Delivery of Virtual Care in Oncology: Province-Wide Interprofessional Consensus Statements Using a Modified Delphi Process

Virtual cancer care (i.e., teleoncology) was rapidly adopted during the COVID-19 pandemic to meet the needs of patients with cancer. However, there is a paucity of guidance for clinicians regarding virtual cancer care. We sought to develop consensus-based statements to guide the optimal provision of virtual care for clinicians caring for patients with cancer, using a modified Delphi consensus process with a 29-member panel consisting of an interprofessional group of clinicians caring for patients with cancer and patient representatives. The consensus process consisted of two rounds and one synchronous final consensus meeting. At the end of the modified Delphi process, 62 of 62 statements achieved consensus. Fifty-seven statements reached consensus in the first round of the process. Concerns regarding the ability to convey difficult news virtually and maintaining similar standards as in-person care without disproportionate strain on clinicians and patients were addressed in the consensus process. We achieved interprofessional consensus on virtual cancer care practices. Further research examining the impact of virtual cancer care on person-centred and clinical outcomes are needed to inform practices during the COVID-19 pandemic and beyond.

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E-PSMA: the EANM standardized reporting guidelines v1.0 for PSMA-PET

European Journal of Nuclear Medicine and Molecular Imaging ◽

10.1007/s00259-021-05245-y ◽

2021 ◽

Cited By ~ 4

Author(s):

Francesco Ceci ◽

Daniela E. Oprea-Lager ◽

Louise Emmett ◽

Judit A. Adam ◽

Jamshed Bomanji ◽

...

Keyword(s):

Reporting Guidelines ◽

Delphi Consensus ◽

Consensus Process ◽

Modified Delphi ◽

Structured Report ◽

Interpretation Criteria ◽

Positron Emission ◽

Psma Pet ◽

Consensus Statements ◽

Standardized Reporting

Abstract Rationale The development of consensus guidelines for interpretation of Prostate-Specific Membrane Antigen (PSMA)-Positron Emission Tomography (PET) is needed to provide more consistent reports in clinical practice. The standardization of PSMA-PET interpretation may also contribute to increasing the data reproducibility within clinical trials. Finally, guidelines in PSMA-PET interpretation are needed to communicate the exact location of findings to referring physicians, to support clinician therapeutic management decisions. Methods A panel of worldwide experts in PSMA-PET was established. Panelists were selected based on their expertise and publication record in the diagnosis or treatment of PCa, in their involvement in clinical guidelines and according to their expertise in the clinical application of radiolabeled PSMA inhibitors. Panelists were actively involved in all stages of a modified, nonanonymous, Delphi consensus process. Results According to the findings obtained by modified Delphi consensus process, panelist recommendations were implemented in a structured report for PSMA-PET. Conclusions The E-PSMA standardized reporting guidelines, a document supported by the European Association of Nuclear Medicine (EANM), provide consensus statements among a panel of experts in PSMA-PET imaging, to develop a structured report for PSMA-PET in prostate cancer and to harmonize diagnostic interpretation criteria.

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Vaccinations in patients with multiple sclerosis: A Delphi consensus statement

Multiple Sclerosis Journal ◽

10.1177/1352458520952310 ◽

2020 ◽

pp. 135245852095231 ◽

Cited By ~ 1

Author(s):

Agostino Riva ◽

Valeria Barcella ◽

Simone V Benatti ◽

Marco Capobianco ◽

Ruggero Capra ◽

...

