Second-round Survey Research Articles

P3.07-019 AMDAT Lung, An Ideal Lung Cancer MDT Dataset: Topic: Other – Geographical Differences

Background: The role of multidisciplinary teams (MDTs) is central to lung cancer care in Australia with support at policy level and with the development of a nation-wide lung cancer MDT directory from Lung Foundation Australia. In parallel, the importance of accessible, clinically relevant information from routine data collection in lung cancer (as well as other tumor streams) is receiving increased recognition. MDT meetings increasingly act as central hubs for the co-ordination of lung cancer care and therefore have the opportunity to focus on quality assurance as well as analyses of patterns of care and identification and targeting of evidence-practice gaps. MDT meetings can act as central sources of data collection and analysis and as such a standardized approach to lung cancer MDT data collection in Australia is warranted. This study will present the results of a modified Delphi study, surveying Australian lung cancer clinicians, aiming to finalize an ideal clinical dataset for collection through lung cancer multidisciplinary meetings. Methods: A 17-item survey has been circulated to a broad, representative sample of lung cancer clinicians, medical and allied health, in Australia. Clinicians were identified and contacted either as (1) part of a purposive sample or (2) through MDT lead clinicians identified through convenience or through the Lung Foundation Australia Lung Cancer MDT registry. Results of an initial survey will be analyzed and a second-round survey will be circulated to an expert panel drawn from the first-round participants prior to finalization of the dataset. Results: The first round of the survey is reaching completion at the time of abstract submission. A total of 98 responses have been received across the two sampling strategies in the 4 weeks since surveys were distributed. Initial data analysis showed a predominance of pulmonary physicians, attendance at MDT weekly more than fortnightly, support for inclusion of most of the variables presented in the survey and a leaning towards MDT presentation of complex/multimodality therapy and stage IIIA cases rather than all cases of lung cancer. Conclusion: The findings of the study will support the development of a standard dataset for collection at lung cancer MDT meetings. This dataset will be utilized in future planned studies across multiple sites for targeted data intervention and feedback strategies and analysis of effect on lung cancer outcomes.

Developing a Unified List of Physicians’ Reasoning Tasks During Clinical Encounters

The clinical reasoning literature focuses on how physicians reason while making decisions, rather than on what they reason about while performing their clinical tasks. In an attempt to provide a common language for discussing, teaching, and researching clinical reasoning, the authors undertook the task of developing a unified list of physicians' reasoning tasks, or what they reason about, during clinical encounters. The authors compiled an initial list of 20 reasoning tasks based on the literature from four content areas--clinical reasoning, communications, medical errors, and clinical guidelines. In the summer and fall of 2010, they surveyed a purposive sample of 46 international experts in clinical reasoning and communications. From the results of the first survey, the authors refined their list of reasoning tasks, then resurveyed 22 of the original participants. From the results of the second survey, they further refined their list and validated the inclusion of the reasoning tasks. Twenty-four of 46 (52%) and 15 of 22 (65%) participants completed the first- and second-round surveys, respectively. Following the second-round survey, the authors' list included 24 reasoning tasks, and a clinical example corresponding to each, that fell into four broad categories: framing the encounter (3), diagnosis (8), management (11), and self-reflection (2). The development of this unified list represents a first step in offering a vocabulary for discussing, reflecting on, teaching, and studying physicians' reasoning tasks during clinical encounters.

Prevention and control of major non-communicable diseases in China from 1990 to 2009: results of a two-round Delphi survey

Objective: The aim of this study was to learn about the progress of the prevention and control of major non-communicable diseases (NCDs) in China from 1990 to 2009 and to determine what prevention and control gaps remain based on the opinions of a group of panellists.Design: Sixty-four panellists, who are members of the Subcommittee of the Non-Communicable Diseases, the Expert Committee on Disease Control and Prevention established by China's Ministry of Health in 2010, were invited to participate in an email-based, two-round Delphi survey. In each round, a structured questionnaire was given to participants, who were asked to rate the importance and practical implementation of items relevant to the prevention and control of NCDs over two periods, 1990–1999 and 2000–2009, on a 10-point scale.Results: Of the 64 panellists invited, 20 (31.3%) completed the first-round survey, and, of those, 14 (70.0%) completed the second-round survey. Of the 237 common variables in the two survey rounds, there were 161 (67.9%) and 209 (88.2%) with an interquartile range ≤2 in the first round and second round, respectively. These results indicated a better expert consensus in the second round. There were 92 items in total in the second round of the questionnaire, 88 (95.7%) of which had median importance rating scores of equal to or greater than 7.00. The median scores for the practical implementation items during 2000–2009 were greater than those for the 1990–1999 period. The results indicate improved implementation in the recent decade.Conclusions: China has made progress in the prevention and control of NCDs during the 21st century. However, these intuitive rating results indicate that there are still large action gaps in the fight against epidemic NCDs in China.To access the supplementary material to this article please see Supplementary files under Article Tools online.

