rounds was conducted. An electronic survey was distributed among senior surgeons, anaesthetists and senior scrub nurses/practitioners, with participants recruited via surgical societies. Participants were asked to rank each statement on a Likert scale of 1 to 5. Consensus was considered if achieved for any statement for which 75% or more indicated agreement. The study was registered with the Open Science Framework. A total of 261 participants completed the Delphi process; 239 valid responses were included in round 1, with a 23% dropout in round 2. Participants were from 23 countries, 66% were from the UK, 58.2% were male, 51% were from the 30 to 40-year age group, 39% were consultant surgeons and 49% were senior trainees. General surgeons made up 68.6% of respondents, trauma and orthopaedic surgeons 13.4%, healthcare practitioners 2.1% and anaesthetists 1.3%. Thirteen statements were excluded, and 29 reached agreement and were included in the final guidance. There was agreement among a large international group of surgeons to develop a standardised guidance for theatre etiquette, addressing most of the key aspects of professional conduct and team dynamics. We anticipate that this guidance will serve as a valuable resource for orienting new members of the surgical team, providing a clear framework for maintaining professionalism and fostering effective communication within the theatre environment.

Development and contextual analysis of a person-centered professional practice model in a home care service in French-speaking Switzerland.

The Swiss healthcare system faces increasing challenges with an aging population and rising prevalence of chronic conditions, necessitating better-coordinated care delivery, particularly in home care settings. This study aimed to develop (objective 1) and conduct a contextual analysis for implementation (objective 2) of a person-centered professional practice model for home care services in French-speaking Switzerland. A multi-method approach was used. For objective 1, concept mapping with 157 healthcare professionals (86% response rate) was conducted to develop the model. For objective 2, a contextual analysis was guided by the Intervention Mapping framework, involving focus groups with stakeholders (n = 14) and field validation with frontline staff (n = 6). Data analysis included both quantitative and qualitative methods. The concept mapping process identified 13 core values rated on importance (scale 1-5), with health promotion scoring highest (4.4) and interprofessionalism lowest (3.7). Implementation analysis revealed key facilitators including leadership support (83% agreement) and barriers such as linguistic/cultural differences. Eight implementation strategies were identified and validated through a Delphi process, including continuous training (67% strong agreement) and safety culture promotion (83% strong agreement). The study demonstrates that developing and implementing a person-centered professional practice model is feasible in home care settings when supported by strong leadership commitment and structured implementation strategies. The model's alignment with the Person-centred Practice Framework of McCance and McCormack provides theoretical validation while offering practical guidance for implementation.

Practice recommendations for work-related medical rehabilitation in psychosomatic rehabilitation facilities - results of a Delphi process

In a recently completed randomized controlled trial, we found that work-related medical rehabilitation (WMR) was implemented very differently in rehabilitation facilities. Its additional effects were particularly evident when the emphasis on work-related issues was clearly communicated to participants. We therefore developed practice recommendations for a structured further development of WMR in psychosomatic rehabilitation facilities.In a two-stage Delphi process, 119 recommendations were evaluated by various experts including people who had received psychosomatic WMR. The assessment of the strength of consensus followed the guidelines of the Association of the Scientific Medical Societies in Germany (AWMF). The results of the first round were discussed with the participants before the second round.A total of 19 and 17 individuals participated in the respective votes. In the second Delphi round, 80 recommendations achieved strong consensus (74.8%) and 24 recommendations achieved consensus (22.4%). Two recommendations received majority approval. One recommendation was rejected by a majority. We reformulated the 106 remaining recommendations according to the AWMF recommendations in order to express the strength of consensus ("is to", "should", "can").The strong consensus on around three quarters of all practice recommendations suggests that the final assessment of the different groups involved was similar. The large number of recommendations that achieved strong consensus indicates the complexity of the intervention. A regular review of the practice recommendations is advisable.

How can the poor have their say in agencies working to solve poverty? Social work practice, religion and governance inclusion

ABSTRACT Administration and governance remain critical to good social work practices. However, debates about low-income persons’ involvement in nonprofit corporations’ decision-making remain muffled. As we celebrate the 60th anniversary year of the War on Poverty (1964–2024), what are some lessons learned from the one-time priority of low-income voices engaged in the governance and planning of anti-poverty nonprofits to today’s insights from the Diversity, Equity, Inclusion and Belonging (DEI&B) literature regarding the incentives and obstacles to low-income and marginalized persons’ participation in the governance of the organizations created to serve them? Lessons learned specifically from Catholic-funded organizations, which play a significant role in this research, serve as a focal point on how religion impacts social welfare institutional practices. This paper shares learnings about how various organizations engaged low-income and marginalized persons in their governance through a case study of the community development corporations (CDCs) – some funded by the Catholic Church – and community service agency (CSA) network in Youngstown, Ohio, USA. The Delphi process involving CEOs and board members, along with social network theory, provides further insights into the salient factors affecting the access and barriers to low-income persons’ participation in corporate governance.

