Consensus in controversy: The modified Delphi method applied to Gynecologic Oncology practice

• Type of Material: Article
• Authors: David E. Cohn, Ohio State University; Laura J. Havrilesky, Duke University School of Medicine; Kathryn Osann, University of California at Irvine; Joseph Lipscomb, Emory University; Susie Hsieh, University of California at Irvine; Joan L. Walker, University of Oklahoma; Alexi A. Wright, Harvard Medical School; Ronald D. Alvarez, University of Alabama at Birmingham; Beth Y. Karlan, Cedars Sinai Medical Center; Robert E. Bristow, University of California at Irvine; Paul A. DiSilvestro, Brown University; Mark T. Wakabayashi, Brown University; Robert Morgan, City of Hope; Dana B. Mukamel, University of California Irvine; Lari Wenzel, University of California at Irvine
• Language: English
• Date: 2015-09
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ygyno.2015.07.014
• Title of Journal or Parent Work: Gynecologic Oncology
• ISSN: 0090-8258
• Volume: 138
• Issue: 3
• Start Page: 712
• End Page: 716
• Keywords: Delphi technique; Intraperitoneal (IP); Ovarian cancer; Opinion
• Research Categories: Health Sciences, Oncology; Health Sciences, Obstetrics and Gynecology; Health Sciences, Public Health

Abstract

Objectives To determine the degree of consensus regarding the probabilities of outcomes associated with IP/IV and IV chemotherapy. Methods A survey was administered to an expert panel using the Delphi method. Ten ovarian cancer experts were asked to estimate outcomes for patients receiving IP/IV or IV chemotherapy. The clinical estimates were: 1) probability of completing six cycles of chemotherapy, 2) probability of surviving five years, 3) median survival, and 4) probability of ER/hospital visits during treatment. Estimates for two patients, one with a low comorbidity index (patient 1) and the other with a moderate index (patient 2), were included. The survey was administered in three rounds, and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers. Results The ranges were smaller for IV compared with IP/IV therapy. Ranges decreased with each round. Consensus converged around outcomes related to IP/IV chemotherapy for: 1) completion of 6 cycles of therapy (type 1 patient, 62%, type 2 patient, 43%); 2) percentage of patients surviving 5 years (type 1 patient, 66%, type 2 patient, 47%); and 3) median survival (type 1 patient, 83 months, type 2 patient, 58 months). The group required three rounds to achieve consensus on the probabilities of ER/hospital visits (type 1 patient, 24%, type 2 patient, 35%). Conclusions Initial estimates of survival and adverse events associated with IP/IV chemotherapy differ among experts. The Delphi process works to build consensus and may be a pragmatic tool to inform patients of their expected outcomes.