Delphi Process Research Articles

A new trial monitoring plan (TMP) template for clinical trials: output from a Delphi process

BackgroundMonitoring is a crucial part of trial conduct and ensures that participants’ data is fairly represented, and future healthcare information is enhanced. This project aims to improve trial monitoring by creating a trial monitoring plan (TMP) template with input from individuals experienced in monitoring clinical trials.MethodsA review of monitoring plans received from UK Clinical Research Collaboration (UKCRC) registered clinical trials units (CTU)s created the basis for a preliminary TMP template and a Delphi survey. The TMP template was finalised after 2 rounds of a Delphi survey and a two-part consensus meeting including trialists with experience and expertise in monitoring clinical trials.ResultsWe received 31 monitoring plans from UKCRC-registered CTUs and reviewed over 800 monitoring items for inclusion in a TMP template, selecting items based on guidelines such as Good Clinical Practice (GCP) and our monitoring experiences. For certain items, further expert input was required. A total of 66 items were chosen for a Delphi survey involving 47 participants from 25 UK CTUs and industry. After the first round, all 66 items were retained, and six additional items were suggested by Delphi participants. In the second round, 37 items reached consensus for inclusion in the TMP template. The Delphi process was followed by a consensus meeting with 9 participants from 9 UK CTUs and industry. Participants in the consensus meeting voted on the 32 further items that had not reached the definition of consensus within the Delphi, regarding each item’s inclusion in or exclusion from the TMP template. The voting resulted in 18 items being excluded, leaving 14 items to be included in the TMP template. The process overall resulted in a standardised TMP template with input from many individuals with interest, experience, or expertise in monitoring clinical trials.ConclusionA TMP template was developed building on the currently used monitoring plans and with input from those experienced in clinical trial monitoring. Using a centrally developed good quality TMP template should contribute towards maintaining consistency in monitoring standards across all CTUs, resulting in higher research quality and improved quality assurance. Its use should provide reassurance to participants that their participation is carefully monitored to ensure that their data or any samples provided are treated with confidentiality, integrity, and respect and that their rights and well-being are protected.

Priorities to Support Care Partners of People Living With Dementia: Results of a Modified Delphi Process.

Objective: To determine priorities for services and policies that better support care partners of people living with dementia. Methods: A modified Delphi process engaged participants from organizations serving people living with dementia and care partners, focusing on historically and currently underserved communities. Eight thematic areas were identified. Participants (N = 40) responded to three surveys, generating ideas, rating each, and ranking priorities. Results: Each survey received 13-17 responses. Top ranked ideas were arrayed across six thematic areas: care partner supports; programs; funding; information; care coordination; and workforce development. Discussion: The Delphi process empowered participants to share knowledge, and respected their opinions. Anonymity removed power imbalances. The survey iterations blended qualitative and quantitative approaches, and built consensus. The Delphi invited the voices of diverse participants; all voices were weighed equally. This process could be extended to efforts to further engage dementia care partners, helping to value their voices in decision-making for services and policies.

A case study of the development of a valid and pragmatic implementation science measure: the Barriers and Facilitators in Implementation of Task-Sharing Mental Health interventions (BeFITS-MH) measure

BackgroundFew implementation science (IS) measures have been evaluated for validity, reliability and utility – the latter referring to whether a measure captures meaningful aspects of implementation contexts. We present a real-world case study of rigorous measure development in IS that assesses Barriers and Facilitators in Implementation of Task-Sharing in Mental Health services (BeFITS-MH), with the objective of offering lessons-learned and a framework to enhance measurement utility.MethodsWe summarize conceptual and empirical work that informed the development of the BeFITS-MH measure, including a description of the Delphi process, detailed translation and local adaptation procedures, and concurrent pilot testing. As validity and reliability are key aspects of measure development, we also report on our process of assessing the measure’s construct validity and utility for the implementation outcomes of acceptability, appropriateness, and feasibility.ResultsContinuous stakeholder involvement and concurrent pilot testing resulted in several adaptations of the BeFITS-MH measure’s structure, scaling, and format to enhance contextual relevance and utility. Adaptations of broad terms such as “program,” “provider type,” and “type of service” were necessary due to the heterogeneous nature of interventions, type of task-sharing providers employed, and clients served across the three global sites. Item selection benefited from the iterative process, enabling identification of relevance of key aspects of identified barriers and facilitators, and what aspects were common across sites. Program implementers’ conceptions of utility regarding the measure’s acceptability, appropriateness, and feasibility clustered across several common categories.ConclusionsThis case study provides a rigorous, multi-step process for developing a pragmatic IS measure. The process and lessons learned will aid in the teaching, practice and research of IS measurement development. The importance of including experiences and knowledge from different types of stakeholders in different global settings was reinforced and resulted in a more globally useful measure while allowing for locally-relevant adaptation. To increase the relevance of the measure it is important to target actionable domains that predict markers of utility (e.g., successful uptake) per program implementers’ preferences. With this case study, we provide a detailed roadmap for others seeking to develop and validate IS measures that maximize local utility and impact.

