Lange T, Kopkow C, Ltzner J, Gnther KP, Gravius S, Scharf HP, Stve J, Wagner R, Schmitt J. Markmann C, Spickermann A, von der Gracht HA, Brem A. MacLennan S, Kirkham J, Lam TBL, Williamson PR. [Google Scholar] 16. Changes to supervision in community pharmacy: pharmacist and pharmacy support staff views. The Delphi technique is among the methods used to develop prescribing indicators , . [12]. Dalkey NC. The authors of two reviews investigated the question of how the items were changed during the Delphi process based on the judgments submitted by the experts (ID3, ID12). Relatedly, there is always a chance that consensus represents collective ignorance as opposed to wisdom. Soc Nat Resour. Polit DF, Beck CT. Given the increasing level of uncertainty caused by rapid technological and social change around the globe, collective . This analysis essentially compares apples with oranges because the reviews of the Delphi techniques focus on very diverse themes and questions. According to the recommendations of the US Agency for Health Care Policy and Research (AHCPR), Delphi techniques are considered to provide the lowest level of evidence for making causal inferences and are thus subordinate to meta-analyses, intervention studies and correlation studies ( 3 ). [10,35,74] Overall, consensus is one of the most undefined aspects of Delphis, and stability is the most undefined aspect of consensus. In this context, recommendations such as those made by Hasson and Keeney (54) or by Jnger et al. [8]. Yet, the development of consensus standards using Delphi techniques is challenging because it is dependent on the willingness of experts to participate and the statistical definition of consensus. For experts, the definition and number of participants remain issues of contention, while there are ongoing difficulties with expert selection and retention. Foth T, Efstathiou N, Vanderspank-Wright B, et al. For each category, we focused on the publication practice and the findings reported in the reviews. In this map, we provide an overview of the fields of application for Delphi techniques in health sciences in this map and discuss the processes used and the quality of the findings. According to Dalkey and Helmer (11), it is a technique designed to obtain the most reliable consensus of opinion of a group of experts [] by a series of intensive questionnaires interspersed with controlled feedback. This can be problematic, because increasing attrition over subsequent rounds can be due to participants with dissenting views to drop out, creating a false sense of consensus,[20] leading to a form of response bias. Falzarano M, Zipp GP. [13] Since then, this technique has been declassified and has evolved beyond its military applications into the different health sciences. For more information, please refer to our Privacy Policy. The following objectives are typical for Delphi techniques in health sciences: In methodological literature on about Delphi techniques, five characteristics of classical Delphi techniques have been identified: (7, 23). Therefore, the purpose of this review is to introduce the use of the Delphi method, assess the application of the Delphi technique within health sciences research, discuss areas of methodological uncertainty and propose recommendations. Patients were also included in some Delphi studies. As all human perceptions and actions are shaped by differences in personality, it is sensible to assess the individual personalities of the participants and the reliability of their judgements.33 This could reveal possible reasons for any dissenting judgements. In one review of 100 studies from the care sector, the proportion of articles with unclear selection criteria was 11.2% (ID4), while the proportion was 93.3% in a review of 15 studies from the clinical sector (ID12). [21]. How often did the articles contain a report about consensus aspects? The reasons for this were not discussed in this study. As a whole, an aim of the Delphi technique is to obtain high-quality responses from a select panel of experts, as opposed to getting a representative sample in traditional survey techniques. Although consensus is a defining aspect of Delphi studies, over 70% of Delphi studies do not use the achievement of consensus as a stopping criterion, but instead only run for a predetermined number of rounds. [67] Nonetheless, the midpoint is useful for expressing neutral opinions, which is important for answering obscure and emerging topics,[68] topics which are often studied by Delphis. Green B, Jones M, Hughes D, et al. [16,34,54,60,73] To summarize, researchers should aim for 70% to 80%, unless the research question is 1 that requires incredible precision, such as end-of-life guidelines, in which researchers should aim for 90% to 100%. Therefore, the use of Delphi by various healthcare professionals can allow for opportunities to publish highly visible research. You may be trying to access this site from a secured browser on the server. However, previous analyses have shown that cognitive diversity in an expert group can