Editorial Commentary: Wider Acceptance of Medical Expert Consensus Research Requires Strict Adherence to Delphi Panel Methodology

Abstract

The diagnosis and treatment of an anterior glenohumeral instability remains controversial. Currently, there is no universally globally accepted approach. In addition to individual surgeon's experiences and preferences, surgical training, regional differences in patient's expectations, and demands confound decision-making. Evidence-based medicine and large randomized trials are not helpful, as they cannot possibly account for all potential confounders. The Delphi technique is an expert consensus-based evidence approach and a reasonable alternative to randomized trials. It pools the experience of experts in the field in a scientific fashion but has been criticized for only producing the lowest common denominator, resulting in oversimplification of a complex problem. However, this criticism is commonly a result of inadequate execution of the methods rather than the methodology itself. It could be that strict adherence to Delphi methodology could result in greater acceptance of Delphi (rather than "modified" Delphi) findings; a stricter approach also may lead to lower agreement between participating experts.