Delphi methodology in healthcare research:How to decide its appropriateness

The Delphi technique is a systematic process of forecasting using the collective opinion of panel members.The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine.The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited,ethically/logistically difficult or evidence is conflicting.However,the attempts to assess the quality standard of Delphi studies have reported significant variance,and details of the process followed are usually unclear.We recommend systematic quality tools for evaluation of Delphi methodology;identification of problem area of research,selection of panel,anonymity of panelists,controlled feedback,iterative Delphi rounds,consensus criteria,analysis of consensus,closing criteria,and stability of the results.Based on these nine qualitative evaluation points,we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019.There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members,defining consensus,closing criteria for rounds,and presenting the results.We propose our evaluation points for researchers,medical journal editorial boards,and reviewers to evaluate the quality of the Delphi methods in healthcare research.

Methodological exploration on the construction of a traditional Chinese medicine nursing expert consensus based on evidence--taking stroke as an example

Objective: To explore the methodology of the evidence-based expert consensus formulation process of traditional Chinese medicine(TCM) nursing taking stroke as an example.Methods: First, preliminary and comprehensive presentation of all stroke-related symptoms and corresponding TCM nursing techniques involved were revealed through bibliometric analysis. Then, selection of stroke symptoms and TCM nursing techniques for inclusion in the consensus was performed using an expert consultation method. Next, we determined the search strategy for a precise evidence search;conducted an evaluation of evidence quality and the grade of the evidence;and completed evidence extraction, evidence analysis, and evidence synthesis based on the included symptoms and TCM nursing techniques. The Delphi method was then applied to determine the strength of each recommendation and the choice of nursing care points by referring to the Grading of Recommendations, Assessment, Development, and Evaluations grid. Finally, we conducted an external expert validation of the Delphi results to form an expert consensus guideline.Results: Through the bibliometric analysis, 22 stroke symptoms and 18 TCM nursing techniques were identified in the literature. Then, after expert consultation, 22 symptoms and 111 pairs of symptoms combined with TCM nursing techniques were selected for the evidence search. Evidence integration yielded 10 stroke symptoms corresponding to 29 bodies of evidence;these 10 symptoms were retained through the Delphi consultation, and recommendation strength results for 26 recommendations were obtained. A total of 9 symptoms were further retained for expert external validation to form 24 recommendations, with a recommendation process score range of 7.64-9.99 points and a more scientific and standardized recommendation-formation process.Conclusion: Owing to the current limited conditions of evidence-based resources for TCM nursing, the present consensus-building process represents only a preliminary exploration of an evidence-based expert consensus for TCM nursing to provide a reference for a more scientific and standardized methodology.

Study on traditional Chinese medicine syndrome of esophageal cancer based on Delphi method

Esophageal cancer is one of the common malignant tumors in humans.Traditional Chinese medicine(TCM)has unique advantages in the treatment of esophageal cancer.However,the TCM syndrome classification of esophageal cancer is not standardized.This Delphi survey aimed to explore the TCM syndrome classification and symptom characteristics of esophageal cancer.Methods:Based on literature research,an expert consultation questionnaire was developed for the study of the TCM syndrome rules of esophageal cancer.Two rounds of questionnaire surveys were conducted among 62 experts across the country.Statistical description and statistical analysis of the mean,coefficient of variation,grade sum,and unimportant percentage of the retrieved data.TCM syndrome rules and diagnostic indicators for esophageal cancer after screening and sorting out the questionnaire items,convening experts to demonstrate.Results:62 valid questionnaires were collected,and the expert positive coefficient was 100%.The Kendall's coefficient of concordance W of the first and second rounds are 0.232 and 0.2334 respectively.In addition,the Kendall's coefficient of concordance W of the second round has been improved compared with the first round,suggesting that experts have a better degree of coordination on the importance of indicators.The common TCM syndromes of esophageal cancer are obtained:"liver-stomach disharmony,phlegm and qi obstruction syndrome","liver and spleen disorders,phlegm accumulating with stagnation syndrome","deficiency of liver and kidney yin,stubborn blood syndrome","deficiency of spleen and kidney yang,stubborn blood syndrome".Conclusion:The TCM syndrome indicators of esophageal cancer has been established.It provides a basis for the standardized research of TCM syndrome diagnosis of esophageal cancer,which is of positive significance for improving the level of clinical diagnosis and treatment.

