Choosing Wisely Canada: Canadian Fertility and Andrology Society’s List of Top Items Physicians and Patients Should Question in Fertility Medicine

Abstract Purpose: To create a Choosing Wisely Canada list of the top 5 diagnostic and therapeutic interventions that should be questioned in Reproductive Endocrinology and Infertility in Canada.Methods: The Canadian Fertility and Andrology Society (CFAS) National Working Group developed an initial list of recommendations of diagnostic and therapeutic interventions that are commonly used, but are not supported by evidence, and could expose patients to unnecessary harm. These were chosen based on their prevalence, cost, potential for harm, and quality of supporting evidence. A modified Delphi consensus was used over 5 rounds to generate ideas, review supporting evidence, assess clinical relevance, estimate recommendation impact and narrow the recommendations list to 5 items. Results: Fifty unique ideas were first proposed by the working group, and after 5 rounds including a survey of Canadian Fertility and Andrology Society (CFAS) members, the final list of recommendations was created, including topics related to unnecessary investigations and interventions for patients with infertility and recurrent pregnancy loss, and those undergoing IVF. In this article, we describe not only the Delphi process used to determine the list, but also provide a summary of the evidence behind each of the final recommendations. Conclusions: The list of 5 recommendations highlights opportunities to initiate conversations between clinicians and patients about the risks, benefits, harms and costs of unnecessary fertility treatments and procedures in a Canadian context.

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Management of Pyrexia Associated with the Combination of Dabrafenib and Trametinib: Canadian Consensus Statements

Current Oncology ◽

10.3390/curroncol28050304 ◽

2021 ◽

Vol 28 (5) ◽

pp. 3537-3553

Author(s):

Alia Thawer ◽

Wilson H. Miller ◽

Nancy Gregorio ◽

Joël Claveau ◽

Sudha Rajagopal ◽

...

Keyword(s):

Working Group ◽

Treatment Algorithm ◽

Practice Variation ◽

Routine Practice ◽

Group Consensus ◽

Therapeutic Approaches ◽

Modified Delphi ◽

Delphi Approach ◽

Consensus Statements

The combination of dabrafenib and trametinib is a well-established treatment for BRAF-mutated melanoma. However, the effectiveness of this approach may be hindered by the development of treatment-related pyrexia syndrome, which occurs in at least 50% of treated patients. Without appropriate intervention, pyrexia syndrome has the potential to worsen and can result in hypotension secondary to dehydration and associated organ-related complications. Furthermore, premature treatment discontinuation may result in a reduction in progression-free and overall survival. Despite existing guidance, there is still a wide variety of therapeutic approaches suggested in the literature for both the definition and management of dabrafenib and trametinib-related pyrexia. This is reflected in the practice variation of its prevention and treatment within and between Canadian cancer centres. A Canadian working group was formed and consensus statements were constructed based on evidence and finalised through a two-round modified Delphi approach. The statements led to the development of a pyrexia treatment algorithm that can easily be applied in routine practice. The Canadian working group consensus statements serve to provide practical guidance for the management of dabrafenib and trametinib-related pyrexia, hopefully leading to reduced discontinuation rates, and ultimately improve patients’ quality of life and cancer-related outcomes.

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PREFERRED REPORTING ITEMS FOR STUDIES MAPPING ONTO PREFERENCE-BASED OUTCOME MEASURES: THE MAPS STATEMENT

International Journal of Technology Assessment in Health Care ◽

10.1017/s0266462315000379 ◽

2015 ◽

Vol 31 (4) ◽

pp. 230-235 ◽

Cited By ~ 2

Author(s):

Stavros Petrou ◽

Oliver Rivero-Arias ◽

Helen Dakin ◽

Louise Longworth ◽

Mark Oppe ◽

...