Keyword(s):

Multiple Sclerosis ◽

Seasonal Influenza ◽

Careful Consideration ◽

Delphi Consensus ◽

Consensus Process ◽

Disease Modifying Drugs ◽

Risks And Benefits ◽

Modified Delphi ◽

Increased Risk ◽

Evidence Based Decision Making

Background: Patients with multiple sclerosis (MS) are at increased risk of infection. Vaccination can mitigate these risks but only if safe and effective in MS patients, including those taking disease-modifying drugs. Methods: A modified Delphi consensus process (October 2017–June 2018) was used to develop clinically relevant recommendations for making decisions about vaccinations in patients with MS. A series of statements and recommendations regarding the efficacy, safety and timing of vaccine administration in patients with MS were generated in April 2018 by a panel of experts based on a review of the published literature performed in October 2017. Results: Recommendations include the need for an ‘infectious diseases card’ of each patient’s infectious and immunisation history at diagnosis in order to exclude and eventually treat latent infections. We suggest the implementation of the locally recommended vaccinations, if possible at MS diagnosis, otherwise with vaccination timing tailored to the planned/current MS treatment, and yearly administration of the seasonal influenza vaccine regardless of the treatment received. Conclusion: Patients with MS should be vaccinated with careful consideration of risks and benefits. However, there is an urgent need for more research into vaccinations in patients with MS to guide evidence-based decision making.

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ID: 3519259 BEYOND THE RECENT MODIFIED DELPHI CONSENSUS STATEMENTS ON WATER EXCHANGE (WE) - MORE NOVEL BENEFITS OF WE.

Gastrointestinal Endoscopy ◽

10.1016/j.gie.2021.03.135 ◽

2021 ◽

Vol 93 (6) ◽

pp. AB35-AB36

Author(s):

Yu-Hsi Hsieh ◽

Chih Wei Tseng ◽

Malcolm Koo ◽

Felix W. Leung

Keyword(s):

Water Exchange ◽

Delphi Consensus ◽

Modified Delphi ◽

Consensus Statements

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Evolving oncology provider perspectives on care delivery during the COVID-19 pandemic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18609 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18609-e18609

Author(s):

Divya Ahuja Parikh ◽

Meera Vimala Ragavan ◽

Sandy Srinivas ◽

Sarah Garrigues ◽

Eben Lloyd Rosenthal ◽

...

Keyword(s):

Cancer Care ◽

Care Delivery ◽

The United States ◽

Advanced Practice ◽

Curative Surgery ◽

Time Points ◽

Patients With Cancer ◽

Provider Perspectives ◽

Significant Difference ◽

The Impact

e18609 Background: The COVID-19 pandemic prompted rapid changes in cancer care delivery. We sought to examine oncology provider perspectives on clinical decisions and care delivery during the pandemic and to compare provider views early versus late in the pandemic. Methods: We invited oncology providers, including attendings, trainees and advanced practice providers, to complete a cross-sectional online survey using a variety of outreach methods including social media (Twitter), email contacts, word of mouth and provider list-serves. We surveyed providers at two time points during the pandemic when the number of COVID-19 cases was rising in the United States, early (March 2020) and late (January 2021). The survey responses were analyzed using descriptive statistics and Chi-squared tests to evaluate differences in early versus late provider responses. Results: A total of 132 providers completed the survey and most were white (n = 73/132, 55%) and younger than 49 years (n = 88/132, 67%). Respondents were attendings in medical, surgical or radiation oncology (n = 61/132, 46%), advanced practice providers (n = 48/132, 36%) and oncology fellows (n = 16/132, 12%) who predominantly practiced in an academic medical center (n = 120/132, 91%). The majority of providers agreed patients with cancer are at higher risk than other patients to be affected by COVID-19 (n = 121/132, 92%). However, there was a significant difference in the proportion of early versus late providers who thought delays in cancer care were needed. Early in the pandemic, providers were more likely to recommend delays in curative surgery or radiation for early-stage cancer (p < 0.001), delays in adjuvant chemotherapy after curative surgery (p = 0.002), or delays in surveillance imaging for metastatic cancer (p < 0.001). The majority of providers early in the pandemic responded that “reducing risk of a complication from a COVID-19 infection to patients with cancer” was the primary reason for recommending delays in care (n = 52/76, 68%). Late in the pandemic, however, providers were more likely to agree that “any practice change would have a negative impact on patient outcomes” (p = 0.003). At both time points, the majority of providers agreed with the need for other care delivery changes, including screening patients for infectious symptoms (n = 128/132, 98%) and the use of telemedicine (n = 114/132, 86%) during the pandemic. Conclusions: We found significant differences in provider perspectives of delays in cancer care early versus late in the pandemic which reflects the swiftly evolving oncology practice during the COVID-19 pandemic. Future studies are needed to determine the impact of changes in treatment and care delivery on outcomes for patients with cancer.