support innovative and creative discussion processes and hence are just as important for forming a judgment as the individual abilities and expertise of the experts (36, 37). In one review based on 10 Delphi studies from health sciences (ID7), the authors discovered that the number of experts per round was stated in all articles. [21] Due to their respective differences, the Nominal Group technique is typically used in exploring consumer and stakeholder views, whereas the Delphi technique is used to create best practice guidelines and treatment protocols among healthcare professionals. Keyword Highlighting [40] Although they are conducted in a heterogeneous fashion,[41] policy Delphis tend to involve similar steps as the classic Delphi, in which issues are formulated, participants are asked of their opinion on the items, but also explore the reasons for disagreements and subsequently reevaluate the options.[40]. [3]. The nominal group technique and consensus conferences are also used.34 Based on their prevalence, however, the Delphi technique can be viewed as the standard method used in the health care and nursing sector. Test the questionnaire in advance, especially with respect to the semantics. . Federal government websites often end in .gov or .mil. A review of 48 studies in a medical context indicated that the number of invited experts was stated less frequently with each round (ID6). Springer Science & Business Media; 2012. In Ancient Greece, kings and generals have sought to face their uncertainties for their state and careers by consulting a prophet, the Pythia, or more commonly known as the Oracle of Delphi. Analysis: central tendency and the level of dispersion [quartile deviation QD = (Q3Q1)/2], QD 0.6 (high level of agreement), 0.6 1.0 (low). Ab Latif R, Dahlan A, Mulud ZA, et al. A Delphi method of consensus development was used, comprising three survey rounds. J Elect Public Opin Parties. [27]. The authors of seven reviews investigated whether the number of Delphi rounds was published (ID1, ID3, ID4, ID6, ID9, ID11, ID12). One commonly used descriptive statistic and measure of dispersion is the standard deviation. Published by Wolters Kluwer Health, Inc. Search for other works by this author on: Nursing Direction, Medical Center, University of Freiburg, Faculty of Medicine, University of Freiburg. Group Techniques for Program Planning: A Guide to Nominal Group and. A total of 16 reviews from 1998 to 2019 were identified (Supplementary Table 1). This could have provided useful insight into the potential offered by Delphi techniques for identifying and reaching consensus. Strict selection criteria and definitions of expertise lead to a more homogenous expert panel, whereas less restrictive definitions will lead to a more heterogeneous sample. An international modified, [37]. The opinions of the three groups differed significantly on 12 needs (P<0.05) related to health, family, and policy dimensions. The cut-off value, meaning the value from which consensus was assumed, varied between 20 and 100% agreement in one review (ID6). [25] To illustrate, a smaller panel of 10 experts can be highly unstable, as 1 person makes up 10% of the responses and thus is a major influence on the results of the study. Analysis of the Future: the, [16]. Google Scholar Surg Endosc. In an Argumentative Delphi, the focus is placed on the qualitative justification for the standardized judgments made by the experts (19). On the one hand, they can call on their personal expertise and, on the other hand, they can call on knowledge from other types of studies, e.g., randomized controlled trials or metanalysis (6). Please check for further notifications by email. Morisset J, Johannson KA, Jones KD, et al. According to the recommendations of the US Agency for Health Care Policy and Research (AHCPR), Delphi techniques are considered to provide the lowest level of evidence for making causal inferences and are thus subordinate to meta-analyses, intervention studies and correlation studies (3). Another aspect is that the experts in Delphi studies can draw on various sources of information to make their judgments. Hit or miss: what leads experts to take advice for long-therm judgments? Turnbull AE, Dinglas VD, Friedman LA, Chessare CM, Seplveda KA, Bingham CO, et al.. A survey of Delphi panelists after core outcome set development revealed positive feedback and methods to facilitate panel member participation. If necessary, modify the items or add new ones. It has been proposed by Dajani, Sincoff[78] as a method to check for the stability of the responses, but has been criticized by Holey, Feeley,[75] who argue that Chi squared is instead testing for the independence of the Delphi rounds from responses obtained in them. 2013;21:64454. In one of the reviews, the authors indicated that 59% of the analyzed articles had defined criteria for dropping items (ID3). Fitch K, Bernstein SJ, Aguilar MD, et al. A survey is a series of questions or statements, called items, used in a questionnaire or an interview to measure the self-reports or responses of respondents (Privitera, 2018). Your message has been successfully sent to your colleague. 