Establishing nursing adverse events’reporting content of hospital:using the Delphi method

Objective:To develop nursing adverse events’reporting content of hospital.Methods:The study included two phases.The first phase was to develop the category and definition of nursing adverse events that need to be reported through an expert meeting.The second phase was to develop every nursing adverse event’s reporting content by using the Delphi method.In total,8 experts attended the meeting and 15 experts conducted two rounds of consultation letter.Results:Nursing adverse events that need to be reported of hospital include pressure sore,fall/falling from bed,unplanned extubation,medication error,and accident.Reporting content of these events in detail had also been obtained,which was helpful for cause analysis systematically.Conclusions:The reporting content of the nursing adverse event of hospital is established,and it is a basis for further study of the development of nursing adverse event reporting and feedback system.

Fully Completed Spherical Fuzzy Approach-Based Z Numbers(PHIModel)for Enhanced Group Expert Consensus

This study aims to establish an expert consensus and enhance the efficacy of decision-making processes by integrating Spherical Fuzzy Sets(SFSs)and Z-Numbers(SFZs).A novel group expert consensus technique,the PHImodel,is developed to address the inherent limitations of both SFSs and the traditional Delphi technique,particularly in uncertain,complex scenarios.In such contexts,the accuracy of expert knowledge and the confidence in their judgments are pivotal considerations.This study provides the fundamental operational principles and aggregation operators associated with SFSs and Z-numbers,encompassing weighted geometric and arithmetic operators alongside fully developed operators tailored for SFZs numbers.Subsequently,a case study and comparative analysis are conducted to illustrate the practicality and effectiveness of the proposed operators and methodologies.Integrating the PHI model with SFZs numbers represents a significant advancement in decision-making frameworks reliant on expert input.Further,this combination serves as a comprehensive tool for decision-makers,enabling them to achieve heightened levels of consensus while concurrently assessing the reliability of expert contributions.The case study results demonstrate the PHI model’s utility in resolving complex decision-making scenarios,showcasing its ability to improve consensus-building processes and enhance decision outcomes.Additionally,the comparative analysis highlights the superiority of the integrated approach over traditional methodologies,underscoring its potential to revolutionize decision-making practices in uncertain environments.

基于Delphi法的医疗机构药学服务质量控制指标体系研究

目的:为提高医疗机构药学服务水平、实现药学服务精准化提供参考。方法:在依托广西医院药事管理质控中心对广西三级甲等医院进行抽样调查摸底的基础上,结合文献分析结果和国际相应标准,运用Delphi法采用现场调研和电子邮件调研两种方式发放专家咨询表,对4轮专家咨询的调查结果进行分析总结,建立医疗机构药学服务质量控制指标体系。结果与结论:所有专家(100%)均认为医疗机构药学服务工作非常重要并需要质控指标体系。根据专家咨询结果,最终拟定出5个一级指标(包括药学服务管理组织构架建设、合理用药管理、药学服务专业能力管理、药学服务监测管理和特色药学服务管理)及26个二级指标。一级指标中,“药学服务管理组织构架建设”“合理用药管理”“药学服务专业能力管理”等指标被专家普遍认为是重要的质控指标,“很重要”和“重要”占比分别为96.65%、100%和100%;二级指标中,“组织建设”“制度建设”“处方用药管理”“住院医嘱审核”“不良反应监测”“药学知识”“临床知识”等指标被专家普遍认为是重要的质控指标,“很重要”和“重要”占比分别为95.65%、95.65%、100%、95.66%、96.65%、100%、91.30%。本研究所拟定的医疗机构药学服务质量控制指标体系权威性较高,现已经广西医院药事管理质控中心审核、定稿,并在广西15家医疗机构进行试点。

