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Application of Delphi Method in the Development and Revision of Clinical Practice Guidelines of Traditional Chinese Medicine: Process and Suggestions
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摘要: 在临床实践指南的制订和修订过程中, 共识法是确定临床问题和形成推荐意见的重要方法, 其中以德尔菲法和改良德尔菲法最为常见。为此, 如何科学、规范地应用德尔菲法达成共识(如专家组人员选择、流程设计等)已成为当下亟待研究的重要问题。应用德尔菲法的过程中, 需借鉴国际上较为成熟的方法学建议, 以使共识形成过程结构化、透明化。本文以德尔菲法在中医药临床实践指南制订和修订中的应用为切入点, 阐述其基本流程和关键要素。在德尔菲法主体方面详细阐述了共识组的人数及构成、选取标准及途径、患者参与共识的方式和要点, 在技术要点方面对其匿名性、达成共识的阈值、时间把控进行了阐释, 进而指出德尔菲法应用的局限性及报告要点, 以期促进德尔菲法在指南制订中的规范应用。Abstract: In the process of developing clinical practice guidelines, consensus method is essential to determine clinical problems and recommendations, among which Delphi method and modified Delphi method are the most common. Therefore, scientific and standardized application of Delphi method to reach a consensus (such as expert selection, process design) has become an important topic in urgent need of study. In the process of using Delphi method, it is necessary to refer to mature methodological suggestions to make theconsensus process structured and transparent. This article focuses on the key elements of Delphi method in the development of clinical practice guidelines, and elaborates its basic methods and processes, including the number, composition, standards and selection methods of the "expert group", as well as the key points of patients' participation. In terms of technical points, anonymity, consensus threshold and time control are described. Furthermore, the limitations of Delphi method and the highlights of the report are presented, in order to promote the standardized application of Delphi method in the development of the guidelines.作者贡献：梁昌昊负责查阅资料、撰写论文；尹冠翔、王雅琪、刘思岐负责查阅资料、修订论文；高一城、刘鹏伟、苏祥飞负责论文初稿修订；费宇彤负责指导论文写作及审校。利益冲突：所有作者均声明不存在利益冲突
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表 2 判断标准的量化
判断标准 对该领域的信心 高 中 低 理论分析 0.30 0.20 0.10 实践经验 0.45 0.35 0.20 国内外参考文献 0.20 0.15 0.10 本能选择 0.05 0.05 0.05 
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[1] Dalkey N. An experimental study of group opinion: The Delphi method[J]. Futures, 1969, 1: 408-426. doi: 10.1016/S0016-3287(69)80025-X [2] Black N, Murphy M, Lamping D, et al. Consensus development methods: a review of best practice in creating clinical guidelines[J]. J Health Serv Res Policy, 1999, 4: 236-248. doi: 10.1177/135581969900400410 [3] Fink A, Kosecoff J, Chassin M, et al. Consensus methods: characteristics and guidelines for use[J]. Am J Public Health, 1984, 74: 979-983. doi: 10.2105/AJPH.74.9.979 [4] Nair R, Aggarwal R, Khanna D. Methods of formal consensus in classification/diagnostic criteria and guideline development[J]. Semin Arthritis Rheum, 2011, 41: 95-105. doi: 10.1016/j.semarthrit.2010.12.001 [5] Steurer J. The Delphi method: an efficient procedure to generate knowledge[J]. Skeletal Radiol, 2011, 40: 959-961. doi: 10.1007/s00256-011-1145-z [6] 梁昌昊, 夏如玉, 黄子玮, 等. 共识法在中医临床实践指南及专家共识中的应用及方法学报告特征分析[J]. 中医杂志, 2022, 63: 26-34. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ202201008.htm [7] Diamond IR, Grant RC, Feldman BM, et al. Defining consensus: a systematic review recommends methodologic criteria for reporting of Delphi studies[J]. J Clin Epidemiol, 2014, 67: 401-409. doi: 10.1016/j.jclinepi.2013.12.002 [8] Sandford BA, Hsu CC. The Delphi Technique: Making Sense of Consensus[J]. Pract Assess Res Evaluation, 2007, 26: 289-304. [9] Keeney S, Hasson F, Mckenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research[J]. J Adv Nurs, 2010, 53: 2. [10] Gaakeer MI, Veugelers R, Patka P, et al. On behalf of the Dutch ED Study Group. Minimum operational standards for 24/7 available emergency departments in the Nether-lands: a first step taken by emergency physicians using an e-Delphi approach[J]. Eur J Emerg Med, 2019, 26: 86-93. doi: 10.1097/MEJ.0000000000000494 [11] 曾照云, 程晓康. 德尔菲法应用研究中存在的问题分析: 基于38种CSSCI(2014—2015)来源期刊[J]. 图书情报工作, 2016, 60: 116-120. https://www.cnki.com.cn/Article/CJFDTOTAL-TSQB201616020.htm [12] Mckenna H, Keeney S, Hasson F. The Delphi Technique in Nursing and Health Research[M]. New Jersey: John Wiley & Sons Ltd, 2011: 1-17. [13] 廖星, 谢雁鸣, 张俊华, 等. 中医临床实践指南制修订中专家共识技术规范[J]. 中国中药杂志, 2019, 44: 4354-4359. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZY201920034.htm [14] McMillan SS, King M, Tully MP. How to use the nominal group and Delphi techniques[J]. Int J Clin Pharm, 2016, 38: 655-662. [15] McKenna HP. The Delphi technique: a worthwhile research approach for nursing?[J]. J Adv Nurs, 1994, 19: 1221-1225. doi: 10.1111/j.1365-2648.1994.tb01207.x [16] Wolf R. The decision Delphi[J]. Technol Forecast Soc Change, 1979, 15: 159-169. doi: 10.1016/0040-1625(79)90011-8 [17] Crisp J, Pelletier D, Duffield C, et al. The Delphi method?[J]. Nurs Res, 1997, 46: 116-118. doi: 10.1097/00006199-199703000-00010 [18] Beretta R. A critical review of the Delphi technique[J]. Nurse Res, 1996, 3: 79-89. doi: 10.7748/nr.3.4.79.s8 [19] Dean P, Schumacher D, Florin TA. Defining Pneumonia Severity in Children: A Delphi Study[J]. Pediatr Emerg Care, 2021, 37: e1482-e1490. doi: 10.1097/PEC.0000000000002088 [20] Jordans IPM, de Leeuw RA, Stegwee SI, et al. Sono-graphic examination of uterine niche in non-pregnant women: a modified Delphi procedure[J]. Ultrasound Obstet Gynecol, 2019, 53: 107-115. doi: 10.1002/uog.19049 [21] Gordon T, Pease A. RT Delphi: An efficient, "round-less" almost real time Delphi method[J]. Technol Forecast Soc Change, 2006, 73: 321-333. doi: 10.1016/j.techfore.2005.09.005 [22] Varndell W, Fry M, Elliott D. Applying real-time Delphi methods: development of a pain management survey in emergency nursing[J]. BMC Nurs, 2021, 20: 149. doi: 10.1186/s12912-021-00661-9 [23] Guyatt GH, Oxman AD, Kunz R, et al. Going from evidence to recommendations[J]. BMJ, 2008, 336: 1049-1051. doi: 10.1136/bmj.39493.646875.AE [24] Moberg J, Oxman AD, Rosenbaum S, et al. The GRADE Evidence to Decision (EtD) framework for health system and public health decisions[J]. Health Res Policy Syst, 2018, 16: 45. doi: 10.1186/s12961-018-0320-2 [25] Guyatt G, Oxman AD, Akl EA, et al. GRADE guide-lines: 1. Introduction-GRADE evidence profiles and summary of findings tables[J]. J Clin Epidemiol, 2011, 64: 383-394. doi: 10.1016/j.jclinepi.2010.04.026 [26] WHO. Handbook for Guideline Development[EB/OL]. (2014-12-08)[2023-05-28]. https://www.who.int/publications/i/item/9789241548960 .[27] 胡晶, 张会娜, 康群甫, 等. 共识法在中医临床实践指南制定中的应用[J]. 中医杂志, 2016, 57: 1658-1661. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201619010.htm [28] Goodman CM. The Delphi technique: a critique[J]. J Adv Nurs, 2010, 12: 729-734. [29] Ishikawa A, Amagasa M, Shiga T, et al. The max-min Delphi method and fuzzy Delphi method via fuzzy integration[J]. Fuzzy Sets Syst, 1993, 55: 241-253. doi: 10.1016/0165-0114(93)90251-C [30] NICE. Developing Nice Guidelines the Manual[EB/OL]. (2014-10-31)[2023-05-28]. https://www.nice.org.uk/process/pmg20/chapter/introduction .[31] 周芬. 患者及公众参与临床实践指南构建及其方法的研究进展[J]. 护理学报, 2020, 27: 14-17. https://www.cnki.com.cn/Article/CJFDTOTAL-NFHL202005006.htm [32] Roman BR, Feingold J. Patient-centered Guideline Develop-ment Best Practices Can Improve the Quality and Impact of Guidelines[J]. Otolaryngol Head Neck Surg, 2014, 151: 530-532. doi: 10.1177/0194599814544878 [33] 靳英辉, 王丹琦, 李艳, 等. 临床实践指南制定方法: 国内外临床实践指南制定手册概要[J]. 中国循证心血管医学杂志, 2018, 10: 1-10. https://www.cnki.com.cn/Article/CJFDTOTAL-PZXX201801001.htm [34] 解染, 陈耀龙, 陈昊, 等. 循证指南制定中患者价值观和偏好的研究方法[J]. 中国循证医学杂志, 2015, 15: 586-591. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ201505015.htm [35] 宁允, 李文姣, 程侣, 等. 患者及公众参与患者指南制定的思考[J]. 中国循证心血管医学杂志, 2020, 12: 908-911. https://www.cnki.com.cn/Article/CJFDTOTAL-PZXX202008004.htm [36] 张颖, 季聪华, 李秋爽, 等. 中医临床实践指南制修订中德尔菲法的统计分析方法[J]. 中华中医药杂志, 2018, 33: 249-251. https://www.cnki.com.cn/Article/CJFDTOTAL-BXYY201801064.htm [37] 付红艳. 关于变异系数、偏度系数和峰度系数的U统计量检验法[D]. 长春: 吉林师范大学, 2014. [38] Dai F, Wei K, Chen Y, et al. Construction of an index system for qualitative evaluation of undergraduate nursing students innovative ability: A Delphi study[J]. J Clin Nurs, 2019, 28: 4379-4388. [39] Li Y, Ehiri J, Hu D, et al. Framework of behavioral indicators for outcome evaluation of TB health promotion: a Delphi study of TB suspects and Tb patients[J]. BMC Infect Dis, 2014, 14: 268. [40] 刘弘. 关于痛经辨证分型的专家问卷分析[J]. 中医杂志, 2008, 49: 984-985. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ200811010.htm [41] Green P. The Outdoor Leadership Handbook. A Manual for Leaders of Land-based Outdoor Pursuits in the Pacific Northwest[M]. Tacoma: Emergency Response Institute, 1982: 7-14. [42] Chen L, Wu Y, Wang S, et al. Construction of evidence-based practice competencies for nurses in China: A modified Delphi study[J]. Nurse Educ Today, 2021, 102: 104927. [43] Hasson F, Keeney S, McKenna H. Research guidelines for the Delphi survey technique[J]. J Adv Nurs, 2000, 32: 1008-1015. [44] Martino JP. The Delphi method: Techniques and applica-tions[J]. Technol Forecast Soc Change, 1976, 8: 441-442. [45] Sandrey MA, Bulger SM. The Delphi Method: An App-roach for Facilitating Evidence Based Practice in Athletic Training[J]. Athl Train Educ J, 2008, 3: 135-142. [46] 李博, 任晨儿, 刘阳. 辨证与厘清: 体育科学研究中"德尔菲法"应用存在的问题及程序规范[J]. 体育科学, 2021, 41: 89-97. https://www.cnki.com.cn/Article/CJFDTOTAL-TYKX202101011.htm [47] 管慧, 戴国华, 高武霖, 等. 中医药临床研究中应用德尔菲法的系统评价[J]. 中国循证医学杂志, 2021, 21: 186-190. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZXZ202102009.htm [48] Jünger S, Payne SA, Brine J, et al. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological syste-matic review[J]. Palliat Med, 2017, 31: 684-706. [49] O'Connor N, Clark S. Beware bandwagons! The bandwagon phenomenon in medicine, psychiatry and management[J]. Australas Psychiatry, 2019, 27: 603-606. -
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