Multidisciplinary evidence-based consensus statements on salvage surgery for recurrent head and neck cancer (International Centre for Recurrent head and neck Cancer).

Recurrent head and neck squamous cell carcinomas (rHNSCC) are an understudied subgroup, lacking high quality evidence and thus gold standard management recommendations, resulting in significant variations in practice. The aim of this project was to deliver a national multi-disciplinary expert consensus on patients with rHNSCC managed by curative salvage surgery. The AGREEII protocol guided the Delphi process. Best practice statements were developed after literature review on the perioperative management and surgical salvage of major rHNSCC subsites. Members of the International centre for Recurrent head and neck cancer (IREC) network, and other UK based professional stakeholder organisations were invited into an online Delphi study. Participants voted upon statements over three rounds, with items modified in response to vote thresholds and comments. Twenty-eight experts participated including 11 otolaryngologists, 7 oncologists, 9 oral and maxillofacial surgeons, and 1 speech and language therapist. Consensus was achieved on 73 statements, with 29 (39.7%) achieving unanimous (threshold: 100%) and 25 (34.2%) (threshold >90%) agreement. Salvage surgery for rHNSCC are challenging cases that require intensive multidisciplinary input to achieve cure while balancing impact on function and quality-of-life. In this article, we provide a large series of statements based on UK-wide expert consensus, that will guide clinicians through the complex intra- and perioperative management of patients undergoing surgical salvage.

WHO target product profile for TB detection at peripheral settings: 2024 update.

In 2014, the World Health Organization (WHO) published target product profiles (TPPs) which detailed minimal and optimal criteria to address high-priority TB diagnostic needs. Since then, the TB community's needs have evolved; there has been a surge in new and innovative platforms suggesting use of alternative non-invasive specimens for TB diagnosis. This updated TPP used evidence-based modelling to guide the decision-making process for specific characteristics which was a novel approach to this process. This document focusses on point of care, near point of care and low complexity assays using sputum and non-sputum-based specimens. The standard WHO protocol was followed for this TPP document including Delphi process, public comments and TPP development group consultations. Our modelling work suggests that lower accuracy estimates for point of care, easily accessible tests are acceptable to achieve comparable or better case detection than the current standard of care. In this document, we describe the process of updating the TPP for TB diagnostic tests at peripheral settings, highlight key updates, use of modelling to inform this update, and discuss guidance regarding technical and operational specifications.

Developing a Bimanual Task-Oriented Training Program for Young Children With Unilateral Cerebral Palsy: A Delphi Consensus Study.

Children with unilateral cerebral palsy (UCP) experience motor impairments that affect daily functioning. Despite clinical improvements with current therapies, evidence-based practices for home settings are lacking. To develop a tailored, task-specific, home-based upper limb training program for children with UCP using the Delphi method to bridge the gap between therapy and daily life improvements. Three-phase design that involved identifying key tasks based on Canadian Occupational Performance Measure (COPM) data, developing pilot activities, and achieving expert consensus through Delphi rounds. Electronic survey. Sixty-five experts (30 occupational therapists, 30 physical therapists, and 5 pediatric physiatrists), with 55 participants continuing through the Delphi rounds. Participants rated their level of agreement with the proposed activities on a 10-point scale (1 = strongly disagree, 10 = strongly agree). Agreement was defined as ≥6 or higher, and disagreement as ≤5. A consensus was determined to have been reached if there was ≥70% agreement among panelists and a mean importance of ≥7. The initial COPM results for 22 children with UCP identified self-care tasks as critical, with dressing, feeding, and hygiene as the highest priorities; thus, 110 preliminary therapeutic activities were developed and refined in a pilot study. The Delphi process yielded a consensus on 106 of the 122 proposed activities, resulting in a comprehensive set of task-specific activities. This consensus-driven approach provides expert-supported therapeutic activities with the potential to be applied in real-world settings. Further research should incorporate stakeholder perspectives to validate these activities and assess their impact on outcomes for children with UCP. Plain-Language Summary: There are ongoing questions regarding whether task-specific training can effectively enhance daily performance in children with unilateral cerebral palsy (UCP). To address this issue, we developed a task-oriented training program with input from pediatric therapy experts. This program emphasizes essential self-care tasks, such as dressing, feeding, and hygiene. Through a consensus reached using Delphi rounds, 106 activities were created to help children practice and enhance their skills at home. These activities are intended to make daily tasks easier and improve children's independence. This program provides occupational therapists with a structured framework for implementing task-oriented interventions in real-world settings. Further research is necessary to assess the impact of these activities on improving the outcomes of children with UCP.