2018;210:31627. Identification of the experts was mostly based on multiple criteria (ID4 23%, ID11 28.6%). [30] Thus, more Delphi studies should be conducted by nurses and other healthcare professionals to ensure future methodological clarity and conciseness. Skulmoski GJ, Hartman FT, Krahn J. The. Identifying medication management smartphone app features suitable for young adults with developmental disabilities: [55]. [70]. Negrini S, Armijo-Olivo S, Patrini M, Frontera WR, Heinemann AW, Machalicek W, et al.. DELPHI, 98 Umfrage. Schneider Z, Whitehead D, LoBiondo-Wood G, et al. How often did the investigated articles of the reviews include a report on aspects related to the definition and selection of experts? In healthcare, the Delphi technique is commonly used to determine, predict, and explore group attitudes, needs, and priorities. Keywords educational research, education, social sciences, Delphi Technique, Delphi method, guidelines, consensus, trends, planning, Subsequent rounds involve quantitative questionnaires, with central tendency and measures of dispersion to aggregate data. However, it should be noted that we cannot make any statements about the quality of execution of the Delphi studies but rather our results are exclusively based on the reported findings of the systematic reviews. Guzman J, Tompa E, Koehoorn M, de Boer H, Macdonald S, Alamgir H. Economic evaluation of occupational health and safety programmes in health care, The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies, Groups of diverse problem solvers can outperform groups of high-ability problem solvers, Should nurses be role models for healthy lifestyles? [35] If there is a midpoint, there is a chance that participants may elect to choose the midpoint for: questions they have no opinion on, choosing a minimally acceptable response as soon as it is found and avoidance what appears to be the socially undesirable behavior of selecting a negative option. Alongside differences between the specialist fields, personality traits and methodological aspects of the voting behaviour of the experts can have an influence: Individual value systems, experience and power structures, personal interpretations of the items, and the perceived quality of the existing healthcare25,27 have an impact on the answers given. Keeney S, Hasson F, McKenna HP. 2016;33:3843. 2019;4:5. An exploration of the use of simple statistics to measure consensus and stability in Delphi studies, Evaluation of nine consensus indices in Delphi foresight research and their dependency on Delphi survey characteristics: a simulation study and debate on delphi design and interpretation. [81]. We use systematic reviews of Delphi techniques for the map, summarize their findings and examine them from a methodological perspective. A review of identification methods, How to use the nominal group and Delphi techniques. official website and that any information you provide is encrypted There are specific programs available for real-time Delphi studies.30. Ultimately, this expands the knowledge base and enables a better or more reliable assessment of the issue than when using just one questionnaire.19. This can be done by using questions on self-assessment, personal involvement, psychological scales, or established competency models. The definition of consensus was mostly defined a priori. However, the applicability of the findings of Hejblum, Ioos[63] can be critiqued due to its outdatedness, as the year of implementation is a strong predictor of mail-in-survey response rate.[64]. [50]. In April 2021, the term Delphi method yielded 28,200 search hits in Google Scholar for the past five years alone. systematic reviews, experiments, qualitative studies, personal experience) and on the methods used to ascertain consensus. Delphi techniques have proven to be successful when it comes to developing consensus standards and guidelines in the health care and nursing sector.13 However, personality traits, the design of the questionnaire, and the feedback and affiliation to a particular group can influence the answers given by individual participants. Spickermann A, Zimmerman M, von der Gracht H. Jahn T. Transdisziplinaritt in der Forschungspraxis. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The number of Delphi studies reviewed varied from 10 (ID2, ID7) to 257 (ID6). Medicine 2023;102:7(e32829). The .gov means its official. On the other hand, survey research designs, which can be done in writing or orally, involve the use of a survey to quantify, describe, or characterize an individual or a group. In the other studies, this was either not clearly explained or was decided post priori. [20] Specifically, the Nominal Group technique involves participants receiving and reflecting upon a question, having the facilitator ask each participant to share their ideas to the group, generating a group discussion and lastly ranking the discussed ideas. Anchor; 2005. The authors of the review on palliative care study identified two such studies (ID9). An overview of the results of the analysis into the Delphi variants can be found in Supplementary Table 2. A modified Delphi method toward multidisciplinary consensus on functional convalescence recommendations after abdominal surgery. [30]. The https:// ensures that you are connecting to the Google Scholar {2} D. Bacon, B. Fitzgerald, A systemic framework for the field of information systems, Database for Advances in Information Systems 32 (2), 2001, pp. The following were not applicable: protocol, registration and additional analyses (e.g., sensitivity or subgroup analyses, summary measures, meta-regression). Based on the findings of Delphi techniques, guidelines or white papers are drafted that act as an important basis for carrying out and evaluating studies or publications (4, 5). The site is secure. Schmitt J, Petzold T, Nellessen-Martens G, Pfaff H. Priorisierung und konsentierung von begutachtungs-, frder- und evaluationskriterien fr projekte aus dem innovationsfonds: eine multiperspektivische Delphi-studie, The Delphi technique in health sciences education research, Das Gruppendelphi-Verfahren: Vom Konzept bis zur Anwendung. government site. Although the results provided us with insights into the research practices used for Delphi techniques, we do not claim these insights to be complete or representative in any way. [18] Controlled feedback refers to the fact that participants are informed of the responses of their anonymous colleagues, allowing for the vocalization of the collective opinions and judgments rather than the vocal few. Advancing the state of policy, [42]. may email you for journal alerts and information, but is committed [15] Statistical aggregation involves the presentation of the statistical summary of the group response by the researcher, which are typically measures of central tendency,[15] while also allowing for the final results to be amendable to statistical analysis, leading to a sense of quasi-objectivity. Boulkedid R, Abdoul H, Loustau M, et al. For Likert scales, typically 5 and 10 point scales are used[66] and can be supported through graphical representation, such as bar graphs. Hong and Page describe it in a nutshell with the phrase: Diversity trumps ability (37). Results: The 12 systematic reviews show, that Delphi studies are typically carried out in two to three rounds with a deliberately selected panel of experts. Reflections on the epistemological foundations of the Delphi technique, however, are only mentioned in one publication (ID7) and even there with only a minor reference to the constructivist character of . These categories were based on constituent characteristics of Delphi techniques and guidelines on ensuring the quality of the reporting of Delphi studies (cf. Stability and agreement criteria for the termination of, [79]. This number raises questions about the validity of the findings. Consensus was usually measured in the Delphi studies using percent agreement, units of central tendency (especially the median), or a combination of percent agreement within a certain range and for a certain threshold (mostly the median) (ID1, ID3, ID4, ID6, ID9, ID11). Random selection of the experts remained an exception (ID4, ID11). [22]. [71] With such confusing and ambiguous definitions going around, it is without a doubt that consensus is inadequately addressed by researchers, with roughly 26% of all Delphi studies not even defining consensus.[32]. Fernandes L, Hagen KB, Bijlsma JW, Andreassen O, Christensen P, Conaghan PG, et al.. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis. The RAND/UCLA Appropriateness Method Users Manual. For an online survey, the questionnaire can be programmed using something like Soscisurvey or Surveymonkey. The information provided about the response rate per Delphi round was less (ID1 and ID4 39%). CrossRef Google Scholar Brockhoff, K. (1975), "The performance of forecasting groups in computer dialogue and face to face discussions," in H. Linstone and M. Turoff (eds. In one review, a median for the response rate of 87% in the first round and 90% in the last round was determined for classical Delphis on the subject of health care (ID1). A large number of modifications to the Delphi technique have now been developed. From a normative perspective, it is possible to critically question the stability of the judgments, the composition of the expert groups, and the handling of divergent judgments. The focus of reaching consensus increases the risk of reproducing the habitus mentalis and possibly failing to take new impetus and scientific findings sufficiently into account (14). motive und obstakel der suche nach evidenz. [18] However, Likert survey data are traditionally considered to be on the ordinal scale, and thus cannot be used for calculating the mean, as it can only be used for data on an interval scale. Centeno C, Sitte T, De Lima L, Alsirafy S, Bruera E, Callaway M, et al.. White paper for global palliative care advocacy: recommendations from a PAL-LIFE expert advisory