《心悸(心律失常-室性早搏)多民族医诊疗专家共识》临床问题与结局指标的收集与确定

背景民族医药治疗室性早搏具有诸多优势,然而民族医药滥用的情况普遍,并且缺乏专属的临床用药推荐,因此规范民族医药诊疗室性早搏具有重要意义。目的构建《心悸(心律失常-室性早搏)多民族医诊疗专家共识》的临床问题及结局指标。方法问询专家为共识专家组,涵盖心血管、循证医学、药学领域的专家,心血管方面包括中医、藏医、蒙医、维吾尔医、傣医、朝鲜医、壮医等多民族医专家。基于文献和专家访谈报告,课题组检索中医、藏医、蒙医、维吾尔医、傣医、朝鲜医、壮医等多民族医治疗室性早搏的相关文献。于2023年4月对14位各民族医专家进行一对一线上访谈。整合访谈结果及专家经验,由共识指导委员会、工作组共同起草临床问题与结局指标初稿,并设计调查问卷。于2023年5—7月开展两轮问卷调查,并评价问卷的积极系数、集中程度、协调程度和信度。结果专家组具有多学科协作、权威性和地域代表性的特点。两轮德尔菲法积极系数为99.1%,5个背景问题的均分>4分且满分>40%,10个前景问题的均分>3.9分且满分比>35%,9个结局指标的均分>7分且满分比>30%,平均变异系数分别为14.9%、16.3%、17.6%。临床问题、结局指标的肯德尔和谐系数分别为0.267、0.316,χ^(2)检验P<0.05,Cronbach'sα系数分别为0.913、0.905,均>0.700,质量控制结果较理想,问卷设计可信度高。结论借助德尔菲法,构建《心悸(心律失常-室性早搏)多民族医诊疗专家共识》所需解决的临床问题及结局指标,为后续共识制定奠定了基础。

Delphi专家评分法在景观桥梁方案比选中的应用

针对方案比选中所采用的传统专家法具有主观性强、不能定量分析等缺陷,基于Delphi专家评分法的基本思想和理论,本文将该方法应用到景观桥梁方案比选中,实现了桥梁景观方案比选由定性化变成定量化.以某景区内的一座九孔桥为工程背景,成功的应用了Delphi专家评分法对其景观方案进行了方案比选,取得了良好视觉的效果.本方法可供景观方案比选研究工作参考.

构建中医领域病例-对照研究技术规范:基于Delphi法的第1次调查

[目的]通过专家咨询的方式对调查问题条目进行第1轮评估,经分析讨论后形成第2轮调查问题条目。[方法]采用国际上通用的德尔菲(Delphi)法,以专家咨询的形式进行第1轮咨询调查,对调查问题条目进行重要性评估,并对相关条目提出归纳意见和建议,最后根据专家咨询的结果确定需要纳入的条目,为第2轮咨询调查提供草案。[结果]根据系统查阅文献的结果,结合观察性研究的STROBE规范以及国际上其他相关方法学技术规范制订的过程,最终制订出45条调查问题条目,以此进行专家调查。调查结果显示专家积极系数为81.8%。专家意见的集中程度指标一致,提示专家意见集中程度较好。条目变异系数(CV)均<0.3,提示专家意见协调程度较好。条目平均分≥4分的有36条,3分≤平均分<4分的有9条。其中关于证候和体质时点的确定以及选择新发病例方面是质疑较多的条目。[结论]最后确定纳入第1轮意见征询的条目36条、可能纳入的条目9条。其结果提示,中医药领域的病例-对照研究有其自身的特殊性,尤其是证候、体质方面,需要针对性的方法学指导。

基于Delphi法的《手足口病中医诊疗指南》第一、二轮专家调查问卷结果分析

目的:筛选和评价中医儿科行业专家对《手足口病中医诊疗指南》初稿框架以及诊疗意见的集中程度和协调程度,制定科学实用的《手足口病中医诊疗指南》。方法:采用德尔菲法,在文献研究的基础上制定《手足口病中医诊疗指南专家调查问卷》,向全国40余位专家进行2次问卷调查,并对2次专家调查问卷结果进行分析。结果:2次调查问卷收回有效问卷均为37份,专家积极系数均为92.5%,制定出《手足口病中医诊疗指南》初稿,专家对其中指标意见的集中程度和协调程度较高。结论:专家的积极性和专业水平均较高,分布地区广,具有代表性,《手足口病中医诊疗指南》框架涉及的条目基本得到专家的认可。

