Developing Consensus-Based Priority Outcome Domains for Trials in Kidney Transplantation: A Multinational Delphi Survey With Patients, Caregivers, and Health Professionals

Abstract

Background: Inconsistencies in outcome reporting and frequent omission of patient-centered outcomes can diminish the value of trials in treatment decision making. We identified critically important outcome domains in kidney transplantation based on the shared priorities of patients/caregivers and health professionals.

Methods: In a 3-round Delphi survey, patients/caregivers and health professionals rated the importance of outcome domains for trials in kidney transplantation on a 9-point Likert scale and provided comments. During rounds 2 and 3, participants rerated the outcomes after reviewing their own score, the distribution of the respondents' scores, and comments. We calculated the median, mean, and proportion rating 7 to 9 (critically important), and analyzed comments thematically.

Results: One thousand eighteen participants (461 [45%] patients/caregivers and 557 [55%] health professionals) from 79 countries completed round 1, and 779 (77%) completed round 3. The top 8 outcomes that met the consensus criteria in round 3 (mean, ≥7.5; median, ≥8; proportion, >85%) in both groups were graft loss, graft function, chronic rejection, acute rejection, mortality, infection, cancer (excluding skin), and cardiovascular disease. Compared with health professionals, patients/caregivers gave higher priority to 6 outcomes (mean difference of 0.5 or more): skin cancer, surgical complications, cognition, blood pressure, depression, and ability to work. We identified 5 themes: capacity to control and inevitability, personal relevance, debilitating repercussions, gaining awareness of risks, and addressing knowledge gaps.

Conclusions: Graft complications and severe comorbidities were critically important for both stakeholder groups. These stakeholder-prioritized outcomes will inform the core outcome set to improve the consistency and relevance of trials in kidney transplantation.

Figure 1. Consensus criteria and outcome domains

Outcomes included in the potential core outcome set met at least two of the following criteria: mean score of greater than or equal to 7.5; mean score greater than or equal to 8; proportion of participants rating the outcome 7 to 9 (critically important) is greater than or equal to 75, and the median is less than 10 based on the forced ranking question.

Figure 2

Mean scores of patients/caregivers in rounds 1–3

Figure 3

Mean scores of health professionals in rounds 1–3

Figure 4. Differences in mean scores between patients/caregivers and health professionals in rounds 1–3

*The top 8 outcome domains for both stakeholder groups that met at least two of the following criteria: mean score of greater than or equal to 7.5; mean score greater than or equal to 8; proportion of participants rating the outcome 7 to 9 (critically important) is greater than or equal to 75, and the median is less than 10 based on the forced ranking question.