group of the pontifical academy for life, Vatican City, Self-help strategies that are helpful for sub-threshold depression: a Delphi consensus study. For example, six of the systematic review exclusively focused on Delphi studies carried out in the 2000s or even later (ID2, ID3, ID4, ID5, ID6, ID11). The evaluation of the systematic reviews was carried out by two researchers who consulted with one another in the event of any uncertainty. sharing sensitive information, make sure youre on a federal The contents of the articles included in the review also had to be based on Delphi techniques used in health sciences in general or in a subdiscipline. The following tips for the completion of Delphi studies are useful for achieving the maximum level of consensus between the judgements: Research the relevant groups involved in advance and integrate them into the process in the most balanced way possible, taking into account all relevant perspectives. Some authors define Delphi techniques more specifically and focus on reaching consensus between the experts (2, 9, 10). [25] Interestingly, a bootstrap study done by Akins, Tolson[58] suggests that 23 participants lead to response stability within multiple rounds. Lastly, eDelphi, defined as the classic Delphi but done completely online[38] is increasingly being used as it offers unparalleled convenience, time and cost savings and allows for an unprecedented ease of data management. Using electronic surveys in nursing research. Thus, a reporting guideline must take this diversity into account. The authors of the review of health promotion studies also identified high response rates (ID11). In addition, our analysis exclusively considered reviews of publications and we did not read the original literature. Types of Delphi technique according to Hder (7). The wisdom of select crowds. The patient and parent participants were recruited at the paediatric cardiology clinic of a medical centre in Northern Taiwan. This is particularly important when integrating various groups with different standards of formal education into the Delphi process. In an interesting study, Grant, Booth,[72] used available data sets from published Delphi studies and calculated final consensus based on several commonly used definitions with varying levels of stringency. Throughout this paper, the use of Delphi will be explored, key issues will be discussed, and recommendations will be proposed. Another measure of dispersion is the interquartile range (IQR), which is defined as the amount of spread of the middle 50% of observations. Accordingly, the preliminary reporting guidelines set out by Diamond, Grant[32] can be used as a foundation for future Delphi research. One review of Delphi techniques in a health context determined that the criteria for selecting the experts was reproduced in 65 of 100 articles (65%) (ID3) included in that particular review. Methods: Twelve systematic reviews of Delphi techniques from different sectors of the health sciences were identified and systematically analyzed. Diamond IR, Grant RC, Feldman BM, et al. J Res Pers. However, there is little guidance on how to conduct them, resulting in heterogenous Delphi studies and methodological confusion. From the second Delphi round onwards, alongside the questionnaire, those surveyed also receive statistical feedback on the results of the previous round. Furthermore, despite being used inconsistently,[3032] the Delphi is considered the most widely used consensus group technique. Aengenheyster S, Cuhls K, Gerhold L, Heiskanen-Schttler M, Huck J, Muszynska M. Real-time Delphi in practice a comparative analysis of existing software-based tools, Collective Wisdom: Principles and Mechanisms. statistical findings from the participants own group, the judgements tend to converge more than if combined feedback is provided. Birko S, Dove ES, zdemir V. Evaluation of nine consensus indices in, [78]. The Fuzzy Delphi Method (FDM) is one of the research methods used in obtaining experts' consensus on specific issues. The e-Delphi technique has proved to be a resourceful, systematic and cost-effective method of accelerating knowledge generation in nursing sciences and research. Delphi techniques are used internationally to investigate a wide variety of issues. For example, the authors of one review included online questionnaires as a classical variant (ID11), while this was unclear in other reviews (e.g., ID1). The Delphi Method: Techniques and applications. This site from a methodological perspective systematically analyzed provided about the response rate per Delphi round less... Studies should be conducted by nurses and other healthcare professionals can allow for opportunities publish. A reporting guideline must take this Diversity into account 13 ] Since then, this was either not clearly or... A review of health promotion studies also identified high response rates ( ID11 ) involvement, psychological,. To take advice for long-therm judgments issues will be explored, key issues be! 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