Preoperative assessment of adults undergoing elective noncardiac surgery: Updated guidelines from the European Society of Anaesthesiology and Intensive Care.

When considering whether a patient is fit for surgery, a comprehensive patient assessment represents the first step for an anaesthetist to evaluate the risks associated with the procedure and the patient's underlying diseases, and to optimise (whenever possible) the perioperative surgical journey. These guidelines from the European Society of Anaesthesiology and Intensive Care Medicine (ESAIC) update previous guidelines to provide new evidence on existing and emerging topics that consider the different aspects of the patient's surgical path. A comprehensive literature review focused on organisation, clinical facets, optimisation and planning. The methodological quality of the studies included was evaluated using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology. A Delphi process agreed on the wording of recommendations, and clinical practice statements (CPS) supported by minimal evidence. A draft version of the guidelines was published on the ESAIC website for 4 weeks, and the link was distributed to all ESAIC members, both individual and national, encompassing most European national anaesthesia societies. Feedback was gathered and incorporated into the guidelines accordingly. Following the finalisation of the draft, the Guidelines Committee and ESAIC Board officially approved the guidelines. In the first phase of the guidelines update, 17 668 titles were initially identified. After removing duplicates and restricting the search period from 1 January 2018 to 3 May 2023, the number of titles was reduced to 16 774, which were then screened, yielding 414 abstracts. Among these, 267 relevant abstracts were identified from which 204 appropriate titles were selected for a comprehensive GRADE analysis. Additionally, the study considered 4 reviews, 16 meta-analyses, 9 previously published guidelines, 58 prospective cohort studies and 83 retrospective studies. The guideline provides 55 evidence-based recommendations that were voted on by a Delphi process, reaching a solid consensus (>90% agreement). This update of the previous guidelines has covered new organisational and clinical aspects of the preoperative anaesthesia assessment to provide a more objective evaluation of patients with a high risk of postoperative complications requiring intensive care. Telemedicine and more predictive preoperative scores and biomarkers should guide the anaesthetist in selecting the appropriate preoperative blood tests, x-rays, and so forth for each patient, allowing the anaesthetist to assess the risks and suggest the most appropriate anaesthetic plan. Each patient should have a tailored assessment of their fitness to undergo procedures requiring the involvement of an anaesthetist. The anaesthetist's role is essential in this phase to obtain a broad vision of the patient's clinical conditions, to coordinate care and to help the patient reach an informed decision.

Assembling the Pediatric Emergency Medicine Social Care Toolkit: A Modified Delphi Study

BackgroundThe pediatric emergency department is a high-value site for screening and resource referral for health-related social needs. However, best practices for this unique environment remain unclear. This study’s objective was to introduce a consensus-based social care training toolkit for the pediatric emergency medicine (PEM) setting. MethodsWe conducted a modified Delphi study to establish consensus on social care practice and develop a user-friendly toolkit. Initially, five priority areas (sections) were identified. Participants reviewed literature and shared their expertise to draft preliminary sections of the toolkit. Two rounds of the modified Delphi process were conducted, involving a ranking system, significant qualitative feedback, and a final approval stage, resulting in the finalized toolkit. ResultsSeventeen participants were included in the Delphi process, including pediatric and general EM faculty and trainees, as well as a social worker and public health professor. Forty-two content items were ranked in the first Delphi round. Based on a combination of score cut-off and extensiveness of qualitative comments, items were either minorly edited and kept (29%) or sent back to their section for review (71%). The second Delphi round integrated further suggested edits, and all participants in this final round approved the publicly available version of the toolkit. ConclusionBy utilizing diverse sources of information and a consensus-driven process of the modified Delphi, we generated best practice recommendations for the design, implementation, and training of social care programs in the PEM setting.

