A modified Delphi process to establish research priorities in hernia surgery

Scrimgeour, Duncan; Allan, Morven; Knight, Stephen R; East, B; Blackwell, Sue; Dames, Nicola; Laidlaw, Lynn; Light, Duncan; Horgan, Liam; Smart, Neil; Beaux, Andrew de; Wilson, Michael

doi:10.1007/s10029-021-02519-0

Cited by 4 publications

(3 citation statements)

References 36 publications

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“…11 Modified electronic Delphi process is commonly used to reach consensus and identify research priorities in diverse health areas. [12][13][14][15][16] Several frameworks have been used to guide the process of priority setting, including the James Lind Alliance Priority Setting Partnership (JLA PSP), 17 Essential National Health Research (ENHR) 18 and the Dialogue Model. 19 The JLA PSP method convenes patients, carers and clinicians to equally and jointly identify questions about healthcare that cannot be answered by existing evidence that are important to all groups (ie, research needs).…”

Section: Discussionmentioning

confidence: 99%

European Glaucoma Society research priorities for glaucoma care

Azuara-Blanco,

McCorry,

Tatham

et al. 2023

Br J Ophthalmol

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Background/AimsThe goal of health research is to improve patients care and outcomes. Thus, it is essential that research addresses questions that are important to patients and clinicians. The aim of this study was to develop a list of priorities for glaucoma research involving stakeholders from different countries in Europe.MethodsWe used a three-phase method, including a two-round electronic Delphi survey and a workshop. The clinician and patient electronic surveys were conducted in parallel and independently. For phase I, the survey was distributed to patients from 27 European countries in 6 different languages, and to European Glaucoma Society members, ophthalmologists with expertise in glaucoma care, asking to name up to five research priorities. During phase II, participants were asked to rank the questions identified in phase I using a Likert scale. Phase III was a 1 day workshop with patients and clinicians. The purpose was to make decisions about the 10 most important research priorities using the top 20 priorities identified by patients and clinicians.ResultsIn phase I, 308 patients and 150 clinicians were involved. In phase II, the highest-ranking priority for both patients and clinicians was ‘treatments to restore vision’. In phase III, eight patients and four clinicians were involved. The top three priorities were ‘treatments to stop sight loss’, ‘treatments to restore vision’ and ‘improved detection of worsening glaucoma’.ConclusionWe have developed a list of priorities for glaucoma research involving clinicians and patients from different European countries that will help guide research efforts and investment.

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Section: Discussionmentioning

confidence: 99%

European Glaucoma Society research priorities for glaucoma care

Azuara-Blanco,

McCorry,

Tatham

et al. 2023

Br J Ophthalmol

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“…Four articles reported outcomes; however, these were not standardized, and only one study 15 included patient-reported outcomes. The importance of patient-reported experience measures (PREMS) and patientreported outcome measures (PROMS) is increasingly acknowledged in hernia surgery, 19,20 though variation in questionnaires and tools used internationally makes result interpretation and comparison challenging. 21 Other limitations include low patient numbers in the studies reporting postoperative outcomes, which hindered direct comparison and meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

Towards a complete cycle of care: a multidisciplinary pathway to improve outcomes in complex abdominal wall hernia repair

Kollias

Reid

Udayasiri

et al. 2022

ANZ Journal of Surgery

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Introduction The burden of complex abdominal wall hernia (CAWH) is increasing, with associated high morbidity and healthcare costs. This study evaluates current evidenoptce regarding multidisciplinary care for CAWH patients to improve patient outcomes. Methods A systematic review of Scopus, MEDLINE, Embase, PubMed, Web of Knowledge and Cochrane Library was conducted to identify proposed or established multidisciplinary team (MDT) pathways, necessary MDT constituents, and to evaluate patient outcomes. The pre‐optimization pathways were then compared with a recent Delphi consensus statement. Results Seven articles matched the relevant search criteria. Three were concept articles, without prospective data analysis. Four were case series that applied multidisciplinary care and included limited data analyses with outcomes reported up to 50 months. The consensus was that CAWH MDT requires multiple clinical specialties, including hernia, upper gastrointestinal, colorectal and/or plastic and reconstructive surgeons, along with allied health specialists, radiologists, anaesthetists/pain specialists and infectious diseases consultants. A successful MDT should aim to achieve pre‐optimization and plan the definitive repair. These pre‐optimization pathways were similar to the recent Delphi consensus by international hernia experts. Using these data, we propose a CAWH multidisciplinary pathway model in an Australian tertiary hospital involving a stepwise approach with well‐defined referral criteria, perioperative high‐risk management with pre‐optimization, surgical planning, postoperative care and follow‐up protocols. This pathway incorporates prospective data collection in a Clinical Quality Registry (CQR) to validate its appropriateness. Conclusions CAWH MDT can provide comprehensive, patient‐centred care with improved postoperative outcomes. CQR are important to better evaluate long‐term outcomes and ensure rigorous quality control.

