Three-round Delphi Study Research Articles

Preparing the ground for bespoke nursing training in advanced renal cell carcinoma care (RCC4Nurses): An international prospective study

ObjectivesNurses require specialist knowledge and skills to effectively support an increasing population of people affected by advanced renal cell cancer (aRCC). RCC4Nurses was a three-phase project that aimed to develop bespoke training in aRCC for nurses in Europe. Phase 1 examined pre-existing educational programs in kidney cancer, then developed a curriculum of core education topics in aRCC care to suit generalist and specialist nurses’ education needs. MethodsPhase 1 employed a prospective design that involved two parts. Part 1 was a scoping review of educational programs developed for multidisciplinary health professionals in kidney cancer/RCC. Findings of Part 1 formed the basis for Part 2, which was a three-round Delphi study that involved experts by personal experience or profession in aRCC, who rated the importance of a range of education topics and education methods for inclusion in the developing RCC4Nurses. ResultsThe scoping review identified eight education programs via two published reports and six online resources. Existing programs had limitations in accessibility, recency and target professional groups; none of them was developed specifically for nurses. Program content was primarily focused on diagnostic, treatment and management procedures in kidney cancer. Fourteen educational topics were derived from the review and evaluated during Round 1 of the Delphi by 47 experts. By Round 3, 17 topics had iteratively reached consensus for inclusion within RCC4Nurses. Experts showed preference to problem-solving and clinical-scenario learning methods, but not reflective practice learning. ConclusionsGiven the dearth of up-to-date, evidence-based training for nurses in aRCC, we have prepared the ground to develop a bespoke training course in this area of practice. Implications for Nursing PracticeThe RCC4Nurses project will offer accessible, state-of-the-art education to registered nurses in Europe to help enhance nursing competency in aRCC and enhance the standard of care provided to people affected by aRCC.

Results of a National Delphi consensus on the outpatient management of pediatric psychogenic nonepileptic seizures in the United States

Background and objectivesThe purpose of this study was to develop national consensus based on expert opinion on the optimal outpatient care model of pediatric psychogenic nonepileptic seizures (PNES). MethodsA core working group (CWG) within the PNES special interest group of the Pediatric Epilepsy Research Consortium was established. The CWG developed a rigorous scoring rubric to select experts in pediatric PNES within the United States of America and a three-round Delphi study was conducted to assess consensus on key components of the management of pediatric PNES in the outpatient setting. ResultsEighteen experts representing neurology, psychology, psychiatry, social work and nursing participated in the study. Strong consensus was reached that the multidisciplinary clinic (MDC) model is the gold standard for the outpatient management of pediatric PNES. Consensus was obtained that a neurologist, psychologist and social worker are essential members of the MDC and in the setting of unlimited resources, psychiatry and nursing are also recommended. Further consensus was established on the roles of specific personnel, structure of the clinic, billing practices, trainee inclusion, patient inclusion and exclusion, and end of visit management. While consensus was reached that a new term should be developed for this diagnosis, consensus was not reached on the ideal term. DiscussionExpert consensus was established for the multidisciplinary management of pediatric PNES in the outpatient setting. Specific recommendations were provided that can facilitate the development and implementation of MDCs in other institutions. Further prospective studies are warranted to validate this practice model.

'I am more stressed if my infection affects others': development of a COVID-19-related stress scale in older people and examination of its validity and associations with mental health risks.

COVID-19 was a collective traumatic event; however, different individuals may have perceived it differently. This study investigated what older people in a collective culture perceived as stressful during COVID-19 and examined how different stressors related to COVID-19 infection and mental health risks. Thirty-six participants from diverse backgrounds engaged in a three-round Delphi study to generate items for a COVID-19-related stress scale for older adults (CSS-OA). Subsequently, 4674 people (aged ≥60 years) participated in a cross-sectional telephone survey; interviewers collected their responses to CSS-OA and information about COVID-19 infection, depressive symptoms, anxiety, loneliness and demographics. Exploratory factor analysis and confirmatory factor analysis were conducted on CSS-OA. A multiple indicator multiple cause (MIMIC) model was used to examine associations between CSS-OA and other measures. The Delphi process generated eight items, all secondary or tertiary stressors related to infection. Exploratory factor analysis revealed a three-factor model, and confirmatory factor analysis confirmed an excellent fit (comparative fit index = 0.99, root mean square error of approximation = 0.06). Pre-existing mental health conditions, having family members/friends infected with COVID-19, loneliness, anxiety and depressive symptoms were associated with higher stress. Conversely, self-infection with COVID-19, older age, being female and living alone were negatively associated with some domains of CSS-OA (all P < 0.05). The Delphi process enhanced our understanding of what older people perceived as stressful, much of which resulted from certain healthcare strategies and reflected cultural influences. These and the MIMIC results highlight the need to balance public health policies with respect to infectious diseases and older people's mental health and quality of life.