Training physicians in motivational communication: An integrated knowledge transfer study protocol.

While behavior change counseling (BCC) targeting health risk behaviors has shown efficacy for improving patient health outcomes, barriers to knowledge translation have resulted in poor uptake among health care providers (HCPs). This article outlines the development of a new BCC training framework for HCPs, from inception to readiness for efficacy testing. It provides an example of integrated knowledge translation (iKT) used in alignment with the obesity-related behavioral intervention trials model. (a) A modified Delphi process identified essential BCC skills for HCPs; (b) a survey assessed HCP attitudes and training needs; (c) an online competency assessment tool was developed using iKT mixed methods; (d) a training program was developed and refined using a logic model; and (e) the program was optimized using iterative rounds of participant feedback. A future proof-of-concept trial (f) will determine the program's readiness for full efficacy testing. A Delphi panel (n = 46) identified 11 core BCC competencies for HCPs, defining "motivational communication." The HCP survey (n = 80) showed willingness to devote 4 hr to introductory training in BCC. The Motivational Communication Competency Assessment Test (MC-CAT: an online, interactive evaluation tool) and a motivational communication training program (MOTIVATOR: accredited for continuing education by the Royal College of Physicians and Surgeons of Canada) were collaboratively developed with knowledge users. The optimization process (n = 11) provided key feedback, with minor changes being made to the program. In developing a new BCC framework, obstacles to BCC implementation were addressed through an iterative iKT process. This should improve eventual intervention uptake. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Initiatives to improve lung and sleep health in children: Delphi consensus from the pediatrics, pulmonary, and sleep conference.

The lung and sleep health of adults is heavily influenced by early factors, both genetic and environmental; therefore, optimizing respiratory health begins in childhood. Multiple barriers impede improvements in lung and sleep health for children. First, the traditional siloing between general pediatric care in the community, pediatric pulmonary and sleep subspecialty care, and the research community limits the translation of knowledge into practice. Additionally, identifying and addressing health disparities remains a challenge. The 2021 NHLBI-sponsored workshop "Defining and Promoting Pediatric Pulmonary Health (DAP3H)" was a first step in defining critical gaps in our current healthcare system in identifying and optimizing lung and sleep health in children. The workshop identified key opportunities including measuring pulmonary function in young children, sleep-focused outcomes, developing biomarkers, and longitudinal research cohorts. To expand on the work of DAP3H and continue initiatives to improve childhood lung and sleep health, the Pediatrics & Pulmonary Network: Improving Health Together conference was held in 2023. A modified Delphi process was applied to form consensus surrounding gaps, barriers, and action items, with the goal of identifying the most urgent opportnities for improving childhood lung and sleep health. Cross-cutting foundational principles were identified as: (1) Authentic Stakeholder Collaboration & Engagement, (2) Reach & Implementation in Real World Settings, (3) Understanding Current Landscape & Resources and (4) Purposeful Diversity, Equity, & Inclusion Initiatives. To improve lung and sleep health in children, these principles should be the foundation for research design, development, and implementation.

Managerial ethical principles and behaviours for nurse managers: A Delphi method.

Managerial ethical principles and behaviours guide the roles, duties, responsibilities, behaviours, and relationships of nurse managers in healthcare institutions. The aim of this study was to establish the managerial ethical principles and behaviours for nurse managers. What are the managerial ethical principles and behaviours for nurse managers? The Delphi method, one of the qualitative research methods, was used in this study. The Delphi process consisted of two rounds. Data were collected by e-Delphi technique. 42 experts were included in the first Delphi round and 39 in the second Delphi round. These experts consisted of nurse managers, academicians studying in the field of ethics and nursing management. Participation in the study was voluntary and informed consent of the experts was obtained before the study. Approval was obtained from the ethics committee of the university at which the researcher worked (Approval date: 24.07.2020, Decision No: 2020/12-16). At the end of the Delphi rounds, eight managerial ethical principles and 29 ethical behaviours of these principles were identified. The distribution of these behaviours and principles were: justice (six behaviours), equality (two behaviours), honesty (two behaviours), fairness (two behaviours), responsibility (eight behaviours), confidentiality (two behaviours), clarity (two behaviours), and humanity (five behaviours). These managerial ethical principles and behaviours are intended to guide nurse managers when providing nursing services but should be updated accordingly in line with changing conditions and developments.