Future Directions for Advancing Issues in Children’s Mental Health: A Delphic Poll

The current study utilized a Delphic poll to identify significant problems regarding children and families in which psychologists can assist. The Delphic poll methodology combines both qualitative and quantitative methodologies to obtain information and predictions about the future from a panel of knowledgeable experts. Thirty-one professionals participated in the first round of the survey, and 26 participants (83.9 % of the round 1 participants) chose to complete the second-round survey. Several themes emerged consistently across questions as important issues to be addressed in the future of childhood mental health. For example, participants frequently identified access, advocacy, research and research dissemination, prevention/early intervention, and integration of services as important issues. Implications and recommendations are drawn for organizations and individual psychologists as advocates for improving children’s mental health in the United States.

A two-round Delphi study examining consensus of recommended clinical practices for patients with ventricular assist devices as destination therapy

To identify the current clinical practices of Medicare-certified facilities offering ventricular assist devices as destination therapy and to attain a consensus of recommended clinical practices across the United States for the management of adults with ventricular assist devices as destination therapy. Sixty ventricular assist device coordinators from Medicare-certified centers were invited to participate in an online, 2-round Delphi survey. The surveys asked whether recommended practices are current practices and whether respondents always/agreed or never/disagreed with performing the recommended practice guidelines. Consensus was defined as 75% agreement. The clinical areas of focus were patient selection, preoperative preparation, postoperative care, infection control, nutrition, and patient discharge preparation. Practices were extracted from the advanced practice guidelines for HeartMate destination therapy and the International Society for Heart and Lung Transplantation's 2006 guidelines for the care of heart transplant candidates. Representing 21 states across the country, the first-round survey had a response rate of 57% (n = 34). The second-round survey had a response rate of 74% (n = 17), representing 28% of the 60 centers. Consensus was obtained for 122 practices. The dimension of patient selection-diagnostic tests and screening had the highest level of consensus (16%, n = 20), and the dimension of postoperative care-intermediate/intensive care unit dimension had the lowest level of consensus (3.3%, n = 4). Survey results identify a consensus of practices for the specific group of ventricular assist device coordinators who responded, but that consensus cannot be generalized to all ventricular assist device facilities. These results can, however, provide a foundation for further research leading to the development of standard-of-care practices for patients with ventricular assist devices as destination therapy.

A Two-Round Delphi Study Examining Consensus of Recommended Clinical Practices for Patients with Ventricular Assist Devices as Destination Therapy

To identify the current clinical practices of Medicare-certified facilities offering ventricular assist devices as destination therapy and to attain a consensus of recommended clinical practices across the United States for the management of adults with ventricular assist devices as destination therapy. Sixty ventricular assist device coordinators from Medicare-certified centers were invited to participate in an online, 2-round Delphi survey. The surveys asked whether recommended practices are current practices and whether respondents always/agreed or never/disagreed with performing the recommended practice guidelines. Consensus was defined as 75% agreement. The clinical areas of focus were patient selection, preoperative preparation, postoperative care, infection control, nutrition, and patient discharge preparation. Practices were extracted from the advanced practice guidelines for HeartMate destination therapy and the International Society for Heart and Lung Transplantation's 2006 guidelines for the care of heart transplant candidates. Representing 21 states across the country, the first-round survey had a response rate of 57% (n = 34). The second-round survey had a response rate of 74% (n = 17), representing 28% of the 60 centers. Consensus was obtained for 122 practices. The dimension of patient selection-diagnostic tests and screening had the highest level of consensus (16%, n = 20), and the dimension of postoperative care-intermediate/intensive care unit dimension had the lowest level of consensus (3.3%, n = 4). Survey results identify a consensus of practices for the specific group of ventricular assist device coordinators who responded, but that consensus cannot be generalized to all ventricular assist device facilities. These results can, however, provide a foundation for further research leading to the development of standard-of-care practices for patients with ventricular assist devices as destination therapy.

E-Logistics Systems Applications for Service Users and Providers

This paper reports the findings of a second-round Delphi study (interactive forecasting method) that explored the issues surrounding integrated e-logistics systems, applications, and policy for varying stakeholders. A three-stage qualitative research approach began with a literature survey, which was followed by a first-round online Delphi survey in the second stage. The first-round Delphi generated some ideas and statements that were used in the second-round Delphi survey (third and final stage). In this survey, the participants were given three choices: agree, disagree, and no comment. The achievement of majority agreement or disagreement on these statements was a central point. For this research, the majority agreement–disagreement was sought at three levels: simple majority, significant majority, and vast majority. The research verifies the applicability of a definition of e-logistics established in the first-round Delphi. The study also identifies the fields of cost-effective e-logistics applications for logistics companies. The research suggests ways to develop an integrated e-logistics system and associated European Union policies.