Step-by-step: A clinical pathway for stepped care management of fear of cancer recurrence-results of a three-round online delphi consensus process with Australian health professionals and researchers.

Fear of cancer recurrence (FCR) is not routinely addressed in clinical practice, meaning many cancer survivors forego effective interventions. We established expert consensus on a clinical pathway to help health professionals identify and manage FCR in early-stage cancer survivors. Australian health professionals and researchers working with adult cancer survivors participated in a three-round Delphi study promoted via oncology professional bodies and social media. The Round 1 online survey presented 38 items regarding FCR screening, triage, assessment, referral, and stepped care, based on a literature review, related pathways/guidelines, and expert input. Participants rated how representative of best-practice items were on a 5-point scale (strongly disagree-strongly agree), with optional qualitative feedback. Consensus was defined as ≥ 80% of participants strongly/agreeing with items. Items not reaching consensus were re-presented to Round 1 participants in two subsequent rounds with new items, derived from content analysis of qualitative feedback. From 94 participants in Round 1 (89% health professionals), 26/38 (68%) items reached consensus. By round 3, 35/38 (92%) items, including 8 new items, reached consensus. Routine FCR screening and triage conversations and stepped care management (i.e. tailored and staged treatment) were endorsed. However, the timing of FCR screening/triage did not reach consensus. This world-first FCR clinical pathway incorporating contemporary evidence and expert opinion recommends routine screening and triage to stepped care management of FCR. Some pathway components, such as screening or triage timing, may need tailoring for different contexts. Implementation of the pathway could aid routine identification and management of FCR, reducing its burden on cancer survivors and the healthcare system.

Identifying novel metrics of operative performance in surgical training: protocol for a Delphi consensus study

Abstract Introduction: Acquiring the technical and non-technical skills necessary to perform operations safely requires time and dedication. The learning curve is steep and regular feedback on operative performance is needed to help trainees identify strengths and development needs. Traditional methods of assessment are time consuming, prone to bias and lack reliability and scalability. Advances in digital technology in surgery have allowed for more objective measures of operative performance to be generated. Objective performance metrics can provide insights void of opinion and can complement and strengthen traditional methods of feedback. This protocol outlines a study that aims to reach consensus on which performance metrics are most relevant to surgical trainees and how they should be applied in training. Methods and analysis: A three-round electronic Delphi study will be used. Participants will be asked to rate the importance of statements relating to objective performance metrics in surgical training and the ways in which they could be applied. Statements will be created from extensive searches of the literature, discussion with experts and through a pilot. A panel consisting of trainees, trainers, researchers and institutions will be formed to participate in the study. Ethics and dissemination: Formal ethical approval has been granted for this study. Dissemination will be at surgical and education meetings, in addition to publication following peer review.

An ethical framework for human-robot collaboration for the future people-centric manufacturing: A collaborative endeavour with European subject-matter experts in ethics

Envisioning humans and (smart) robots collaboratively working on the manufacturing shop floor, sharing spaces, tasks and objectives, reflects the ambitious goal that the ideal factory of the future aspires to attain. However, ensuring the effective implementation of this novel form of labour organisation remains an ongoing area of research. Key aspects such as the future role of workers, potential psychological risks, and the overall ethical considerations of human-robot (H-R) collaboration warrant further investigation until the underpinning safety challenges have been addressed. This study presents a novel ethical framework for H-R collaboration in manufacturing, which involved 30 subject-matter experts in ethics within the European context in a collaborative design process conducted through a year-long three-round data collection qualitative Delphi study. The ethical framework adopts a human-centric approach, recognising the influences that expand beyond the specific context of H-R dynamics on the shop floor, towards organisational and societal governance for a more responsible integration of (smart) robotics into the professional settings. Ethics, in this regard, aims to foster ethical awareness and accountability in the processes and practices of design and innovation, involving all stakeholders who play a role in shaping the future of Industry 5.0.