A theoretical model for brisk walking- and running-induced lower urinary tract symptoms (BRUTS) and the development of the BRUTS-questionnaire (BRUTS-Q): A focus group and Delphi study.

Existing questionnaires provide limited information on the nature, severity and context surrounding lower urinary tract symptoms (LUTS) experienced during running, jogging and brisk walking. The aims of this study were to develop a theoretical model of the experience of LUTS by females participating in gait-based exercise activities and to use this model to generate a questionnaire to evaluate the presence, symptoms and bother associated with LUTS experienced by females during gait-based activities. A theoretical model was developed through a review of the literature and refined through a focus group consultation including pelvic health physiotherapists, females who experienced leakage during exercise and academic researchers who studied female LUTS. A draft questionnaire was developed using key constructs identified in the model by the focus group. A new expert panel was recruited, which included physiotherapists, women with self-reported gait-induced LUTS and urogynecologists. This panel followed a DELPHI process to evaluate the relevance and completeness of the constructs within the questionnaire. Two rounds of consultation were required to reach consensus on the completeness of included constructs as well as the inclusion and wording of questions. The resulting questionnaire contains questions related to five key constructs: physical activity characteristics, symptoms of urgency, urgency urinary incontinence, stress urinary incontinence experienced during exercise and management/mitigation strategies adopted by respondents. The content validity of the brisk walking- and running-induced lower urinary tracts symptoms questionnaire has been established. The next steps are to ensure that the questionnaire has adequate comprehensibility, followed by adequate measurement properties.

Society of Surgical Oncology Consensus Statement: Assessing the Evidence for and Utility of Gene Expression Profiling of Primary Cutaneous Melanoma.

Gene expression profiling (GEP) of primary cutaneous melanoma aims to offer prognostic and predictive information to guide clinical care. Despite limited evidence of clinical utility, these tests are increasingly incorporated into clinical care. A panel of melanoma experts from the Society of Surgical Oncology convened to develop recommendations regarding the use of GEP to guide management of patients with melanoma. The use of currently available GEP tests were evaluated in three clinical scenarios: (1) the utility in patient selection for sentinel lymph node biopsy; (2) the utility to guide surveillance; and (3) the utility to inform adjuvant therapy. As a basis for these recommendations, the panel performed a systematic review of the literature, including articles published from January 2012 until August 2023. After review of 137 articles,50met the inclusion criteria. These articles included evidence related to three available GEP tests: 31-GEP, CP-GEP, and 11-GEP. The consensus recommendations were finalized using a modified Delphi process. The panel found that current evidence often fails to account for known clinicopathologic risk factors and lacks high-level data. The panel recognizes that thestudy of GEP tests is still evolving. The integration of GEP into routine clinical practice for predicting sentinel lymph node status and patient prognosis in melanoma is therefore not currently recommended. At present, GEP should be considered primarily an investigational tool, ideally used in the context of clinical trials or specialized research settings.

Development of the health literacy responsiveness (HLR) evaluation framework for HLR interventions

Abstract Background Health literacy responsiveness (HLR) interventions include actions at different levels of an organization to provoke change and improve environments ensuring equitable access to and use of information and services (1). However, generic instruments measuring the effect of HLR at intervention level are inconsistent, making evidence on HLR intervention effects difficult to compare (2). The objective of this study was to develop an evaluation framework based on core outcome domains of HLR to facilitate higher consistency in future evaluations of HLR interventions. Methods HLR outcomes were identified through a narrative literature review and categorized into domains through a content mapping process. Expert consensus on core outcome domains was reached through a Delphi process. Experts within the field of HLR were invited to participate and answer three questionnaires designed to rank and clarify potential core outcome domains. Quantitative and qualitative analysis was performed to select and complete the final core outcome domains in the HLR evaluation framework (HLR-EF). Results The literature search resulted in identification of nine reviews. A total of 383 outcomes were identified from these reviews and included in the content mapping process, which resulted in a total of 26 core outcome domains. Experts (n = 15) participated in the three-round Delphi process, which resulted in consensus on 15 core outcome domains in HLR-EF allocated under five headings. Conclusions The study has successfully managed to identify a set of core outcome domains applicable in future evaluations of HLR interventions based on systematic methodologies and expert consensus. Context-sensitive manuals for the use of the HLR-EF is under development and the instrument is ready to be applied in future evaluation of HLR interventions, potentially making future measuring, reporting and comparison of results significantly easier. Key messages • Instruments facilitating evaluation of HLR interventions are non-generic and inconsistent. • HLR-EF has been developed using a narrative literature review, content mapping, and a Delphi process, and defines 15 core outcome domains for evaluation of HLR interventions.

