Three nested randomized controlled trials of peer-only or multiple stakeholder group feedback within Delphi surveys during core outcome and information set development

Abstract

Background: Methods for developing a core outcome or information set require involvement of key stakeholders to prioritise many items and achieve agreement as to the core set. The Delphi technique requires participants to rate the importance of items in sequential questionnaires (or rounds) with feedback provided in each subsequent round such that participants are able to consider the views of others. This study examines the impact of receiving feedback from different stakeholder groups, on the subsequent rating of items and the level of agreement between stakeholders.

Methods: Randomized controlled trials were nested within the development of three core sets each including a Delphi process with two rounds of questionnaires, completed by patients and health professionals. Participants rated items from 1 (not essential) to 9 (absolutely essential). For round 2, participants were randomized to receive feedback from their peer stakeholder group only (peer) or both stakeholder groups separately (multiple). Decisions as to which items to retain following each round were determined by pre-specified criteria.

Results: Whilst type of feedback did not impact on the percentage of items for which a participant subsequently changed their rating, or the magnitude of change, it did impact on items retained at the end of round 2. Each core set contained discordant items retained by one feedback group but not the other (3-22 % discordant items). Consensus between patients and professionals in items to retain was greater amongst those receiving multiple group feedback in each core set (65-82 % agreement for peer-only feedback versus 74-94 % for multiple feedback). In addition, differences in round 2 scores were smaller between stakeholder groups receiving multiple feedback than between those receiving peer group feedback only. Variability in item scores across stakeholders was reduced following any feedback but this reduction was consistently greater amongst the multiple feedback group.

Conclusions: In the development of a core outcome or information set, providing feedback within Delphi questionnaires from all stakeholder groups separately may influence the final core set and improve consensus between the groups. Further work is needed to better understand how participants rate and re-rate items within a Delphi process.

Trial registration: The three randomized controlled trials reported here were each nested within the development of a core information or outcome set to investigate processes in core outcome and information set development. Outcomes were not health-related and therefore trial registration was not applicable.

Keywords: Consensus; Core information set; Core outcome set; Delphi; Feedback.

Fig. 1

Feedback presented in round 2 questionnaires, example from oesophageal core information set (CIS). Participants were asked to "Please complete this questionnaire and circle the score that best represents your opinion regarding whether each topic should be discussed with patients prior to surgery."Previous ratings are shown here as mean scores from round 1

Fig. 2

Flow diagram for colorectal cancer surgery, breast reconstruction and oesophageal cancer surgery core sets. ^aWhilst 45 patients randomized to the dual feedback group returned a questionnaire, one patient only completed items related to other aspects of the research not reported here; all round 2 scores were missing

Fig. 3

Forest plot of difference in percentage of items re-rated between peer group and multiple group feedback. WMD Weighted mean Difference relates to overall estimate only; I-Squared demonstrates little heterogeneity, fixed effects model presented

Fig. 4

Forest plot of difference in mean absolute change between rounds between peer group and multiple group feedback. WMD Weighted Mean Difference relates to overall estimate only; I-Squared demonstrates little heterogeneity, fixed effects model presented