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. 2024 Jun 18;14(6):e085723.
doi: 10.1136/bmjopen-2024-085723.

Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach

James O Burton  1   2 , Joseph Chilcot  3 , Katie Fielding  4 , Andrew H Frankel  5 , Niraj Lakhani  6 , Pam Nye  7 , Kathrine Parker  8   9 , William Priestman  10 , Fiona Willingham  11
Affiliations

Best practice for the selection, design and implementation of UK Kidney Association guidelines: a modified Delphi consensus approach

James O Burton et al. BMJ Open. .

Abstract

Background: Despite research into how to effectively implement evidence-based recommendations into clinical practice, a lack of standardisation in the commissioning and development of clinical practice guidelines can lead to inconsistencies and gaps in implementation. This research aimed to ascertain how topics in kidney care worthy of guideline development within the UK should be chosen, prioritised, designed and implemented.

Methods: Following a modified Delphi methodology, a multi-disciplinary panel of experts in kidney healthcare from across the UK developed 35 statements on the issues surrounding the selection, development and implementation of nephrology guidelines. Consensus with these statements was determined by agreement using an online survey; the consensus threshold was defined as 75% agreement.

Results: 419 responses were received. Of the 364 healthcare practitioners (HCPs), the majority had over 20 years of experience in their role (n=123) and most respondents were nephrologists (n=95). Of the 55 non-clinical respondents, the majority were people with kidney disease (n=41) and the rest were their carers or family. Participants were from across England, Northern Ireland, Scotland and Wales. Consensus between HCPs was achieved in 32/35 statements, with 28 statements reaching ≥90% agreement. Consensus between patients and patient representatives was achieved across all 20 statements, with 13/20 reaching ≥90% agreement.

Conclusions: The current results have provided the basis for six recommendations to improve the selection, design and implementation of guidelines. Actioning these recommendations will help improve the accessibility of, and engagement with, clinical guidelines, contributing to the continuing development of best practice in UK kidney care.

Keywords: implementation science; nephrology; protocols & guidelines.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
The roles of the 419 respondents. GP, general practitioner.
Figure 2
Figure 2
The combined consensus across statements from HCPs and patients/patient representatives. The dark green line represents consensus threshold of 75% and the light green line represents the threshold for very high consensus (90%). HCPs, healthcare practitioners; UKKA, UK Kidney Association.
Figure 3
Figure 3
(A) Consensus score distribution across the 4-point Likert scale provided to healthcare professional respondents; (B) consensus score distribution across the 4-point Likert scale provided to patient/representative respondents. HCPs, healthcare practitioners; UKKA, UK Kidney Association.
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