A consensus-based electronic medical record template for pediatric morphea patient visits.

Morphea, also known as localized scleroderma, is an inflammatory sclerosing disorder of uncertain pathogenesis that affects the skin and underlying tissues. In the pediatric population, the disease often runs a chronic course with a high risk for irreversible sequelae; as such, patients often require long-term monitoring. The objective of this study is to develop a multi-center, consensus-based electronic medical record template for pediatric morphea patient visits using a modified Delphi method of iterative surveys. By facilitating consistent data collection and interpretation across medical centers and patient populations, this template may improve patient care for pediatric patients with morphea.

Evaluating the categorisation of interventions in individual working practice aimed at preventing work-related musculoskeletal disorders: An international experts consultation.

In a previous scoping review, eight categories of interventions in individual work practice were defined. The aim of the present study is to evaluate the relevance and completeness of these eight categories and to increase the clarity of the nomenclature and definitions of each category. An international expert consultation has been carried out for this purpose. Thirty-eight experts from 13 countries participated. Data collection was conducted using a survey design comprising structured questions. Consensus was reached if 75% of the experts answered 'Strongly agree' or 'Agree' on a 5-point Likert scale. For the topic 'Relevance', there was consensus for six of the eight categories (range 78%-86%), the exceptions were the categories: 'Exercising' (72%) and 'Professional manners' (64%). With regard to the topic 'Nomenclature', consensus was reached for six categories and for the topic 'Definition' this was five categories. The present definitions have been improved based on the expert recommendations. With respect to the topic 'Completeness': although a limited number of suggestions were given, this did not lead to one or more categories being added to the existing eight categories. The final 'Nomenclature' for the categories is: 'Variation', 'Professional behaviour', 'Motoric skills', 'Vocational working techniques', 'Physical workplace', 'Physical training', 'Assistive devices and tools' and 'Task content and task organisation'. This expert consultation has provided a solid basis for endorsing the categorisation of interventions in IWP and is an important step in building a framework to develop and evaluate interventions in IWP.

Spanish experts consensus on emergency psychiatric care in hospital emergency departments.

BACKGROUND: The demand for urgent psychiatric care is increasing, but in Spain there are no clear recommendations for emergency departments (ED) on how to optimize care for patients with psychiatric emergencies. We aimed to provide expert consensus recommendations on the requirements for general hospitals´ emergency departments to treat patients with urgent psychiatric symptoms. METHODS: We used a modified Delphi technique. A scientific committee compiled 36 statements based on literature search and clinical experience. The statements covered the organizational model, facilities, staffing, safety, patient interventions, and staff training. A panel of 38 psychiatry specialists with expertise in psychiatric emergencies evaluated the questionnaire in two rounds. RESULTS: After two rounds of voting, 30 out of 36 proposed items (83%) were agreed upon. The panel agreed that psychiatric emergencies should be managed in a general hospital, with dedicated facilities for patient assessment, direct supervision of patients at risk, and an observation unit run by the psychiatric service. In addition to the psychiatrist, the ED should have specialist nurses and security staff available 24/7. Social workers should also be readily available. ED and consulting rooms should be designed to ensure patient and staff safety. A triage system should be established for patients with psychiatric symptoms, with medical evaluation preceding psychiatric evaluation. Guidance on supplies, equipment, and staff training is also provided. CONCLUSION: All ED in general hospitals should have adequate resources to handle any psychiatric emergency. This paper provides recommendations on the minimum requirements to achieve this goal.

Basic assessment of chronic cough in primary care and referral pathways of patients to different specialists: plain language summary of publication.

People with chronic cough (a cough lasting more than 8 weeks) are often referred to different specialists and undergo numerous diagnostic tests, but clear guidance is lacking. This work summarizes a consensus (an agreement) among medical specialists who are involved in managing people with chronic cough: primary care physicians (family doctors), pulmonologists (doctors who specialize in lung conditions), allergists (medical professionals specializing in allergies) and ear, nose and throat (ENT) specialists. They discussed how to perform a basic assessment of people with chronic cough in primary care (day-to-day healthcare given by a general practitioner or family doctor) and how to refer them to different specialists based on clinical findings or test results.

Collagenase Clostridium Histolyticum for the Treatment of Dupuytren Disease: A Delphi-Based Consensus Study.

