Loeffen E A H, Mulder R L, Kremer L C M, Michiels E M C, Abbink F C H, Ball L M, Segers H, Mavinkurve-Groothuis A M C, Smit F J, Vonk I J M, Vd Wetering M D, Tissing W J E
Department of Pediatric Oncology/Hematology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Support Care Cancer. 2015 Jul;23(7):1987-95. doi: 10.1007/s00520-014-2559-7. Epub 2014 Dec 18.
Currently, very few guidelines for supportive care for children with cancer exist. In the Netherlands, nationwide guidelines are over 10 years old and mostly based on expert opinion. Consequently, there is growing support and need for clinical practice guidelines (CPGs), which ought to be developed with a well-defined methodology and include a systematic search of literature, evidence summaries, and a transparent description of the decision process for the final recommendations. Development of CPGs is time consuming; therefore, it is important to prioritize topics for which there is the greatest clinical demand.
This study aims to prioritize childhood cancer supportive care topics for development of CPGs.
A Delphi survey consisting of two rounds was conducted to prioritize relevant childhood cancer supportive care topics for the development of CPGs. A group of experts comprising 15 pediatric oncologists, 15 pediatric oncology nurses, and 15 general pediatricians involved in care for childhood cancer patients were invited to participate. All relevant supportive care topics in childhood cancer were rated.
In both rounds, 36 panellists (82%) responded. Agreement between panellists was very good, with an intraclass correlation coefficient of 0.918 (95% confidence interval (CI) = 0.849-0.966, p < 0.001) in round 2. The ten topics with the highest score in the final round were infection, sepsis, febrile neutropenia, pain, nausea/vomiting, restrictions in daily life and activities, palliative care, procedural sedation, terminal care, and oral mucositis.
We successfully used a Delphi survey to prioritize childhood cancer supportive care topics for the development of CPGs. This is a first step towards uniform and evidence-based Dutch guidelines in supportive care in childhood cancer. Even though performed nationally, we believe that this study can also be regarded as an example starting point for international development of CPGs in the field of supportive care in cancer or any other field for that matter.
目前，针对癌症患儿的支持性护理指南非常少。在荷兰，全国性指南已有十多年历史，且大多基于专家意见。因此，对临床实践指南（CPG）的支持和需求日益增加，CPG的制定应采用明确的方法，包括对文献的系统检索、证据总结以及对最终建议决策过程的透明描述。CPG的制定耗时较长；因此，对临床需求最大的主题进行优先排序很重要。
本研究旨在对用于CPG制定的儿童癌症支持性护理主题进行优先排序。
进行了两轮德尔菲调查，以对用于CPG制定的相关儿童癌症支持性护理主题进行优先排序。邀请了由15名儿科肿瘤学家、15名儿科肿瘤护士和15名参与儿童癌症患者护理的普通儿科医生组成的专家小组参与。对儿童癌症中所有相关的支持性护理主题进行评分。
两轮调查中，均有36名小组成员（82%）做出回应。小组成员之间的一致性非常好，第二轮的组内相关系数为0.918（95%置信区间（CI）=0.849 - 0.966，p < 0.001）。最后一轮得分最高的十个主题是感染、败血症、发热性中性粒细胞减少、疼痛、恶心/呕吐、日常生活和活动受限、姑息治疗、程序性镇静、终末期护理和口腔黏膜炎。
我们成功地使用德尔菲调查对用于CPG制定的儿童癌症支持性护理主题进行了优先排序。这是朝着制定统一且基于证据的荷兰儿童癌症支持性护理指南迈出的第一步。尽管该研究是在全国范围内进行的，但我们认为这项研究也可被视为癌症支持性护理领域或任何其他领域CPG国际制定的一个示例起点。