Publisher preferences for a journal transparency tool: A modified three-round Delphi study

Background We propose the creation of a journal transparency tool (JTT), which will allow users to obtain information about a given scholarly journal’s operations and policies. We are obtaining preferences from different stakeholders to inform the development of this tool. This study aimed to identify the publishing community’s preferences for the JTT. Methods We conducted a modified three-round Delphi survey. Representatives from publishing houses and journal publishers were recruited through purposeful and snowball sampling. The first two Delphi rounds involved an online survey with items about JTT metrics and user features. During the third round, participants discussed and voted on JTT metric items that did not reach consensus after round 2 within a virtual consensus meeting. We defined consensus as 80% agreement to include or exclude an item in the JTT. Results Eighty-six participants completed the round 1 survey, and 43 participants (50% of round 1) completed the round 2 survey. In both rounds, respondents voted on JTT user feature and JTT metric item preferences and answered open-ended survey questions regarding the JTT. In round 3, a total of 21 participants discussed and voted on JTT metric items that did not reach consensus after round 2 during an online consensus group meeting. Fifteen out of 30 JTT metric items and none of the four JTT user feature items reached the 80% consensus threshold after all rounds of voting. Analysis of the round 3 online consensus group transcript resulted in two themes: ‘factors impacting support for JTT metrics’ and ‘suggestions for user clarity.’ Conclusions Participants suggested that the publishing community’s primary concerns for a JTT are to ensure that the tool is relevant, user-friendly, accessible, and equitable. The outcomes of this research will contribute to developing and refining the tool in accordance with publishing preferences.

The core competencies of a health education teacher.

Teachers play a crucial role in students' learning and in the development of health literacy. Hence, the aim of this study was to identify the core competencies needed for teachers of health education in supporting student learning. A three-round Delphi study was carried out over an 8-week period, through consultation with 25 Finnish experts in health education. An open-ended question was used to identify the core competencies for school health educators. The data were analysed using inductive content analysis. In subsequent rounds, experts were asked to assess the importance of the identified competencies on a 7-point Likert scale, and finally to rank the most important competencies. In total, 52 competencies were identified and categorized into eight core competence domains. Thereafter, 40 competencies were assessed and selected for the third round, in which the experts ranked the 15 most important competencies, encompassing four core domains, i.e. pedagogic and subject-specific didactic, social and emotional, content knowledge and continuous professional development. Other domains of competence identified in the present study were ethical competence, competence in school health promotion, contextual competence and professional well-being competence. The study defines health education teacher core competencies and domains, and the information can be used in teacher education programmes, for developing teaching and for teachers' self-evaluation.

Perioperative patient safety indicators-A Delphi study.

To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context. A modified Delphi method. A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study. The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment. Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety. This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement. The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care. The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'. No patient or public contribution.

Developing consensus to enhance perinatal mental health through a model of integrated care: Delphi study.

Perinatal mental illness is an important public health issue, with one in five birthing persons experiencing clinically significant symptoms of anxiety and/or depression during pregnancy or the postpartum period. The purpose of this study was to develop a consensus-based model of integrated perinatal mental health care to enhance service delivery and improve parent and family outcomes. We conducted a three-round Delphi study using online surveys to reach consensus (≥75% agreement) on key domains and indicators of integrated perinatal mental health care. We invited modifications to indicators and domains during each round and shared a summary of results with participants following rounds one and two. Descriptive statistics were generated for quantitative data and a thematic analysis of qualitative data was undertaken. Study participants included professional experts in perinatal mental health (e.g., clinicians, researchers) (n = 36) and people with lived experience of perinatal mental illness within the past 5 years from across Canada (e.g., patients, family members) (n = 11). Consensus was reached and all nine domains of the proposed model for integrated perinatal mental health care were retained. Qualitative results informed the modification of indicators and development of an additional domain and indicators capturing the need for antiracist, culturally safe care. The development of an integrated model of perinatal mental health benefitted from diverse expertise to guide the focus of included domains and indicators. Engaging in a consensus-building process helps to create the conditions for change within health services.

Developing a Vape Shop-Based Smoking Cessation Intervention: A Delphi Study.

