What Is the Correct Application of the Delphi Technique in Healthcare?

What Is the Correct Application of the Delphi Technique in Healthcare?

The Delphi technique is a structured communication method used to reach consensus among a panel of experts, particularly in areas where empirical evidence is limited or opinions are divided. In healthcare, it is frequently applied to develop clinical guidelines, define treatment protocols, or establish research priorities. However, its effectiveness relies on a correct application of the Delphi technique, which can only be achieved through a rigorous methodology.

Key Use Cases for the Delphi Technique in Healthcare

Below are some common applications:

Key Considerations for a correct application of the Delphi Technique in Healthcare

To conduct a robust Delphi study, researchers should follow a structured approach from planning to dissemination. Below are the critical steps:

1. Establish a Clear Research Question

Before initiating a Delphi study, a well-defined research question must be established. This ensures that the study remains focused and aligns with its intended purpose (e.g., guideline development, clinical decision-making, or research prioritization). The research question should be:

• Specific (avoiding broad or vague objectives)
• Feasible (answerable within the Delphi framework)
• Relevant (addressing a genuine gap in evidence or practice)

A poorly defined question can lead to ambiguous results and difficulty in achieving meaningful consensus.

2. Agree Data Management Approaches

While Delphi studies often do not require formal ethics approval because they involve expert consultation rather than patient data collection, consider:

• Whether your institution requires review for survey-based research
• Obtaining informed consent from panelists
• Ensuring anonymity of responses

3. Conduct an Initial Literature Review

A scoping or targeted literature review should precede the first Delphi round to:

• Identify existing evidence and avoid redundancy
• Inform the development of Delphi survey questions
• Ensure that any steering group discussions are grounded in current knowledge

This step strengthens the study’s credibility and prevents unnecessary repetition of prior work.

4. Form a Steering Group

Consider establishing a small steering group (3-5 members) to:

• Help refine the research question and methodology
• Review survey design before distribution
• Validate interim findings between rounds
• Provide oversight on consensus thresholds

Including subject-matter experts in this group enhances study rigor.

5. Select an Expert Panel

The quality of a Delphi study hinges on the expertise and representativeness of the panel. Considerations include:

• Diversity: Include clinicians, researchers, policymakers, and (where relevant) patient advocates
• Size: Typically 15-100 experts, balancing breadth of perspectives with manageability
• Recruitment: Use purposive sampling to ensure relevant expertise, and consider snowball sampling

6. Design the Questionnaire & Develop Statements

The quality of a Delphi study depends heavily on well-crafted statements or questions. Here’s how to develop a strong questionnaire:

Sources for Initial Statement Development

1. Open First Round (Classic Delphi Approach)

• Begin with broad, open-ended questions related to the overall research question (e.g., “What are the key barriers to implementing this treatment in clinical practice?”)
• Collect qualitative responses from experts (this may be the steering group or the wider expert panel)
• Thematic analysis of responses generates structured statements for subsequent round

2. Steering Group Input

A small steering group (3-5 experts) can draft initial statements based on:

• The research question
• Gaps identified in the literature
• Clinical experience
• Helps ensure statements are clear, unbiased, and comprehensive

3. Literature Review Findings

• Extract key themes, controversies, or evidence gaps from the review
• Convert these into measurable statements (e.g., “The treatment should be first-line for patients with [specific criteria]”)
• Ensures statements are evidence-informed

4.  Hybrid Approach (Recommended)

Combine methods for robustness:

• Use literature review to draft initial statements
• Refine with steering group input
• Include open-ended questions to capture unanticipated perspectives

Best Practices for Statement Design

• Clarity: Avoid jargon; each statement should be unambiguous and should provoke an opinion to be provided
• Single idea per statement: Avoid compound questions
• Balanced coverage: Ensure all aspects of the research question are represented

Likert Scale Considerations

• Standard scales: 4 or 5-point (Strongly Disagree to Strongly Agree) or 9-point (for finer granularity)
• Include definitions: Anchor points should be clearly defined (e.g., “5 = Essential, 1 = Not relevant”)
• Option for comments: Allow free-text justification for ratings to capture nuanced opinions

By carefully developing statements through these methods, researchers ensure the Delphi process captures meaningful, actionable consensus.

Determine the Threshold for Consensus

Common approaches include:

• Predefined percentage agreement (e.g., ≥75%)
• Stability between rounds (stopping when responses show minimal change)

Plan the Number of Rounds & Stopping Criteria

• Typical rounds: up to 3, but may extend if consensus is evolving
• Stopping criteria:
  • Stability in responses
  • Achievement of predefined consensus thresholds
  • Panel fatigue considerations

Alternative Consensus Methods

RAND Appropriateness Method (RAM)

A modified Delphi approach useful when assessing clinical appropriateness:

• Combines expert ratings with face-to-face discussion
• Particularly valuable for evaluating treatment necessity in specific patient subgroups

Nominal Group Technique (NGT)

An alternative when real-time interaction is beneficial:

• Structured in-person or virtual discussions
• Useful for urgent policy decisions or when live debate adds value
• Usually focused on highly specific or narrow issues

Reporting & Publication Considerations

To enhance publishability:

• Follow ACCORD guidelines for transparent reporting
• Document methodology rigorously (panel selection, consensus definition)
• Report response rates for each round
• Discuss limitations (potential biases, generalizability)

Conclusion

The Delphi technique offers a systematic approach to consensus-building in healthcare when applied rigorously. Key success factors include clear research questions, proper expert selection, thoughtful questionnaire design, and transparent reporting.

By following a correct application of the Delphi technique – researchers can produce valuable, publishable findings that advance clinical practice and policy.

Ready to employ the Delphi method and create positive change?

At Triducive, we specialize in delivering consensus-led evidence that gets published and supports change. With over a decade of experience and more than 50 peer-reviewed publications, we’ve helped transform evidence into action for healthcare systems worldwide.

Get in touch today with our expert team to learn about how we can help your project.