Constructing post-surgical discharge instructions through a Delphi consensus methodology

Scott, Aaron; Sanderson, Cody J.; Rush, A. John; Alore, Elizabeth A.; Naik, Aanand D.; Berger, David H.; Suliburk, James W.

doi:10.1016/j.pec.2017.12.004

Cited by 5 publications

(4 citation statements)

References 31 publications

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“…Zite and Wallace (2011) demonstrated that the use of a low health literacy consent form increased patients' knowledge retention compared to the standard consent process. Scott et al (2018) used a Delphi process to improve discharge instructions through consensus opinion on over 20 topics. This endeavor proved difficult as few topics reached consensus and the original materials were above the 6th-grade reading level.…”

Section: Discussionmentioning

confidence: 99%

Health Literacy in Surgery

Chang¹,

Baker²,

Marques³

et al. 2020

HLRP: Health Literacy Research and Practice

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Background: Low health literacy is associated with poor health outcomes in many chronic diseases and may have an important role in determining surgical outcomes. This study aims to comprehensively review the current state of science on adult health literacy in surgery and to identify knowledge gaps for future research. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic search was conducted to identify all studies from January 2002 through May 2018 that used validated instruments to assess health literacy among adult patients undergoing surgery. Studies were assessed for quality using the Newcastle-Ottawa scale and evaluated on findings by their focus on identifying health literacy levels, understanding associations with surgical outcomes, and/or developing interventions to address low health literacy. Key Results: There were 51 studies on health literacy with data from 22,139 patients included in this review. Low health literacy was present in more than one-third of surgical patients (34%, interquartile range 16%-50%). The most commonly used validated instrument for assessment of health literacy in the surgical population was the Newest Vital Sign. Most studies were focused on identifying the prevalence of low health literacy within a surgery population (84%, n = 43). Few studies focused on understanding the association of health literacy to surgical outcomes (12%, n = 6) and even fewer studies developed interventions to address health literacy (4%, n = 2). Discussion: Low health literacy is common among surgical patients. Important opportunities exist to better understand the role of health literacy in determining surgical outcomes and to develop more health literacy-sensitive models of surgical care. [HLRP: Health Literacy Research and Practice. 2020;4(1):e45-e65.] Plain Language Summary: Health literacy has not been well-studied in surgery but likely plays an important role. In this article, we reviewed all current research on health literacy in surgery to help us understand where we are at and where we need to go. We found that low health literacy is common and we need more ways to address it in surgery. METHODS Systematic Search Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (Liberati et al., 2009), a comprehensive search of the National Library of Medicine's PubMed database, Embase, Scopus database, Proquest, PsychInfo, and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) was performed through May 31, 2018. Through partnerships with Library Services at the University of Alabama Birmingham, keywords and medical subject heading (MESH) terms used in the search included "health literacy, " "surgical, " "post-operative, " and "surgery. " The entire search string for each database along with the number of screened abstracts can be found in Table A. Two authors (S.J.B. and I.C.D.S M.) who are experienced researchers independently evaluated abstracts of the 673 articles obt...

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Section: Discussionmentioning

confidence: 99%

Health Literacy in Surgery

Chang¹,

Baker²,

Marques³

et al. 2020

HLRP: Health Literacy Research and Practice

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“…The Delphi methodology used in this study follows accepted guidelines for the Delphi process [18][19][20][21][22]. Other studies have used this process to develop consensus on the content of discharge instructions related to other topics [23,24]. This study was approved by the Ottawa Health Science Network Research Ethics Board.…”

Section: Methodsmentioning

confidence: 99%

“…A total of 24 panelists were recruited for the study. This number is similar to other Delphi studies examining the contents of discharge instructions [23,24]. Panelists were recruited for the study from the following…”