Providing access to a vape shop-based smoking cessation intervention may simultaneously increase e-cigarette use and increase the effectiveness of e-cigarettes for smoking cessation. The aim of this study was to identify the most important elements of vape shop-based smoking intervention to stakeholders who would be involved in delivering or accessing such an intervention. We conducted a three-round Delphi study of vape shop staff (n = 40), stop smoking professionals and tobacco control leads (n = 30), and smokers, vapers, and dual users (n = 30) in the United Kingdom in May-August 2021. In each round participants were asked whether they agreed or disagreed with statements related to vape shop-based interventions. Forty-six of 95 statements reached consensus in round 1, 29 out of 49 in round 2, and 8 out of 20 in round 3. There was support for a vape shop-based intervention across stakeholder groups (96%). There was consensus that the service should comprise both product (98%) and behavioral support (97%), and that quitting vaping should not be a goal of the service (79%). Although there was consensus that there should be some free product provision, there was less consensus as to what this should involve. Views were mostly consistent across stakeholder groups. There was broad consensus on how to deliver a vape shop-based smoking cessation intervention, providing a strong basis for future intervention development and implementation. Challenges around misuse of the service and misperceptions about vaping would need to be addressed for such an intervention to be feasible and effective. Many smokers who make a quit attempt using e-cigarettes purchase their vaping products in vape shops. Delivering vape-shop-based smoking cessation interventions could help to maximize the effectiveness of e-cigarettes for quitting smoking. This study used a Delphi approach to identify the most important elements of a vape shop-based intervention among stakeholders. The findings could be used to help develop future interventions.

Research and practice priorities in pilonidal sinus disease: a consensus from the PITSTOP study.

Pilonidal sinus disease is a common condition treated by colorectal surgeons. There is a lack of literature in the field to guide optimal management of this condition. As part of the PITSTOP study, we aimed to identify policy and research priorities to provide direction to the field. Patients and surgeons were invited to participate. A 'So what, now what' exercise was conducted, informed by data from PITSTOP. This generated statements for research and practice priorities. A three-round online Delphi study was conducted, ranking statements based on policy and research separately. Statements were rated 1 (not important) to 9 (important). Statements that were rated 7-9 by more than 70% of participants were entered into the consensus meeting. Personalized voting feedback was shown between rounds. A face-to-face meeting was held to discuss statements, and participants were asked to rank statements using a weighted choice vote. Twenty-two people participated in the focus group, generating 14 research and 19 policy statements. Statements were voted on by 56 participants in round 1, 53 in round 2 and 51 in round 3. A total of 15 policy statements and 19 research statements were discussed in the consensus round. Key policy statements addressed treatment strategies and intensity, surgeon training opportunities, need for classification and the impact of treatment on return to work. Research recommendations included design of future trials, methodology considerations and research questions. This study has identified research and policy priorities in pilonidal sinus disease which are relevant to patients and clinicians. These should inform practice and future research.

An Exercise Prescription for Patients with Stroke and Sarcopenia Based on the Modified Delphi Study.

We aimed to develop a consensus on the need for and priorities of exercise to treat preexisting sarcopenia with hemiplegic stroke. A modified three-round Delphi study was conducted. The panelists responded to the questionnaire on a 7-point Likert scale. Responses were returned with descriptive statistics in the next round. Consensus was defined as >75% agreement (score of 5-7) with a median > 5. The percentage of strong agreement (score of 6-7) and Kendall's coefficient of concordance were calculated to demonstrate a more refined interpretation of the consensus. Fifteen panelists contributed to all rounds. The need for exercise was demonstrated. The consensus was reached on 53 of 58 items in the first round and all items in the second and final rounds. The percentage of strong agreement was high for all but eight items. This study is the first Delphi study to investigate the need for and priorities of exercise for treating preexisting sarcopenia in stroke hemiplegia. We present a standard recommendation including 57 priorities and a strong recommendation including 49 priorities. The eight items that were excluded reflected factors that are less important to hemiplegic patients with poor balance, cognitive decline, or mental vulnerability.