Development of a Standard for Hospital-Based Palliative Care Consultation Teams Using a Modified Delphi Method

Although palliative care consultation teams are rapidly being disseminated throughout Japan as a result of government policy, the role of these teams has not been standardized. The aim of this study was to develop a hospital-based palliative care consultation team standard. We adopted a modified Delphi method to develop a standard. Twenty-seven multiprofessional panelists were selected according to two criteria: adequate experience as part of a palliative care consultation team and representative of 16 palliative care-related organizations. Panelists rated the appropriateness of 33 statements in a provisional standard, which was generated by the authors, using a nine-point Likert-type scale in a first-round survey. We set two criteria for agreement: the median value was 8 or more, and the difference between the minimum and maximum was 4 or less. There were 15 disagreements in the first-round survey. Based on discussions through e-mails and a panel meeting, these 15 statements were dealt with as follows: one was rejected, one was combined with another statement, three were unmodified, and 10 underwent minor revisions. Moreover, two statements that generated agreement were divided into two statements each. Consequently, the number of statements was 37. In a second-round survey, three statements engendered disagreement and were modified. At the end of the process, there were 37 statements in four areas: “philosophy and policy,” “structure for care provision,” “contents of activities,” and “quality assurance and care improvements.” This standard may be useful as a clinical activity guide as well as a method to evaluate palliative care consultation teams.

Dietitians’ Opinions and ExperiencesOf Client-Centred Nutrition Counselling

The concept of "client-centredness" was explored within a nutrition counselling relationship. A two-round reactive Delphi survey was used. The first survey was sent to 65 Dietitians of Canada members who indicated in the member database that they had advanced counselling skills. Following analysis of the data, the second-round questionnaire was developed and sent to participants with a report of the first-round results. Analysis of the second-round survey indicated that participants' responses had remained stable, and the Delphi survey was terminated. Participants agreed that most of the issues identified in the Delphi questionnaire should be included in a client-centred approach to practice; however, when participants were asked about their experience in these areas, median responses and/ or the interquartile ranges changed, indicating some difficulty in implementing the client-centred approach. Comments also indicated that the reality of their workplaces did not allow participants to be as client-centred as they thought they should be, and suggested that the concept of "client-centredness" is not universally understood by dietitians. If a client-centred approach to practice is truly important, we need to start a dialogue within the profession to gain a deeper understanding of what this means and how it can be implemented.

Identifying and Weighting Teaching and Scholarship Activities Among Faculty Members

Objective. To identify and weight sets of activities performed by faculty members in the areas of teaching and scholarship. Methods. A panel of faculty members diverse in rank, gender, and discipline convened in a focused discussion and a modified Delphi procedure to identify 29 activities in teaching and 44 activities in scholarship for weighting by the general faculty. Twenty-three of 33 faculty members responded to an anonymous questionnaire eliciting values for each of the activities in a process designed to produce a set of weights on a ratio scale to facilitate comparisons among teaching and scholarship activities. Nineteen of 23 faculty members responded to a second-round survey instrument. Results. A set of weights was derived for all 73 activities. Respondents placed considerable value on developing a new course, chairing completed doctoral dissertation committees, obtaining high-impact grant monies, and winning University and national teaching awards. Conclusions. The results assisted School adm...

Work Reorganization in an Era of Restructuring: Trends in Diffusion and Effects on Employee Welfare

High Performance Work Organizations (HPWOs) took root in the early 1990s but then faced an environment of organizational turmoil and restructuring. This paper, drawing on a second-round survey of employers that replicated and extended a 1992 survey, addresses two questions: whether HPWO practices continued to spread, and whether their productivity and quality gains redounded to employees' benefit. The results show that HPWO practices continued to diffuse at a rapid rate between the 1992 and 1997 survey dates, although more slowly for self-managed teams than for other practices. With regard to the second question, however, the author finds that adoption of HPWO practices in 1992 was associated with increased layoff rates in subsequent years and no compensation gains. In addition, HPWO practices are linked to employment reorganization, such as reductions in contingent and managerial employment.

Work Reorganization in an Era of Restructuring: Trends in Diffusion and Effects on Employee Welfare

High Performance Work Organizations (HPWOs) took root in the early 1990s but then faced an environment of organizational turmoil and restructuring. This paper, drawing on a second-round survey of employers that replicated and extended a 1992 survey, addresses two questions: whether HPWO practices continued to spread, and whether their productivity and quality gains redounded to employees' benefit. The results show that HPWO practices continued to diffuse at a rapid rate between the 1992 and 1997 survey dates, although more slowly for self-managed teams than for other practices. With regard to the second question, however, the author finds that adoption of HPWO practices in 1992 was associated with increased layoff rates in subsequent years and no compensation gains--patterns that appear to result largely because HPWO practices are linked to employment reorganization, such as reductions in contingent and managerial employment.