Section: Selection Of Panelistmentioning

confidence: 98%

Emergency department opioid discharge instructions: a multidisciplinary national Delphi study

et al. 2022

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Objectives Currently, there are no Canadian guidelines for discharge instruction to be given to patients receiving an opioid prescription in the ED. This likely contributes to inadequate discharge instructions for these potentially dangerous medications. The principal goal of this study was to develop an interdisciplinary Canadian consensus regarding important concepts to be included in written opioid discharge instructions within the ED setting. Methods We conducted a modified Delphi study between May and August 2021. The national multidisciplinary panel consisted of 23 healthcare professionals and one patient partner. The survey consisted of 19 initial concepts developed after a review of the literature and a meeting with local experts. The panel added four new concepts after the first survey round. Three rounds of online surveys were distributed in total. Panel consensus was defined a priori as a disagreement index score less than 1, in accordance with the RAND/UCLA Appropriateness Method. ResultsWe achieved a 100% response rate in round one and a 96% response rate in rounds two and three of our Delphi study. There was group consensus (disagreement index = 0.66, median importance = 9) that all patients receiving opioid prescriptions from the ED should receive written discharge instructions. The interdisciplinary panel arrived at a consensus on 21/23 concepts for ED opioid discharge instructions. The concepts with the highest level of agreement were related to minimizing the use of the prescribed opioid medication and opioid use safety (mixing with drugs/alcohol, storage, and impairment). Conclusion This Delphi study with a national, multidisciplinary panel achieved consensus on 21 concepts that should be included in written discharge instructions to patients receiving an opioid prescription upon discharge from the ED. Keywords Emergency department • Opioid • Delphi consensus method • Discharge instructions • Patient education RésuméObjectifs Actuellement, il n'y a pas de lignes directrices canadiennes sur les instructions de sortie à donner aux patients qui reçoivent une ordonnance d'opioïdes aux urgences. Cela contribue probablement à des instructions de sortie inadéquates pour ces médicaments potentiellement dangereux. L'objectif principal de cette étude était d'établir un consensus canadien interdisciplinaire sur les concepts importants à inclure dans les directives écrites de sortie des opioïdes dans le contexte des urgences.

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“…Since its inception, the Delphi method has been modified for use in a broad spectrum of applications including business and technology forecasting, public policy creation, and as a consensus-building tool for health-care research, clinical guidelines, and education, including pharmacy research. [17][18][19][20][21] These studies suggest that the Delphi method is particularly useful in the development of patient education materials as it allows for expert consensus in both content and patient readability.…”

Section: Introductionmentioning

confidence: 99%

Use of the Delphi Method to Enhance Pharmacist Contraceptive Counseling Materials

Meredith

Wilkinson

Campi

et al. 2019

Journal of Pharmacy Practice

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Background: Many states have pharmacist contraceptive prescribing laws with several others in the process of enacting similar legislation. Little continuity or standardization exists across these programs, including development of counseling materials. Although the risk of unplanned pregnancy is greatest among adolescents and young adults, developed materials are not always sensitive to youth. Objective: To use a modified Delphi method to develop standardized youth-friendly counseling tools that are sensitive to pharmacy workflow during pharmacist contraceptive prescribing. Methods: A multidisciplinary expert panel of women’s health pharmacists, community pharmacists, adolescent medicine pediatricians, obstetrician–gynecologists, and public health advocates was assembled and reviewed materials over 3 iterations. Comments were anonymized, summarized, and addressed with each iteration. A graphic designer assisted with visual representation of panel suggestions. Reviewer feedback was qualitatively analyzed for emergent themes. Results: The Delphi method produced 5 main themes of feedback integrated into the final materials including attention to work flow, visual appeal, digestible medical information, universal use of materials, and incorporating new evidence-based best practices. Final materials were scored at a Flesch-Kincaid grade of 5.1 for readability. Conclusions: The use of the Delphi method allowed for the efficient production of materials that are medically accurate, patient-centered, and reflect multiple disciplinary perspectives. Final materials were more robust and sensitive to the unique needs of youth.

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Constructing post-surgical discharge instructions through a Delphi consensus methodology

Cited by 5 publications

References 31 publications

Health Literacy in Surgery

Health Literacy in Surgery

Emergency department opioid discharge instructions: a multidisciplinary national Delphi study

Use of the Delphi Method to Enhance Pharmacist Contraceptive Counseling Materials

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