Development of a self-care guideline to prevent rehospitalization in stroke patients: a modified Delphi study

Introduction: Since 2007, the number of stroke cases in Indonesia has continued to increase. Stroke patients who have passed the acute phase of stroke still have a risk of recurrent stroke and rehospitalization. This study aimed to develop self-care guidelines to prevent the rehospitalization of stroke patients. Methods: A three-round modified Delphi study was applied to a panel of 24 experts with different fields of expertise, consisting of doctors, nurses, families, and patients. In the first round, data were collected through a literature review and semi-structured interviews. In the second and third rounds, data were collected using a survey questionnaire on a 9-point Likert scale. Results: The first round produced seven themes around self-care activities, including drug therapy, physical exercise, diet and nutrition, stress management, self-motivation, functional status screening, and control for risk factors. In the second round, all types of self-care in the first round were agreed upon for content in preparing the guidebook. The third round resulted in agreement on the guidebook that had been designed, with scores of 8 and above by 100% of the expert panel. Conclusions: The development of a self-care guidebook to prevent rehospitalization of stroke patients through a three-round Delphi study has reached a consensus among the entire panel of experts. Further research by testing guidebooks in the healthcare system is needed to determine their effectiveness in preventing re-hospitalization in stroke patients.

Neuropsychological assessment of aggressive offenders: a Delphi consensus study.

This study explores the intricate relationship between cognitive functioning and aggression, with a specific focus on individuals prone to reactive or proactive aggression. The purpose of the study was to identify important neuropsychological constructs and suitable tests for comprehending and addressing aggression. An international panel of 32 forensic neuropsychology experts participated in this three-round Delphi study consisting of iterative online questionnaires. The experts rated the importance of constructs based on the Research Domain Criteria (RDoC) framework. Subsequently, they suggested tests that can be used to assess these constructs and rated their suitability. The panel identified the RDoC domains Negative Valence Systems, Social Processes, Cognitive Systems and Positive Valence Systems as most important in understanding aggression. Notably, the results underscore the significance of Positive Valence Systems in proactive aggression and Negative Valence Systems in reactive aggression. The panel suggested a diverse array of 223 different tests, although they noted that not every RDoC construct can be effectively measured through a neuropsychological test. The added value of a multimodal assessment strategy is discussed. This research advances our understanding of the RDoC constructs related to aggression and provides valuable insights for assessment strategies. Rather than suggesting a fixed set of tests, our study takes a flexible approach by presenting a top-3 list for each construct. This approach allows for tailored assessment to meet specific clinical or research needs. An important limitation is the predominantly Dutch composition of the expert panel, despite extensive efforts to diversify.

Building consensus on a set of ENDS-specific pictorial health warnings: a Delphi study among a tobacco control expert panel

BackgroundThis study reports on the development of pictorial health warning labels for electronic nicotine delivery system (ENDS) using the Delphi approach with a panel of tobacco control experts. Twenty-four evidence-based...

Top 10 needs of Ukraine’s Olympic sports in hostile conditions: a Delphi study

Following the tragic events surrounding the war in Ukraine, which started on 24 February 2022, Russian troops have been destroying many Olympic sports infrastructures and athletes and Olympic sports professionals...

Establishing consensus on principles and competencies for the use of play in clinical practice in hospitals: An international Delphi study

Although play has existed in paediatric hospitals for decades, a shared understanding of why and how healthcare professionals use play in clinical practice is lacking. This study aims to reach consensus on a common set of principles and competencies for play interventions and practices in hospitals. We conducted a three-round Delphi study that included healthcare professionals selected by hospital management. The first round comprised open-ended questions on the use of play in clinical practice. Principles and competencies, including learning objectives, were established using content analysis through an iterative process. Participants rated the importance of each principle and learning objective in the second and third rounds. Among the 66 participants, 45 (68%) responded in round 1 and 41 (62%) in rounds 2 and 3. The participants represented ten countries and nine different health professions. After the three rounds, we identified 33 principles and six overall competencies: building trusting relationships; delivering information and increasing understanding; promoting cooperation and participation; reducing procedure-related anxiety and pain; supporting coping and development; and ensuring a professional approach to play, which comprised 20 learning objectives. Conclusion: According to healthcare professionals, play in clinical practice can be used to communicate and build relationships with paediatric patients and thus potentially help provide patient-centred care. Our findings may help guide and prioritize future research initiatives and operationalize play interventions and practices in hospitals.What is Known:• Evidence suggests that using play in clinical practice can help paediatric patients during hospitals stays.• Despite the evidence supporting the use of play, a shared understanding of why and how paediatric healthcare professionals use play is needed.What is New:• This international Delphi study contributes to a shared interprofessional understanding of the principles, competencies and learning objectives for the use of play in clinical practice.• The findings have the potential to aid initiatives in developing training programmes for healthcare professionals in using play to provide care with a patient-centred approach.

