Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA.
University of Miami and Jackson Memorial Hospital, 1500 NW 10th Avenue, Miami, FL, USA.
Pituitary. 2017 Aug;20(4):422-429. doi: 10.1007/s11102-017-0801-2.
Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing's disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course.
The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after ("second round") an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: "agreement" if no more than two responses were outside a 2 week window around the median response; "disagreement" if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results.
Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8-24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy.
With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.
需要随访指南来评估皮质醇增多症（Cushing's disease，CD）患者的护理质量，并确保他们获得最佳的长期预后。本研究旨在评估专家对 CD 患者在治疗过程不同阶段的推荐随访间隔的一致性。
采用 RAND/UCLA 改良 Delphi 法评估专家共识。11 名经常管理 CD 患者的临床医生在进行面对面小组讨论以澄清定义之前和之后（“第二轮”）对 79 个假设患者情况进行了评分。这些情景描述了治疗后不同时间点的 CD 患者。对于每个情景，小组成员以周为单位建议随访间隔。小组共识分配如下：如果中位数回复周围不超过两个回复在 2 周窗口之外，则为“一致”；如果中位数回复周围超过两个回复在 2 周窗口之外，则为“不一致”。建议是基于第二轮的结果制定的。
面对面讨论前的小组一致性为 65.9%，讨论后的小组一致性为 88.6%。该小组建议糖皮质激素替代治疗缓解且术后 1 年内的患者应在 8 周内进行随访；持续或复发疾病未得到控制的患者应在 4 周内进行随访；接受放射治疗且接受药物治疗控制的患者应在 8-24 周内进行随访；双侧肾上腺切除术后无明显症状且 ACTH 血浆浓度稳定的患者应在 24 周内进行随访。
使用 Delphi 过程达成了高度共识，小组成员建议在大多数患者情况下定期随访这种慢性疾病。这些建议对于评估 CD 护理在研究和临床实践中都可能有用。