Purpose: The aim of this study was to establish the consensus recommendations among hand surgeons who were experts in the use of collagenase clostridium histolyticum (CCH) on the appropriate treatment of Dupuytren disease in well-defined patient populations with varying degrees of disease severity and functional impairment. Methods: A three-round, blinded, modified Delphi process examined panelists' approaches to CCH treatment of metacarpophalangeal (MP) or proximal interphalangeal (PIP) joint contractures involving one or two fingers with varying degrees of severity. Clinical scenarios related to poor-quality skin, postfasciectomy scarring, boutonnière deformity, closed capsulotomy, and blood thinner use were also presented for panelist consideration. Panelists provided responses to clinical scenarios using a 5-point Likert scale or a yes/no response. Consensus was defined as ≥66.7% panelist agreement or disagreement. Results: Twenty panelists completed round 1; 19 of the 20 panelists completed rounds 2 and 3. Panelists achieved a high level of consensus for using CCH for the treatment of patients with palpable cords and varying severity contractures representing one- or two-finger MP joint contractures, most one- or two-finger PIP joint contractures, and most combined MP and PIP joint contractures. Consensus for the treatment of PIP joint contractures was mostly achieved, but clinical scenarios related to recurrent PIP contracture with poor-quality skin and/or significant postfasciectomy scarring, boutonnière deformity, PIP contractures >70°, closed capsulotomy, and blood thinner use were modified, and then most (95.3%) statements reached consensus for agreement in round 2. In round 3, open-ended responses indicated that panelists considered CCH appropriate for most patients with Dupuytren disease. Conclusions: Consensus-based findings among expert hand surgeons with substantial CCH experience indicated that CCH has a wide-ranging application for the treatment of Dupuytren disease in patients with varying degrees of disease severity and functional impairment. Type of study/level of evidence: Therapeutic V.

Policy suggestions for improving nursing education in a low- and middle-income country: A modified Delphi study.

BACKGROUND: Health policy critically influences a national healthcare system and nurse's roles, working conditions, and professional development opportunities, especially in low- and middle-income countries. PURPOSE: To explore and prioritize the major challenges and solution, and establish policy directions for improving nursing education in the Kyrgyz Republic. METHODS: The key stakeholders of nursing practice, education, policymaking, and regulation were involved in this modified Delphi study. Following two rounds of exploring priority issues and potential strategies, the participants of the final round assembled for consensual discussions on the establishment of policy directions. DISCUSSION: Innovations in nursing education systems, building educational capacity, and ensuring educational outcomes were suggested and agreed upon for the sequential improvement of nursing education. Timely enactment of these policies will enable the Kyrgyz Republic to mitigate nursing shortages, improve the quality of healthcare services, and enhance overall public health outcomes. CONCLUSION: The policy suggestions derived from this study, including the improvement of nursing education quality and the assurance of nurses' competencies, have great potential for improving quality healthcare practice and sustaining an effective healthcare system.

2024 multidisciplinary consensus on image-guided lung tumor ablation from the Taiwan Academy of Tumor Ablation.

In this article, the multidisciplinary team of the Taiwan Academy of Tumor Ablation, who have expertise in treating lung cancer, present their perspectives on percutaneous image-guided thermal ablation (IGTA) of lung tumors. The modified Delphi technique was applied to reach a consensus on clinical practice guidelines concerning ablation procedures, including a comprehensive literature review, selection of panelists, creation of a rating form and survey, and arrangement of an in-person meeting where panelists agreed or disagreed on various points. The conclusion was a final rating and written summary of the agreement. The multidisciplinary expert team agreed on 10 recommendations for the use of IGTA in the lungs. These recommendations include terms and definitions, line of treatment planning, modality, facility rooms, patient anesthesia settings, indications, margin determination, post-ablation image surveillance, qualified centers, and complication ranges. In summary, IGTA is a safe and feasible approach for treating primary and metastatic lung tumors, with a relatively low complication rate. However, decisions regarding the ablation technique should consider each patient's specific tumor characteristics.

Factors Associated with Non-Adherence to Self-Management Among Patients with Chronic Obstructive Pulmonary Disease: A Survey Using the Delphi Technique and Analytic Hierarchy Process.