Case study on communicating with research ethics committees about minimizing risk through software: an application for record linkage in secondary data analysis.

In retrospective secondary data analysis studies, researchers often seek waiver of consent from institutional Review Boards (IRB) and minimize risk by utilizing complex software. Yet, little is known about the perspectives of IRB experts on these approaches. To facilitate effective communication about risk mitigation strategies using software, we conducted two studies with IRB experts to co-create appropriate language when describing a software to IRBs. We conducted structured focus groups with IRB experts to solicit ideas on questions regarding benefits, risks, and informational needs. Based on these results, we developed a template IRB application and template responses for a generic study using privacy-enhancing software. We then conducted a three-round Delphi study to refine the template IRB application and the template responses based on expert panel feedback. To facilitate participants' deliberation, we shared the revisions and a summary of participants' feedback during each Delphi round. 11 experts in two focus groups generated 13 ideas on risks, benefits, and informational needs. 17 experts participated in the Delphi study with 13 completing all rounds. Most agreed that privacy-enhancing software will minimize risk, but regardless all secondary data studies have an inherent risk of unexpected disclosures. The majority (84.6%) noted that subjects in retrospective secondary data studies experience no greater risks than the risks experienced in ordinary life in the modern digital society. Hence, all retrospective data-only studies with no contact with subjects would be minimal risk studies. First, we found fundamental disagreements in how some IRB experts view risks in secondary data research. Such disagreements are consequential because they can affect determination outcomes and might suggest IRBs at different institutions might come to different conclusions regarding similar study protocols. Second, the highest ranked risks and benefits of privacy-enhancing software in our study were societal rather than individual. The highest ranked benefits were facilitating more research and promoting responsible data governance practices. The highest ranked risks were risk of invalid results from systematic user error or erroneous algorithms. These societal considerations are typically more characteristic of public health ethics as opposed to the bioethical approach of research ethics, possibly reflecting the difficulty applying a bioethical approach (eg, informed consent) in secondary data studies. Finally, the development of privacy-enhancing technology for secondary data research depends on effective communication and collaboration between the privacy experts and technology developers. Privacy is a complex issue that requires a holistic approach that is best addressed through privacy-by-design principles. Privacy expert participation is important yet often neglected in this design process. This study suggests best practice strategies for engaging the privacy community through co-developing companion documents for software through participatory design to facilitate transparency and communication. In this case study, the final template IRB application and responses we released with the open-source software can be easily adapted by researchers to better communicate with their IRB when using the software. This can help increase responsible data governance practices when many software developers are not research ethics experts.

Stroke Care Planner: A Delphi Study

Abstract Objective: The objective of the study was to analyse the efficacy and acceptability of a care planning tool for comprehensive post-stroke rehabilitation. Materials and Methods: An expert panel of physiatrists from Kerala, India, participated in a three-round Delphi study. Intervention: Nil. Results: Consensus was reached on 13 deficit-oriented modules with best practice key statements. They stress the need for supervised rehabilitation interventions provided by trained health professionals early after discharge from the acute care setting to optimise patient outcomes. Patient-specific, centre-specific and culturally appropriate factors were considered during formulation. Acute care, triage, routine workflow, outcome assessment, trajectory assessment and rationale were recommended, and several standardised outcome measures were identified. Follow-up and community-based rehabilitation suggestions were provided. Specifics on timing, service providers, need for long-term follow-up and interventions differed per module. Conclusion: A rigorous consensus method led to key recommendations in modular form using the available evidence and consideration of contextual factors to facilitate clinical practice. This is an important step towards reducing practice variation, closing the evidence–practice gap and improving the quality of rehabilitation services after stroke. Significance and Innovations: This is the first formal consensus process to integrate available evidence and expert opinion with a ‘deficit to metric to treatment to outcome’ approach to recommend key aspects of post-stroke rehabilitation from admission to return to the community. The expert panel recommended structured physiatrist-led rehabilitation, initiated early to optimise patient outcomes. In addition to physical rehabilitation, it is important to recognise cognitive and psycho-social deficits along with the influence of contextual factors that impact rehabilitation structures, processes and outcomes.