Keyword(s):

Outcome Measures ◽

Working Group ◽

De Novo ◽

Economic Evaluations ◽

Biomedical Journal ◽

Modified Delphi ◽

Journal Editorial ◽

Guidance Documents ◽

Completeness Of Reporting

Background:“Mapping” onto generic preference-based outcome measures is increasingly being used as a means of generating health utilities for use within health economic evaluations. Despite publication of technical guides for the conduct of mapping research, guidance for thereportingof mapping studies is currently lacking. The MAPS (MApping onto Preference-based measures reporting Standards) statement is a new checklist, which aims to promote complete and transparent reporting of mapping studies.Methods:In the absence of previously published reporting checklists or reporting guidance documents, ade novolist of reporting items was created by a working group comprised of six health economists and one Delphi methodologist. A two-round, modified Delphi survey with representatives from academia, consultancy, health technology assessment agencies, and the biomedical journal editorial community was used to identify a list of essential reporting items from this larger list.Results:From the initialde novolist of twenty-nine candidate items, a set of twenty-three essential reporting items was developed. The items are presented numerically and categorized within six sections, namely: (i) title and abstract, (ii) introduction, (iii) methods, (iv) results, (v) discussion, and (vi) other. The MAPS statement is best applied in conjunction with the accompanying MAPS explanation and elaboration document.Conclusions:It is anticipated that the MAPS statement will improve the clarity, transparency. and completeness of reporting of mapping studies. To facilitate dissemination and uptake, the MAPS statement is being co-published by seven health economics and quality of life journals, and broader endorsement is encouraged. The MAPS working group plans to assess the need for an update of the reporting checklist in five years’ time.

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Monitoring quality of care for patients with pancreatic cancer: a modified Delphi consensus

HPB ◽

10.1016/j.hpb.2018.08.016 ◽

2019 ◽

Vol 21 (4) ◽

pp. 444-455 ◽

Cited By ~ 6

Author(s):

Ashika D. Maharaj ◽

Liane Ioannou ◽

Daniel Croagh ◽

John Zalcberg ◽

Rachel E. Neale ◽

...

Keyword(s):

Pancreatic Cancer ◽

Quality Of Care ◽

Delphi Consensus ◽

Modified Delphi ◽

Monitoring Quality

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Choosing Wisely Canada's emergency medicine recommendations: Time for a revision

CJEM ◽

10.1017/cem.2019.405 ◽

2019 ◽

Vol 21 (6) ◽

pp. 717-720 ◽

Cited By ~ 1

Author(s):

Amy H. Y. Cheng ◽

Sam Campbell ◽

Lucas B. Chartier ◽

Shawn Dowling ◽

Tom Goddard ◽

...

Keyword(s):

Emergency Medicine ◽

Working Group ◽

Ad Hoc ◽

Choosing Wisely ◽

Emergency Physicians ◽

Medical Tests ◽

Canadian Association ◽

National Initiative ◽

New Evidence

ABSTRACTChoosing Wisely Canada (CWC) is a national initiative designed to encourage patient-clinician discussions about the appropriate, evidence-based use of medical tests, procedures and treatments. The Canadian Association of Emergency Physicians’ (CAEP) Choosing Wisely Canada (CWC) working group developed and released ten recommendations relevant to Emergency Medicine in June 2015 (items 1–5) and October 2016 (items 6–10). In November 2016, the CAEP CWC working group developed a process for updating the recommendations. This process involves: 1) Using GRADE to evaluate the quality of evidence, 2) reviewing relevant recommendations on an ad hoc basis as new evidence emerges, and 3) reviewing all recommendations every five years. While the full review of the CWC recommendations will be performed in 2020, a number of high-impact studies were published after our initial launch that prompted an ad hoc review of the relevant three of our ten recommendations prior to the full review in 2020. This paper describes the results of the CAEP CWC working group's ad hoc review of three of our ten recommendations in light of recent publications.

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The Canadian Dermatology Association’s Top Five Choosing Wisely Canada Recommendations

Journal of Cutaneous Medicine and Surgery ◽

10.1177/1203475420928904 ◽

2020 ◽

Vol 24 (5) ◽

pp. 461-467

Author(s):

Linghong Linda Zhou ◽

Sabrina Nurmohamed ◽

Sheila Au ◽

Jennifer Beecker ◽

Peter Green ◽

...

