Abstract
Background
The Delphi technique is an effective method for collecting and synthesizing informed opinions on a highly focused task, from a diverse group of experts who have specialized knowledge in an area of interest. This method has been successfully applied to palliative care research but not commonly to palliative care tool development. The Delphi technique has recently been employed in the development of two palliative pain assessment tools: the Edmonton Classification System for Cancer Pain (ECS-CP) and the Alberta Breakthrough Pain Assessment Tool for Research (ABPAT-R).
Aims
The purpose of this paper is to: (a) report on our experience of using the Delphi technique for gathering validity evidence for the ECS-CP and ABPAT-R; (b) identify challenges in using this technique including sampling, study and survey design, consensus setting and response rates; and (c) suggest approaches that can add to its effectiveness in national and international collaborations in palliative care instrument development and research.
Conclusions
Depending on the design, the Delphi technique can facilitate national or international cooperation both asynchronously (e.g., with mail-out or electronic surveys) and synchronously (e.g., with face-to-face meetings or videoconferencing). International input can assure palliative care tools are relevant in diverse clinical settings and practice cultures. The use of the Delphi technique in palliative care tool development may thereby facilitate international collaborations, rapid knowledge transfer, and effective uptake of novel tools across diverse palliative care settings.
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References
Allison EM (2005) Planning, monitoring, and evaluation. Community Health Nursing: a Canadian Perspective. Pearson Prentice Hall, Toronto, Ontario, pp 205–220
Alvarez-Dardet C, Ruiz MT (1993) Thomas McKeown and Archibald Cochrane: a journey through the diffusion of their ideas. BMJ 306:1252–1255
Boberg AL, Morris-Khoo SA (1992) The Delphi method: a review of methodology and an application in the evaluation of a higher education program. Can J Program Eval 7:27–39
Borgman CL (1989) Bibliometrics and scholarly communication: editor’s introduction. Communic Res 16:583–599
Chang E, Daly J (1998) Priority areas for clinical research in palliative care nursing. Int J Nurs Pract 4:247–253
Christie CA, Barela E (2005) The Delphi technique as a method for increasing inclusion in the evaluation process. Can J Program Eval 20:105–122
Dalkey NC (1969) The Delphi method: an experimental study of group opinion. Rand, Santa Monica, CA
Dimmick SL, Ignatova KD (2006) The diffusion of a medical innovation: where teleradiology is and where it is going. J Telemed Telecare 12:S51–S58
Dowling S, Leary A, Broomfield D (2005) Palliative care education: a Delphi survey of Irish general practitioners. Educ Prim Care 16:458–466
Ehrlich A, Koch T, Amin B, Liewehr DJ, Steinberg SM, Turner ML, Blauvelt A (2006) Development and reliability testing of a standardized questionnaire to assess psoriasis phenotype. J Am Acad Dermatol 54:987–14
Fainsinger RL, Nekolaichuk CL, Lawlor PG, Neumann CM, Hanson J, Vigano A (2005) A multicenter study of the revised Edmonton Staging System for classifying cancer pain in advanced cancer patients. J Pain Symptom Manage 29:224–237
Hagen NA, Stiles C, Nekolaichuk C, Biondo P, Carlson L, Fisher K, Fainsinger R. (2007) The Alberta Breakthrough Pain Assessment Tool for cancer patients: a validation study using a Delphi process and patient think aloud interviews. J Pain Symptom Manage (in press)
Hasson F, Keeney S, McKenna H (2000) Research guidelines for the Delphi survey technique. J Adv Nurs 32:1008–1015
Hawryluk LA, Harvey WRC, Lemieux-Charles L, Singer PA (2002) Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Med Ethics 3(E3):1–9
Herdman M, Rajmil L, Ravens-Sieberer U, Bullinger M, Power M, Alonso J (2002) Expert consensus in the development of a European health-related quality of life measure for children and adolescents: a Delphi study. Acta Paediatr 91:1385–1390
Keeney S, Hasson F, McKenna H (2006) Consulting the oracle: ten lessons from using the Delphi technique in nursing research. J Adv Nurs 53:205–212
Kennedy HP (2004) Enhancing Delphi research: methods and results. J Adv Nurs 45:504–511
Linstone HA (1978) The Delphi technique. In: Fowles J (ed) Handbook of futures research. Greenwood, Westport, CT, pp 273–300
Messick S (1989) Validity. In: Linn RL (ed) Educational measurement. American Council on Education & Macmillan Publishing, New York, pp 13–10
Morita T, Bito S, Kurihara Y, Uchitomi Y (2005) Development of a clinical guideline for palliative sedation therapy using the Delphi method. J Palliat Med 8:716–729
Nekolaichuk CL, Fainsinger RL, Lawlor PG (2005) A validation study of a pain classification system for advanced cancer patients using content experts: the Edmonton Classification System for Cancer Pain. Palliat Med 19:466–476
Oxenham D, Duncan R, Fischbacher M (2003) Cancer pain management in Lanarkshire: a community-based audit. Palliat Med 17:708–713
Rogers EM (1996) Diffusion of innovations. Free Press, New York
Uhl NP (1983) Using the Delphi technique in institutional planning. In: Uhl NP (ed) Using research for strategic planning. New directions for institutional research. Jossey-Bass, San Francisco, CA, pp 81–9
Williams PL, Webb C (1994) The Delphi technique: a methodological discussion. J Adv Nurs 19:180–186
Acknowledgements
Infrastructural support was provided by the Canadian Institutes for Health Research through grant support of the CIHR Team in Difficult Cancer Pain (CIHR PET69772).
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Biondo, P.D., Nekolaichuk, C.L., Stiles, C. et al. Applying the Delphi process to palliative care tool development: lessons learned. Support Care Cancer 16, 935–942 (2008). https://doi.org/10.1007/s00520-007-0348-2
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DOI: https://doi.org/10.1007/s00520-007-0348-2