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The HOLA COVID-19 study: Evaluating the impact of caring for patients with COVID-19 on cancer care delivery in Latin America.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1537 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1537-1537

Author(s):

Carolina Bernabe Ramirez ◽

Ana I. Velazquez Manana ◽

Coral Olazagasti ◽

Cristiane Decat Bergerot ◽

Enrique Soto Perez De Celis ◽

...

Keyword(s):

Latin America ◽

Latin American ◽

Cancer Care ◽

Online Survey ◽

Care Delivery ◽

Healthcare Delivery ◽

Significant Proportion ◽

Multiple Choice Questions ◽

Patients With Cancer ◽

The Impact

1537 Background: The severe acute respiratory syndrome 2 (SARS-cov-2) virus causing COVID-19 has brought great challenges to global health services affecting cancer care delivery, outcomes, and increasing the burden in oncology providers (OP). Our study aimed to describe the challenges that OP faced while delivering cancer care in Latin America. Methods: We conducted an international cross-sectional study using an anonymous online survey in Spanish, Portuguese, and English. The questionnaire included 43 multiple choice questions. The sample was stratified by OP who have treated patients with COVID-19 versus those who have not treated patients with COVID-19. Data was analyzed with descriptive statistics and Chi-square tests. Results: A total of 704 OP from 20 Latin American countries completed the survey (77% of 913 who started the survey). Oncologists represented 46% of respondents, followed by 25% surgical-oncologists. Of the respondents, 56% treated patients with COVID-19. A significant proportion of OP reported newly adopting telemedicine during COVID-19 (14% vs 72%, p=0.001). More than half (58%) of OP reported making changes to the treatments they offered to patients with cancer. As shown in the table, caring for patients with COVID-19 significantly influenced practice patterns of OP. Access to specialty services and procedures was significantly reduced: 40% noted significantly decreased or no access to imaging, 20% significantly decreased or no access to biopsies, 65% reported delays in surgical oncology referrals, and 49% in radiation oncology referrals. A vast majority (82%) reported oncologic surgeries were delayed or cancelled, which was heightened among those treating patients with COVID-19 (87% vs 77%, p=0.001). Conclusions: The COVID-19 pandemic has significantly affected the way cancer care is delivered in globally. Although changes to healthcare delivery are necessary as a response to this global crisis, our study highlights the significant disruption and possible undertreatment of patients with cancer in Latin America that results from COVID-19.[Table: see text]

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Developing a Fracture Risk Clinical Assessment Protocol for Long-Term Care: A Modified Delphi Consensus Process

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2020.08.015 ◽

2020 ◽

Author(s):

Caitlin McArthur ◽

Loretta Hillier ◽

George Ioannidis ◽

Jonathan D. Adachi ◽

Lora Giangregorio ◽

...

Keyword(s):

Fracture Risk ◽

Clinical Assessment ◽

Long Term Care ◽

Delphi Consensus ◽

Consensus Process ◽

Term Care ◽

Assessment Protocol ◽

Modified Delphi

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Defining colchicine resistance/intolerance in patients with familial Mediterranean fever: a modified-Delphi consensus approach

Rheumatology ◽

10.1093/rheumatology/keaa863 ◽

2020 ◽

Author(s):

Seza Özen ◽

Erdal Sag ◽

Eldad Ben-Chetrit ◽

Marco Gattorno ◽

Ahmet Gül ◽

...