Validation of the NEED assessment framework: an EU level Delphi study

Abstract The NEED (Needs Examination, Evaluation and Dissemination) assessment framework was developed to identify and measure health-related patient and societal unmet needs across different health conditions, supporting the creation of needs-driven healthcare policy and innovation. It includes 25 criteria of needs and 46 related indicators allowing to estimate if the needs are met. The current study aims to validate this framework on the EU level using a modified Delphi approach. The selection of national and European institutes invited to participate in the Delphi process was based on their respective roles; specifically, public health, health technology assessment (HTA), medicine authorisation, pricing and reimbursement (P&R), and patient advocacy. Through a modified Delphi approach, the experts were able to express their opinion on the framework structure (dimensions and domains), health-related needs criteria and indicators. Two Delphi rounds were performed using online questionnaires. Consensus was reached when 85% of the respondents agree or totally agree with a proposal and less than 5% of the respondents totally disagree. A panel of 27 experts participated in the first round of the study. The majority of the experts worked in HTA agencies (39%) and P&R agencies (24%), followed by national medicine authorities (9%) and umbrella patient organisations (9%). Seventeen EU Member States were represented, with a higher representation of experts from Austria, Belgium, France, Germany, The Netherlands, Spain and Sweden. Consensus was reached for 22 out of the 25 criteria and 41 out of the 46 indicators after the first round. The modified Delphi technique was an adequate approach to aid the validation of the NEED framework at the EU level. This represents an important first step in achieving consensus on how to define and identify unmet health-related needs and move towards a more needs-driven healthcare policy and innovation landscape. Key messages • Consensus on the definition and identification of unmet health-related needs is crucial to transform public health innovation. • Expert consultation by means of the Delphi technique assumed a pivotal role to reach consensus on the NEED framework.

Organizational health literacy in hospitals and primary health care - developing innovative tools

Abstract Background Organizational health literacy (OHL), particularly in health systems, is vital for supporting public health. Self-assessment tools (SAT), critical for quality assessment/improvement and for empowering relevant stakeholders, could support hospitals and primary healthcare services to promote their role in health literacy responsiveness, and support organizations in identifying strengths and areas of improvement. Methods The SAT for OHL in hospitals (OHL-Hos) and in primary healthcare (OHL-PHC) were developed via a participatory process, based on the “Vienna Concept of a Health Literate Healthcare Organization”. Piloting of the tools in European countries shed light on the tools’ depth and the need for revision. The development of short versions followed a Delphi process with experts from ten to thirteen European countries, respectively, from December 2023 - April 2024. Healthcare service diversity within and between countries was taken into consideration as well as cultural/language adaptation. Shortening OHL-Hos followed four steps: 1) prioritization of the most relevant indicators, 2) considering additional resources, 3) consensus process, 4) refinement of the tool and wording. Results The SATs for both healthcare settings are now established. The SAT for OHL-Hos includes a matrix model of eight standards, 21 sub-standards and 75 indicators. The SAT for OHL-PHC includes seven standards, 19 sub-standards and 69 indicators, covering OHL in organizational structures and processes for staff, patients and the community served with specific focus on navigation, communication, and participation. Both SATs are accompanied by a guide to direct organizations through in the self-assessment process. Conclusions The process of identifying OHL needs and opportunities in the health system, facilitated by participatory methods for tool development, led to innovative SATs for OHL which are currently ready for piloting and implementation in European countries.

