Swiss Paraplegics Centre, Nottwil, Switzerland.
Head Neck. 2012 Jul;34(7):956-66. doi: 10.1002/hed.21844. Epub 2011 Sep 22.
The Comprehensive International Classification of Functioning, Disability and Health Core Set for Head and Neck Cancer (ICF-HNC) is an application of the ICF and guides multidisciplinary cancer follow-up and rehabilitation in patients with head and neck cancer. The objective of this study was to understand the role of physicians within the multidisciplinary team and to explore the content validity of the ICF-HNC from the perspective of physicians.
In a 3-round Delphi survey, physicians experienced in the treatment of head and neck cancer were asked what patients' problems, resources, and aspects of environment they treat. The responses of the first round were linked to the ICF. In the second round the participants received a list of identified ICF categories and were asked if these ICF categories represent patients' problems, resources, and aspects of the environment they treat. Round 3 required a reconsideration of the given answers in accord with the group response. The agreement of the linking process between 2 health care professionals was calculated using kappa statistics.
In all, 55 physicians from 25 countries gave 781 statements; 83 ICF categories were linked to the statements after the first round; 55 ICF categories reached consensus of ≥ 75% after the third round. Of these, 46 categories (84%) are already included in the ICF-HNC. Within the entire ICF-HNC, physicians treat most categories from body structures (88%) and functions (76%) and some categories from activities and participation (15%) and environmental factors (21%). The kappa coefficient for linking ICF categories was 0.988 (95% bootstrapped confidence interval: 0.95-0.99).
The content validity of the ICF-HNC was supported by the perspective of physicians. This study supports the need for a multidisciplinary team. The aspects of functioning which are not treated by physicians should be addressed by timely involvement of other health professions.
头颈部癌症综合功能、残疾和健康分类核心集（ICF-HNC）是国际功能、残疾和健康分类（ICF）的应用，指导头颈部癌症患者的多学科癌症随访和康复。本研究的目的是了解多学科团队中医生的作用，并从医生的角度探讨 ICF-HNC 的内容效度。
在三轮 Delphi 调查中，经验丰富的头颈部癌症治疗医生被要求列出他们治疗的患者问题、资源和环境方面。第一轮的回答与 ICF 相关联。在第二轮中，参与者收到了一组已确定的 ICF 类别，并被要求回答这些 ICF 类别是否代表他们治疗的患者问题、资源和环境方面。第三轮要求根据小组的反应重新考虑给定的答案。两名卫生保健专业人员之间的链接过程的一致性使用 Kappa 统计进行计算。
共有来自 25 个国家的 55 名医生提供了 781 条陈述；第一轮后有 83 个 ICF 类别与陈述相关联；第三轮后有 55 个 ICF 类别达成了≥75%的共识。其中，46 个类别（84%）已包含在 ICF-HNC 中。在整个 ICF-HNC 中，医生治疗大多数来自身体结构（88%）和功能（76%）的类别，以及一些来自活动和参与（15%）和环境因素（21%）的类别。链接 ICF 类别的 Kappa 系数为 0.988（95% bootstrap 置信区间：0.95-0.99）。
从医生的角度来看，ICF-HNC 的内容效度得到了支持。本研究支持多学科团队的需求。未被医生治疗的功能方面应通过及时让其他卫生专业人员参与来解决。