Keyword(s):

Familial Mediterranean Fever ◽

Nominal Group ◽

Evidence Based ◽

Delphi Consensus ◽

Modified Delphi ◽

Health Authorities ◽

Colchicine Resistance ◽

Mediterranean Fever ◽

Definition Of ◽

The Impact

Abstract Objectives Colchicine is the main treatment for familial Mediterranean fever (FMF). Although a number of individuals with FMF are intolerant/resistant to colchicine, there is no standard definition of colchicine resistance/intolerance. We developed a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF that may serve as a guide for clinicians and health authorities. Methods A set of statements was identified using a modified-Delphi consensus-based approach. The process involved development of an initial colchicine resistance/intolerance-related questionnaire derived from a systematic literature review. The questionnaire, which was completed by an international panel of 11 adult and pediatric rheumatologists with expertise in FMF, was analysed anonymously. The results informed draft consensus statements that were discussed by a round-table expert panel, using a nominal group technique to agree on the selection and wording of the final statements. Results Consensus among the panel was achieved on 8 core statements defining colchicine resistance/intolerance in patients with FMF. A definition of resistance was agreed upon that included recurrent clinical attacks (average one or more attacks per month over a 3-month period), or persistent laboratory inflammation in between attacks. Other core statements recognize the importance of assessing treatment adherence, and the impact of active disease and intolerance to colchicine on quality of life. Conclusion Based on expert opinion, a set of evidence-based core statements defining colchicine resistance/intolerance in patients with FMF were identified to help guide clinicians and health authorities in the management of patients with FMF.

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Home therapy for inherited bleeding disorders in South Africa: Results of a modified Delphi consensus process

South African Medical Journal ◽

10.7196/samj.2019.v109i9.13637 ◽

2019 ◽

Vol 109 (9) ◽

pp. 639

Author(s):

J N Mahlangu ◽

Y Naidoo ◽

Y Goga ◽

M Vaithlingum ◽

J Joubert ◽

...

Keyword(s):

South Africa ◽

Bleeding Disorders ◽

Home Therapy ◽

Delphi Consensus ◽

Consensus Process ◽

Modified Delphi

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Identifying Breast Cancer Care Quality Measures for a Cancer Facility in Rural Sub-Saharan Africa: Results of a Systematic Literature Review and Modified Delphi Process

JCO Global Oncology ◽

10.1200/go.20.00186 ◽

2020 ◽

pp. 1446-1454

Author(s):

Lydia E. Pace ◽

Lauren E. Schleimer ◽

Cyprien Shyirambere ◽

André Ilbawi ◽

Jean Marie Vianney Dusengimana ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Care ◽

Quality Measurement ◽

Quality Measures ◽

Care Quality ◽

Delphi Process ◽

Sub Saharan Africa ◽

Breast Cancer Care ◽

Modified Delphi ◽

Sub Saharan

PURPOSE The burden of cancer is growing in low- and middle-income countries (LMICs), including sub-Saharan Africa. Ensuring the delivery of high-quality cancer care in such regions is a pressing concern. There is a need for strategies to identify meaningful and relevant quality measures that are applicable to and usable for quality measurement and improvement in resource-constrained settings. METHODS To identify quality measures for breast cancer care at Butaro Cancer Center of Excellence (BCCOE) in Rwanda, we used a modified Delphi process engaging two panels of experts, one with expertise in breast cancer evidence and measures used in high-income countries and one with expertise in cancer care delivery in Rwanda. RESULTS Our systematic review of the literature yielded no publications describing breast cancer quality measures developed in a low-income country, but it did provide 40 quality measures, which we adapted for relevance to our setting. After two surveys, one conference call, and one in-person meeting, 17 measures were identified as relevant to pathology, staging and treatment planning, surgery, chemotherapy, endocrine therapy, palliative care, and retention in care. Successes of the process included participation by a diverse set of global experts and engagement of the BCCOE community in quality measurement and improvement. Anticipated challenges include the need to continually refine these measures as resources, protocols, and measurement capacity rapidly evolve in Rwanda. CONCLUSION A modified Delphi process engaging both global and local expertise was a promising strategy to identify quality measures for breast cancer in Rwanda. The process and resulting measures may also be relevant for other LMIC cancer facilities. Next steps include validation of these measures in a retrospective cohort of patients with breast cancer.

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