基于Delphi法的消毒供应中心实习生教学大纲的构建与应用

目的构建消毒供应中心实习生教学大纲,并通过实际应用确认大纲的教学效果。方法以Delphi专家咨询法为基础,建立包括教学项目、教学内容、教学方式、课时安排等内容的教学大纲。结果教学大纲应用结果表明,该教学大纲可靠性较高,提升了护理实习生的理论与技能水平。结论该教学大纲符合消毒供应中心实习生带教工作的特点,具有一定的指导意义。

基于Delphi法构建眼科高级实践护士的角色、职能、岗位设置等方案

[目的]探讨眼科高级实践护士(APN)的角色职能等相关问题,为我国眼科APN的研究和培养提供依据。[方法]设计眼科APN培养相关问题专家咨询问卷,采用Delphi法对26名专家进行两轮咨询后形成眼科APN的角色职能定位及岗位设置等的具体方案。[结果]构建的眼科APN培养的选拔准入、角色定位、岗位设置、工作职责等内容包括4个方面、11个条目,选择率为54.5%~100.0%。[结论]确定了眼科APN的培养准入、岗位设置等方案,为眼科APN的培养和临床角色发展提供了依据。

基于Delphi法《小儿反复呼吸道感染瘀热内结证中医诊疗专家共识》专家问卷分析

目的对《小儿反复呼吸道感染瘀热内结证中医诊疗专家共识》三轮问卷结果进行总结分析,制定科学、客观、实用的推荐共识。方法在文献研究基础上,采用Delphi法制定并完成三轮问卷,每轮向全国20位专家进行问卷调查,并对专家意见集中程度、协调程度及问卷信度进行评价。结果每轮收回有效问卷20份,专家积极系数均为100%,该问卷总格朗巴赫α系数为0.986,制定出《小儿反复呼吸道感染瘀热内结证中医诊疗专家共识》初稿。结论基于Delphi法能很好地总结专家经验,为制定《小儿反复呼吸道感染瘀热内结证中医诊疗专家共识》提供依据。

基于计算机仿真的Delphi专家评分法在景观桥梁视觉参数分析中的应用

针对传统视觉参数分析方法有主观性强、不能定量分析等缺陷,提出了一种比较客观、能进行定量分析的景观桥梁视觉参数分析的方法,即基于计算机仿真技术,建立了景观桥梁各参数的视觉分析模型,引入Delphi专家评分法对模型进行视觉参数分析,确定出视觉效果较好时的参数值,得到了景观桥最优造型.以某景区内的一座九孔拱桥为工程背景,成功应用该方法进行桥梁视觉参数分析,取得了良好视觉的效果.

应用Delphi法筛选周围性面瘫急性期针刺适宜取穴方案

目的应用Delphi法对周围性面瘫取穴相关内容进行专家咨询,筛选出较为公认的周围性面瘫急性期针刺适宜取穴方案。方法在前期文献研究基础上设计专家咨询问卷,采用Delphi法对46名专家进行2轮问卷咨询,根据专家积极系数、专家权威系数、专家意见集中程度、专家意见协调程度进行统计与评价。结果95.65%的专家同意最终确定的周围性面瘫急性期治疗的针刺取穴方案,包括局部穴组(阳白、攒竹、太阳、四白、迎香、水沟、颧髎、颊车、地仓、承浆、牵正、翳风、风池)、远端穴组(合谷、太冲、足三里、外关)。结论本研究参与专家学科代表性强,积极性、权威性高,专家意见协调性好,应用Delphi法筛选的周围性面瘫急性期针刺治疗的取穴方案专家认可度高、临床可取。

基于Delphi-TOPSIS法的雷达装备可靠性评估指标约简方法

为提高雷达装备可靠性指标评估的科学性,建立科学合理的雷达装备可靠性评估指标,论文初步建立了雷达装备可靠性评估指标,并针对评估指标数量过多带来的评估过程冗余和部分指标信息重复的问题,提出了一种基于专家调查法(Delphi)的指标体系筛选的方法对雷达装备可靠性指标体系进行约简,删除了可靠性评估过程中的信息重复冗余指标。应用实例,通过AHP-TOPSIS法的雷达装备可靠性评估模型,证明了该方法的合理性和有效性。