Keyword(s):

Best Practices ◽

Task Force ◽

Acne Vulgaris ◽

Choosing Wisely ◽

Annual Conference ◽

Patient Harm ◽

Modified Delphi ◽

Value Based Care ◽

Dermatophyte Infection ◽

Initial List

Introduction In this article, we present the Canadian Dermatology Association’s (CDA) Choosing Wisely Canada (CWC) list of top “Five Things Physicians and Patients Should Question in Dermatology” and the evidence in support of each recommendation. Methods Using a nominal technique, the CDA Working Group and Task Force generated an initial list based on literature review and expert consultation. After several rounds of list refinement via a modified Delphi process, a final list of recommendations was generated. These were approved by the CDA Board of Directors, presented at the CDA 93rd Annual Conference in 2018, and published by CWC in 2019. Results The top five recommendations are as follows: (1) Don’t routinely prescribe antibiotics for bilateral lower leg redness and swelling; (2) Don’t routinely prescribe topical combination corticosteroid/antifungal products; (3) Don’t routinely use topical antibiotics on a surgical wound; (4) Don’t prescribe systemic antifungals without mycological confirmation of dermatophyte infection; and (5) Don’t use oral antibiotics for acne vulgaris for more than 3 months without assessing efficacy. Discussion This list of recommendations aims to encourage both physicians and patients to reevaluate ineffective, yet common, practices in treating dermatologic conditions. These recommendations represent actionable changes in practice, and therefore have considerable potential to enhance value-based care in dermatology. Conclusions This list was developed to identify tangible changes in practice within dermatology that may reduce inefficiencies, prevent potential patient harm, and improve care. Future advocacy work may include updates, feedback obtainment, and patient care handouts, to continue to promote value-based healthcare and best practices.

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Palliative care competencies for geriatricians across Europe: a Delphi consensus study

European Geriatric Medicine ◽

10.1007/s41999-020-00445-5 ◽

2021 ◽

Author(s):

Sophie Pautex ◽

◽

Regina Roller-Wirnsberger ◽

Katrin Singler ◽

Nele Van den Noortgate

Keyword(s):

Palliative Care ◽

Older People ◽

Rating Scale ◽

Geriatric Medicine ◽

Delphi Consensus ◽

Modified Delphi ◽

Postgraduate Level ◽

Modified Delphi Technique ◽

Care For Older People

Abstract Purpose Integration of palliative care competencies with geriatric medicine is important for quality of care for older people, especially in the last years of their life. Therefore, knowledge and skills about palliative care for older people should be mandatory for geriatricians. The European Geriatric Medicine Society (EuGMS) has launched a postgraduate curriculum for geriatric medicine recently. Aim Based on this work, the Special Interest Group (SIG) on Palliative care in collaboration with the SIG in Education and Training aimed to develop a set of specific palliative care competencies to be recommended for training at a postgraduate level. Methods Competencies were defined using a modified Delphi technique based upon a Likert like rating scale. A template to kick off the first round and including 46 items was developed based on pre-existing competencies developed in Switzerland and Belgium. Results Three Delphi rounds were necessary to achieve full consensus. Experts came from 12 EU countries. In the first round, the wording of 13 competencies and the content of 10 competencies were modified. We deleted or merged ten competencies, mainly because they were not specific enough. At the end of the 2nd round, one competence was deleted and for three questions the wordings were modified. These modifications had the agreement of the participants during the last round. Conclusion A list of 35 palliative care competencies for geriatricians is now available for implementation in European countries.

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Modified Delphi Consensus on Developing Home Care Service Quality Indicator for Stroke Survivor in Yogyakarta, Indonesia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.455 ◽

2019 ◽

Vol 7 (10) ◽

pp. 1712-1718

Author(s):

Nur Chayati ◽

Christantie Effendy ◽

Ismail Setyopranoto

Keyword(s):