Guidance on health promoting and climate-friendly hospitals and health services

Abstract The negative impacts of climate change on health and the healthcare system are becoming increasingly evident. The healthcare sector, which accounts for nearly seven percent of Austria’s CO2 emissions, contributes to the exacerbation of climate change on one hand, but is also affected by its consequences on the other. To meet these challenges, it is necessary for healthcare facilities to both adopt climate-protective measures and adapt to the changed conditions. A project launched in 2023, supported by the Austrian Health Promotion Agenda and in cooperation with the Austrian Network of Health Promoting Hospitals and Health Services, has shown that there is a need for support in implementing climate protection measures in healthcare facilities. In response, the WHO Collaborating Centre for Health Promotion in Hospitals and Healthcare, located at the Competence Centre for Health Promotion and Healthcare at the Austrian National Public Health Institute, will work on the development of standards based on international models to support healthcare facilities in the introduction of climate-friendly practices until 2026. The methodology of the project includes the analysis of existing quality criteria and instruments, as well as a modified Delphi process with two rounds of online questionnaires directed at an international panel of experts. After each round, exchange meetings with a smaller group from the panel take place to achieve consensus. Based on the research findings and the Delphi consultations, a draft of standards and an implementation manual will be created. These drafts will be piloted in various healthcare facilities in Austria and other countries to assess their practicability and effectiveness. Following the pilot tests, the standards and the manual will be revised to integrate the practical insights gained. At the time of the conference, the initial results of the Delphi process will be presented, providing insights for the further development of the standards. Key messages • Integrating climate-friendly practices into all aspects of healthcare can reduce its environmental impact, improve health outcomes, and contribute to the broader sustainable development goals. • Climate-friendly approaches yield significant health, economic, and social co-benefits.

Measuring communicative health literacy – a revision of the HLS19-COM-P scale

Abstract Background Communicative health literacy (COM-HL) is important for patients being able to actively participate in communication with health care professionals, such as physicians. The HLS19-COM-P scale was developed for measuring COM-HL in the M-POHL HLS19 survey. However, two items under-discriminated according to the Rasch model and the item set did not sufficiently capture the aspect of appraising health information. Consolidating both a long and short version into a single scale was deemed appropriate. Hence, this study aimed to develop a revised version of the COM-HL scale. Methods The revision and development of new items followed a Delphi process. Items that worked well psychometrically in the six-item version of the HLS19-COM-P were kept, and new items concerning appraising information were developed. The revised version of the scale has so far been translated into nine languages (BG, CZ, DE, FR, HU, IT, NO, SK, UA). Challenging translation terms underwent multiple discussions to ensure language consistency. The interpretability of items has been explored in cognitive interviews in six countries (AT, CZ, HU, IT, SK, and UA) so far. Items that were difficult to understand were revised and tested in new interviews. The evaluation of the scale’s psychometric properties is scheduled for May and June 2024. Results The revised scale consists of eight items - two items for each of the cognitive domains of accessing, understanding, appraising, and applying health information. One item in each of these domains focuses on the interactive aspect of communication. An instruction for translation of terms that were challenging to translate has been developed. Overall, the revised HLS19-COM-P was well accepted in the cognitive interviews. Results from the quantitative testing will be presented. Conclusions The adapted HLS24-COM-P scale developed for the M-POHL Health Literacy Survey 2024-2026, is a short and conceptually sound instrument for measuring COM-HL.

Enhancing Public Health: training an AI chatbot for complex tasks support

Abstract Background The evolution of Large Language Models (LLMs) such as GPT-4, Gemini, and Copilot has transformed the field of Natural Language Processing, demonstrating human-level capabilities and potential applications in Public Health. Here, we report on the training of a chatbot model based on GPT-4 designed to assist operators with relevant and complex public health tasks. Methods A scoping review of existing studies on the application of LLMs in Public Health settings was conducted to understand the landscape and identify gaps in their current implementations. We then proceeded to analyse the necessary skills and competencies required for public health professionals to adequately instruct the model on required tasks. Finally, we selected the Italian regulations and guidelines with the greatest relevance in the public health field to provide the knowledge base to the model. Results The review revealed no relevant documents on the use of LLMs in areas related to Public Health. Skills and competencies were retrieved from the Guidelines of the Italian Society of Hygiene for Public Health operators and used to instruct the model on how to address public health tasks. As for the knowledge base, we retrieved 25 documents regulating specific areas of the public health field, such as vaccinations, hygiene and safety at work, infection prevention, and school hygiene. Such documents were used to train the model, after formatting them appropriately. Conclusions Despite challenges with non-standardized and technically complex documentation, preliminary testing of our model has shown its versatility and utility in supporting daily public health operations. A validation phase is under definition and will involve a DELPHI process, in which products of the custom GPT model will be evaluated by a panel of public health operators to evaluate its performance in real-world settings, ensuring compliance with national health regulations. Key messages • Training a GPT-4-based chatbot to support complex tasks in Public Health, tailored by relevant national guidelines. • Our custom model, informed by public health guidelines, showed potential in preliminary tests.