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“…DOOR has more statistical power than analyzing outcomes separately or binary composites, like textbook outcomes. At every iteration, surgical DOORs used a modified Delphi process, a valid, established method to substantiate consensus among experts (and previously used to determine research priorities for various surgical specialties and a surgical safety checklist). Surgical DOORs demonstrated improved detection of complex SDOH relationships within private-sector cohorts .…”

Section: Introductionmentioning

confidence: 99%

Social Determinants of Health and Surgical Desirability of Outcome Ranking in Older Veterans

Jacobs,

Gao,

Schmidt

et al. 2024

JAMA Surg

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ImportanceEvaluating how social determinants of health (SDOH) influence veteran outcomes is crucial, particularly for quality improvement.ObjectiveTo measure associations between SDOH, care fragmentation, and surgical outcomes using a Desirability of Outcome Ranking (DOOR).Design, Setting, And ParticipantsThis was a cohort study of US veterans using data from the Veterans Affairs (VA) Surgical Quality Improvement Program (VASQIP; 2013-2019) limited to patients aged 65 years or older with inpatient stays between 2 and 30 days, merged with multiple data sources, including Medicare. Race and ethnicity data were retrieved from VASQIP, Medicare and Medicaid beneficiary summary files, the Veterans Health Administration Corporate Data Warehouse, and the United States Veterans Eligibility Trends and Statistics file. Data were analyzed between September 2023 and February 2024.ExposureLiving in a highly deprived neighborhood (Area Deprivation Index &gt;85), race and ethnicity used as a social construct, rurality, and care fragmentation (percentage of non-VA care days).Main Outcomes and MeasuresDOOR is a composite, patient-centered ranking of 26 outcomes ranging from no complication (1, best) to 90-day mortality or near-death complications (6, worst). A series of proportional odds regressions was used to assess the impact of SDOH and care fragmentation adjusted for clinical risk factors, including presentation acuity (presenting with preoperative acute serious conditions and urgent or emergent surgical procedures).ResultsThe cohort had 93 644 patients (mean [SD] age, 72.3 [6.2] years; 91 443 [97.6%] male; 74 624 [79.7%] White). Veterans who identified as Black (adjusted odds ratio [aOR], 1.06; 95% CI, 1.02-1.10; P = .048) vs White and veterans with higher care fragmentation (per 20% increase in VA care days relative to all care days: aOR, 1.01; 95% CI, 1.01-1.02; P &lt; .001) were associated with worse (higher) DOOR scores until adjusting for presentation acuity. Living in rural geographic areas was associated with better DOOR scores than living in urban areas (aOR, 0.93; 95% CI, 0.91-0.96; P &lt; .001), and rurality was associated with lower presentation acuity (preoperative acute serious conditions: aOR, 0.88; 95% CI, 0.81-0.95; P = .001). Presentation acuity was higher in veterans identifying as Black, living in deprived neighborhoods, and with increased care fragmentation.Conclusions and RelevanceVeterans identifying as Black and veterans with greater proportions of non-VA care had worse surgical outcomes. VA programs should direct resources to reduce presentation acuity among Black veterans, incentivize veterans to receive care within the VA where possible, and better coordinate veterans’ treatment and records between care sources.

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A modified Delphi process to establish research priorities in hernia surgery

Cited by 4 publications

References 36 publications

European Glaucoma Society research priorities for glaucoma care

European Glaucoma Society research priorities for glaucoma care

Towards a complete cycle of care: a multidisciplinary pathway to improve outcomes in complex abdominal wall hernia repair

Social Determinants of Health and Surgical Desirability of Outcome Ranking in Older Veterans

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