Home Care ◽

Quality Indicator ◽

Health Workers ◽

Care Service ◽

Care Quality ◽

Delphi Process ◽

Face Validity ◽

Delphi Consensus ◽

Modified Delphi

BACKGROUND: Assessing the quality of health services provided at home (home care) is a challenge. The formulation of indicators requires open-minded people, who able to formulate several purposes objectively, and play an active role in decision making. PURPOSE: To test the face validity of the home care quality indicator in stroke patients with the modified Delphi method. METHOD: Eighty-one indicators generated from previous studies were assessed using 3 processes to get the final results: 1) conducted modified Delphi in two rounds, namely rating or scoring by experts (using median scores); 2) reviewing qualitative suggestions from experts during the Delphi process (using comments from both Delphi rounds); 3) sorting out and correcting the grammar of the appropriate indicator (based on the median score > 7, and no disagreement). RESULT: Eighty-seven experts were involved in the first round Delphi and 34 experts in the second round. The experts were home care team selected from health care institutions in Yogyakarta with various professional backgrounds. Delphi process resulted in 67 indicators from 81 indicators which were divided into 10 domains: 1) Personal (2 indicators), 2) Documents (13 indicators), 3) Professionalism development (3 indicators), 4) Supporting facilities (8 indicators), 5) Administrative activities (4 indicators), 6) Health workers interaction with patients and families (15 indicators), 7) Physical conditions (2 indicators), 8) Self-actualization (1 indicator), 9) Psychological condition (5 indicators), 10) Family independent and coping (14 indicators). Selected indicators got to score more than 7 and no disagreement at all. CONCLUSION: Sixty-seven indicators of the quality of home care, which were generated from modified Delphi consensus, were face validated. Further research could be conducted particularly on the trial process of these indicators at the actual home dwelling service setting.

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O-BN01 The para-oesophageal hernia symptom tool (post): A modified delphi consensus study

British Journal of Surgery ◽

10.1093/bjs/znab429.006 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Aiysha Puri ◽

Nikhil Patel ◽

Viknesh Sounderajah ◽

Lorenzo Ferri ◽

Ewen Griffiths ◽

...

Keyword(s):

Quality Of Life ◽

Surgical Intervention ◽

A Priori ◽

Decision Support Tool ◽

Delphi Consensus ◽

Support Tool ◽

Modified Delphi ◽

Related Quality ◽

Specific Symptoms

Abstract Background Patients with a para-oesophageal hernia (POH) report a complex range of symptoms and quality of life (QOL) issues. Clinicians often utilise existing health related quality of life tools to (1) identify patients who are eligible for surgical management and (2) to evaluate the benefit of surgical intervention. However, the most commonly used tools for this purpose are not disease specific. As such, crucial POH specific symptoms which impact QOL may not be captured. In order to address this issue, a modified Delphi consensus study was undertaken to establish a HRQOL instrument specific to POH. Methods A two-round modified Delphi consensus study was conducted with a group of international experts. Participants were identified through (1) their authorship in landmark POH studies and (2) the professional networks of the study investigators. Prior to the Delphi process, a scoping survey was undertaken in order to generate a list of candidate items. Participants were asked to rate the items’ importance in assessing patients with POH using a 5-point Likert scale. The a priori threshold for inclusion was 80% for scores of 4 or 5. If consensus was not achieved, the item was carried through to the next round. Results The candidate list of items consisted of 64 symptoms, refined to 20 for inclusion within the first modified Delphi round. Four symptoms; ‘difficulty getting solid foods down’, ‘chest pain after meals’, ‘difficulty getting liquids down’ and ‘shortness of breath only after meals’, reached consensus threshold of 80% in the first round and one additional symptom, ‘early feeling of fullness after eating’, reached consensus in the second. A total of 26 participants took part in the first and 24 in the second round. These five symptoms have been identified to form the initial version of the Para-Oesophageal Hernia Symptom Tool (POST). Conclusions POST is the first tool that aims to capture POH-specific symptoms that impact upon HRQOL. Prior to clinical use, this tool will be presented in international patient workshops to assess its construct validity. Following this, we aim to assess the content validity of the tool through a longitudinal study in a cohort of patients with POH who are undergoing repair. We hope that this tool will serve as a decision support tool for clinicians who are evaluating the risk-benefit of surgical intervention in this cohort of patients.

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Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

Digestive Disease Interventions ◽

10.1055/s-0040-1718390 ◽

2020 ◽

Vol 04 (03) ◽

pp. 311-322

Author(s):

Robert J. Litwin ◽

Johanna L. Chan ◽

Steven Y. Huang

Keyword(s):

Clinical Presentation ◽

Practice Patterns ◽

Patient Care Team ◽

Therapeutic Interventions ◽

Collaborative Approach ◽

Malignant Bowel Obstruction ◽

Advanced Malignancy ◽

Gastrointestinal Obstruction ◽

Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

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