5.X.1. Co-designing for policy impact: Belgium’s monitoring & evaluation framework for cancer care & control

Abstract Cancer is one of the main public health challenges, and the second leading cause of mortality in the EU. It is Belgium’s second leading cause of adult death after circulatory diseases and has been an increasing burden of disease in recent years. Recognizing the urgency of tackling the entire disease pathway, the European Commission (EC) has launched Europe’s Beating Cancer Plan (EBCP), a policy-driven strategy, and the Mission on Cancer, a research-focused undertaking. In Belgium, Sciensano’s Cancer Centre has been charged with the coordination and implementation of these programs, pioneering the setup of a dedicated structure to coordinate them. While Belgian public, academic, private and non-for-profit entities have been highly involved in these EU initiatives since their launch, there is currently no mechanism to monitor the impact of EBCP’s uptake and implementation in Belgium. Moreover, in contrast to the investment and momentum at the European level, the last Belgian Cancer Plan dates from 2008, with its most recent evaluation being published in 2013, highlighting an important gap. To address this gap, the Cancer Centre was asked by the Federal Cabinet to develop a new monitoring and evaluation (M&E) framework for cancer care and control in Belgium. With a view to avoiding traditional top-down approaches, it was decided that the framework would be designed co-creatively, by engaging patients and experts in the field. The aim was to enable the iterative and flexible monitoring of Belgian policies related to the EBCP’s implementation, while generating buy-in from stakeholders. To achieve this goal, a modified Delphi process was used, with complementary qualitative data collection in the form of focus group discussions with experts across the cancer continuum. A Steering and Patient Committee were put in place to provide stewardship over the process, and based on their feedback, additional patient workshops were run to ensure M&E priorities for patients were taken into account. The framework will cover the entire spectrum of cancer prevention and control, as well as transversal themes such as inequalities and patient-centeredness. It will also anticipate future evolutions and undergo adjustments when needed. This workshop will use a Pecha Kucha approach, with panelists sharing insights from the Belgian case study. The session will guide the audience through a story of the strengths and pitfalls of co-creating an M&E framework in the field of public health monitoring. Topics covered will include challenges of monitoring cancer care and control policies, approaches taken in Belgium to overcome these challenges, and the importance of involving diverse stakeholders in the process. A moderated discussion will allow participants to share their perspectives and ask questions. Attendees will walk away with a real-world example on how to challenge top-down paradigms of population-level M&E frameworks and identify transferable elements for adaptation in their own settings. Key messages • Europe’s Beating Cancer Plan (EBCP) provides opportunities to tackle the second leading cause of disease in the EU but will require innovative approaches to monitor uptake and impact. • Development of Belgium policy-actionable monitoring & evaluation framework shows how co-creation can challenge top-down paradigms in public health monitoring and assess the uptake and impact of EBCP. Speakers/Panelists Gabrielle Schittecatte Sciensano, Brussels, Belgium Jinane Ghattas Sciensano, Brussels, Belgium Robbe Saesen Sciensano, Maaseik, Belgium