Background: The relevant factors and patterns of non-adherence to self-management among patients with chronic obstructive pulmonary disease (COPD) need to be elucidated to improve self-management. Purpose: This study was a survey to prioritize the relevance of factors associated with non-adherence to COPD self-management using the Delphi technique and analytic hierarchy process (AHP). Patients and Methods: A total of 15 expert panels were established to determine the priority of relevant factors in a three-round Delphi survey and an AHP. To develop the preliminary conceptual framework for non-adherence to COPD self-management, findings from a systematic literature review, a qualitative study using in-depth interviews with COPD patients, and the first round of the Delphi survey were integrated. Based on the preliminary framework, the content validity ratio (CVR) was analyzed to examine the consensus among expert panels in the second and third rounds of the Delphi survey, and the relative weight was determined by pairwise comparisons between alternative factors in the AHP. Results: In developing the preliminary conceptual framework, 8 factor categories and 53 factors were identified as relevant to non-adherence to COPD self-management. Of the 53 factors, 22 factors with a CVR of 0.49 or higher were identified in the Delphi survey. A total of 14 of the 53 factors were common to both the Delphi survey and AHP with high weights. The most notable factors were prolonged treatment, experience of treatment failure, and unknown effects of medication. Conclusion: Through consensus decision-making by experts, 14 factors were identified as relevant factors associated with non-adherence to COPD self-management. A hierarchical and systematic framework incorporating factors associated with non-adherence to COPD self-management was developed in this study. Further research is needed to develop intervention strategies based on factors associated with non-adherence to COPD self-management.

Development of a team-specific research strategy using a modified Delphi method in a regional public hospital dietetics department.

OBJECTIVE: Evaluate research capacity and culture among regional hospital dietitians, develop a team specific research strategy, and build research skills of novice researchers. METHODS: The Research Capacity in Context Tool was used to assess current research capacity and culture at organisational, team and individual levels. Results were analysed using descriptive statistics and content analysis of free text responses. A modified Delphi method gained consensus regarding research capacity building. DESIGN: Mixed method study. SETTING: Dietetics department of a regional tertiary hospital (Modified Monash Category 2). PARTICIPANTS: All clinical dietitians currently employed within the hospital (n = 20) regardless of employment duration. MAIN OUTCOME MEASURES: Self-rated response to research capacity and culture to produce a dietetics-specific research strategy. RESULTS: Fifteen dietitians (75%) completed the Research Capacity in Context Tool. The overall mean score was highest at an organisational level at 7.9 (IQR 2), and lowest at team and individual levels at 4.3 (IQR 2.7) and 4.9 (IQR 3.3) respectively. Common barriers to research included time, lack of skills, knowledge and support. Using the modified Delphi method 39 statements relating to research capacity building met consensus and informed the creation of a research strategy. CONCLUSION: The results of the Research Capacity in Context Tool from this regional study reflect those reported in the literature at metropolitan sites. A dietetic-specific research strategy was developed to assist with increasing research capacity at a team and individual level in a regional setting. Evaluation of long-term outcomes post implementation will be the subject of further research.

Consensus-based recommendations for the development and expansion of palliative day care clinics in Germany: results of a Delphi study.

BACKGROUND: Needs-based, patient-oriented palliative care includes palliative day care clinics as a specialized semi-inpatient care offer. However, the establishment and development of these facilities has been unsystematic. Research is needed to strengthen their transparency and ensure their accessibility, quality, and structural adequacy. A national Delphi study was conducted to generate appropriate recommendations for the establishment and development of palliative day care clinics in Germany. METHODS: Recommendations were formulated from focus group data on the development and expansion of palliative day care clinics in Germany. Experts on in- and outpatient palliative care rated 28 recommendations for relevance and feasibility, respectively, using a 4-point Likert-type scale. Suggestions for improvement were captured via free text comments. Items were considered consented when more than 80% of the experts scored them 4 (strongly agree) or 3 (somewhat agree), regarding both relevance and feasibility. RESULTS: A total of 23 experts (32% response rate) completed three Delphi rounds. Following the first round, 10 of 28 recommendations were revised according to participants' comments; 1 recommendation was rejected. After the second round, 3 of these 10 recommendations were revised, while 3 were rejected. Consensus was achieved after the third round for 22 of the initial recommendations. CONCLUSIONS: The Delphi-consented recommendations provide a basis for the targeted evidence- and needs-based development of palliative day care clinics. The findings show a need for standards setting and the meaningful integration of these clinics into existing structures. TRIAL REGISTRATION: The present study was prospectively registered on April 20, 2020, with the German Clinical Trials Register (DRKS00021446).