心房颤动患者左心耳封堵术护理方案的构建

目的 构建一套科学、标准化、具有较强临床实践性且符合我国心房颤动(房颤)患者的左心耳封堵术护理方案。方法 于2022年1-6月,通过国内外文献回顾和半结构式访谈初步构建方案,对19名专家实施德尔菲函询完成方案调整,并结合层次分析法确定各指标权重系数。结果 2轮函询问卷有效回收率分别为95%和100%;专家权威系数分别为0.879和0.896。最终确立了6个一级指标,28个二级指标,50个三级指标构成的房颤患者左心耳封堵术护理方案。各指标重要性赋值均数为4.47~5.00,满分率为52.6%~100.0%,变异系数为0.00~0.16,肯德尔系数为0.202~0.327(P<0.001)。结论 构建的房颤患者左心耳封堵术护理方案可信且具科学性,能够为房颤患者左心耳封堵术护理实践提供参考。

基于德尔菲法构建护理专业学位研究生与肿瘤专科护士核心能力联合培养方案

目的:构建护理专业学位研究生与肿瘤专科护士核心能力联合培养方案,为推动我国护理专业学位研究生教育的发展提供参考。方法:通过文献分析法及半结构化访谈初步形成护理专业学位研究生与肿瘤专科护士核心能力联合培养方案条目池,制定专家函询问卷,并采取德尔菲专家函询法对15名专家进行专家函询,最终形成护理专业学位研究生与肿瘤专科护士核心能力联合培养方案。结果:3轮函询专家积极性系数均为100.0%,专家权威系数分别为0.838,0.880和0.880。经过咨询最终形成包括理论知识掌握能力、临床综合实践应用能力、组织管理能力、教学及科研能力、发展能力5个一级指标、17个二级指标、96个三级指标的护理专业学位研究生与肿瘤专科护士核心能力联合培养方案。结论:构建的护理专业学位研究生与肿瘤专科护士核心能力联合培养方案具有良好的可靠性与科学性,对肿瘤护理方向专科人才培养提供参考。

基于三维质量结构模型构建神经外科患者身体约束护理质量评价指标体系

目的 构建神经外科患者身体约束护理质量评价指标,用于指导护士临床实践工作,持续改进工作流程与质量。方法 以三维质量结构模型为理论指导,通过回顾文献和专家访谈,运用Delphi专家函询法,构建神经外科患者身体约束护理质量评价指标。结果 3轮专家函询问卷的有效回收率均为100%,专家权威系数均>0.9,一、二级的协调系数分别为0.126、0.094(P<0.001),最终确定的评价指标包括一级指标3个,二级指标31个。结论 建立的评价指标科学、规范、内容全面,对神经外科患者身体约束护理质量具有指导作用。

《中医药防治新型冠状病毒感染专家共识》临床问题的确定

目的确定《中医药防治新型冠状病毒感染专家共识》的临床问题,为该共识形成推荐意见提供基础,为突发急性传染病相关共识的制定提供参考。方法采用文献调研与德尔菲法相结合的方法,开展文献研究和专家学术观点的梳理,采用德尔菲法开展第一轮问卷调查,确定临床一线医生关注的主要临床问题形成条目池,在此基础上制定第二轮调查问卷,以票选率>70%为标准纳入原始问题清单。梳理共14个临床问题及15个结局指标,开展第三轮问卷调查,得票率>70%的项目纳入指南问题清单及结局指标。结果最终纳入文献145篇,专家对新冠病毒感染的病因、病机、分期及治疗方面的认识比较一致,认为“湿”为本病的核心病机,普遍认同分消走泄、疏通气机是治疗关键,在病名的命名方面分歧比较明显。第一轮德尔菲法回收82份问卷,第二轮德尔菲法回收92份问卷,形成原始问题清单;第三轮问卷调查最终采纳14项临床问题及12个结局指标。结论规范地在文献研究及与德尔菲法问卷调查基础上筛选制定的临床问题能够比较全面地反映临床一线需求、主要学术观点及外感热病经典理论,能够提高指南的可推广性和可行性。