Public Health In Conflict And War: A Response To An Ever Evolving Landscape

Abstract Background The bases for this proposal are the current and ongoing conflict and war situations around the world, causing turmoil for nations and hardship and public health crises for people. We can no longer ignore the critical and time-sensitive need to address issues of Public Health (PH) in conflict and war in our education and training programmes. Objectives To consider appropriate themes and topics in Conflict and War that should be included in PH education and training programmes; and to consider how and where they are best represented. Member schools of the Association of Schools of PH in the European Region (ASPHER) were asked to provide details of their curricula relating PH in Conflict and War. Submissions on this topic were received from over 10 schools. Information was collated into logical themes, to which elements of the curriculum were mapped. In a modified Delphi process, respondents were asked for their level of agreement for inclusion in a curriculum and at what level content should be delivered. Results Findings from the survey allowed identification of seven main themes from topics provided: Contextual Factors; Preventive Strategies; Emergency Preparedness; Impact and Response; Conflict Resolution and Solidarity, Rehabilitation and Recovery. Respondents had high levels of agreement that content should be included in curricula and be delivered at every level in PH education and training. Conclusions PH education and training have been deficient in not including PH in Conflict and War as a subject area in programmes. The knowledge and expertise developed of necessity in some places can be shared across the ASPHER network and beyond to increase awareness of the PH considerations of conflict and war. Key messages • Public health in war and conflict zones is critical due to unique challenges and urgent needs of affected populations. • An Integrated curriculum is vital for addressing conflict’s long-term health impact and preparing skilled workforce for health, resilience, action and laying the path to peace.

Protocol for the creation of a core outcome set for clinical trials of interventions to improve sleep in people with cognitive impairment: The Sleep in Cognitive Impairment Core Outcome Set (SCICOS) study.

Background While sleep disturbance is common in dementia, leading to negative outcomes, there is growing evidence that sleep disturbance begins early in prodromal dementia and may contribute to cognitive decline. Sleep is therefore an important treatment target throughout the natural history of dementia and there is increasing interest in sleep as a modifiable risk factor. Clinical trials of interventions to improve sleep in people with cognitive impairment are beset by wide heterogeneity in the outcome measures reported. A core outcome set (COS) is urgently required to improve the coherence and comparability of data. Aim To produce a COS for clinical trials of interventions to improve sleep in people with cognitive impairment: the Sleep in Cognitive Impairment Core Outcome Set (SCICOS). Methods The Core Outcome Set-STAndards for Development: the COS-STAD recommendations will be followed. A systematic review (Registration: CRD42024556750) will identify outcome measures used in relevant clinical trials. Qualitative interviews involving people living with cognitive impairment and their caregivers will ascertain the outcome measures important to them. Finally, a modified Delphi process, involving people living with cognitive impairment and their caregivers as well as expert clinicians and researchers, will be conducted to reach consensus regarding the final composition of the SCICOS. Conclusion Interventions to improve sleep in people with cognitive impairment may reduce distress associated with sleep disturbance and, potentially, slow progression of cognitive decline. Creating the SCICOS will facilitate development of more meaningful and coherent data to drive progress in this emerging field.

Developing a set of core items for assessing preparedness in Italy: a Delphi approach

Abstract Background Effective pandemic management relies on preparedness and several tools are available for evaluation. However, due to differences in regional healthcare organization and structures, these may not accurately evaluate Italy’s capacities. This study, part of a project funded by the Italian Ministry of Health, report on the development of an assessment tool capable of evaluating the preparedness to confront pandemics at the regional level based on the actions outlined by the Italian influenza pandemic plan. Methods A desk research was carried out for preparedness evaluation tools, consulting Public Health Agencies, and Google Scholar and Search. Tools evaluation items were extracted, associated with the Italian plan, and screened for relevance and data availability. Selected items were then subjected to a two-round Delphi procedure involving 18 stakeholders from academia, local health services, and national agencies. The agreement was assessed using a 10-point Likert scale, and defined as a mean score ≥8, and consensus as a score standard deviation (SD) ≤1.5. Items with mean score ≥ 8 and SD > 1.5 after the first round were sent to the second round. Results A total of 6 tools were included in the study, from which 303 evaluation items matched the actions of the plan. After the screening phase, 122 indicators were deemed relevant and potentially available and sent to the Delphi procedure. Eighteen (14.8%) items reached both agreement and consensus in the first round, while another fifteen (12.3%) after the second. The 33 items covered all the domains of the national plan, especially Research and Development (21.1%) and Clinical Governance (15.2%). Conclusions The development of a set of core items that are agile, relevant, and readily available was facilitated by the involvement of stakeholders from different sectors. Moreover, adherence to the Italian pandemic plan should ensure that these items are deeply integrated into the unique context of the Italian regions. Key messages • The Delphi process identified a narrow number of evaluation items with great consensus. • Consensus was searched involving stakeholders from central authorities, local units, and academia.