Development and Validation of a Discharge Assessment Scale for Outpatients Undergoing Sedative Anesthesia in the Ambulatory Postanesthesia Care Unit: A Comprehensive Delphi Study.

PURPOSE: The purpose of this study was to develop a discharge assessment scale tailored for outpatients undergoing sedative anesthesia treatment in the ambulatory postanesthesia care unit and validate its agreement with the Post-Anesthetic Discharge Scoring System. DESIGN: The Delphi method. METHODS: A Delphi survey was conducted with 30 experts focusing on the evaluation of outpatient discharges following treatment under ambulatory anesthesia. Subsequently, a cross-sectional observational study employing convenience sampling selected 2,579 outpatients who had undergone painless ambulatory gastrointestinal endoscopy at a tertiary hospital to analyze the level of agreement with the Post-Anesthesia Discharge Scoring System. FINDINGS: The study conducted three rounds of expert consultations to create the ambulatory discharge assessment scale. Twenty-five experts from 12 provinces and municipalities in our country were interviewed. The discharge assessment form encompassed five aspects: consciousness level, vital signs, directional stability, mobility, and adverse reactions. According to the scale, if the total score exceeded 9 points, with none of the items scoring 0 points, the ambulatory patient could be discharged from the hospital with the accompaniment of family members. Patients assessed using this newly constructed scale were able to leave the hospital earlier compared to those assessed using the comparative scale. No significant differences were observed in vital signs at the time of discharge or the occurrence of adverse events within 24 hours after the procedure. CONCLUSIONS: This assessment tool for discharging ambulatory patients after the ambulatory anesthesia from the postanesthesia outpatient care unit can be considered a valuable addition to formalize the discharge process in outpatient services.

Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study.

PURPOSE: To identify elements of timely integration of palliative care (PC) into hospital oncology care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient and relative representatives on the characteristics of timely integration of PC. METHODS: A three-round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient and 2 relative representatives. In the first round, four elements of integrated PC were considered: (1) identification of potential PC needs, (2) advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. A priori consensus was set at ≥ 70%. RESULTS: A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second and 49 (54%) the third. Panellists agreed that all patients with incurable cancer should have their PC needs assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient's request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of less than 3 months should be offered a consultation (71%). CONCLUSION: The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is particularly needed in patients with multidimensional symptom burden and in those nearing death.

Application of the Delphi method to the development of common data elements for social drivers of health: A systematic scoping review.

Collaborative data science requires standardized, harmonized, interoperable, and ethically sourced data. Developing an agreed-upon set of elements requires capturing different perspectives on the importance and feasibility of the data elements through a consensus development approach. This study reports on the systematic scoping review of literature that examined the inclusion of diverse stakeholder groups and sources of social drivers of health variables in consensus-based common data element (CDE) sets. This systematic scoping review included sources from PubMed, Embase, CINAHL, WoS MEDLINE, and PsycINFO databases. Extracted data included the stakeholder groups engaged in the Delphi process, sources of CDE sets, and inclusion of social drivers data across 11 individual and 6 social domains. Of the 384 studies matching the search string, 22 were included in the final review. All studies involved experts with healthcare expertise directly relevant to the developed CDE set, and only six (27%) studies engaged health consumers. Literature reviews and expert input were the most frequent sources of CDE sets. Seven studies (32%) did not report the inclusion of any demographic variables in the CDE sets, and each demographic SDoH domain was included in at least one study with age and sex assigned at birth included in all studies, and social driver domains included only in four studies (18%). The Delphi technique engages diverse expert groups around the development of SDoH data elements. Future studies can benefit by involving health consumers as experts.

Collecting and capturing social factors that affect individuals' health is imperative. Social drivers of health data allow researchers to understand health disparities to make healthcare available, accessible, and affordable. However, collecting common health data elements has challenged researchers due to limited resources to facilitate change. Incorporating various stakeholders, such as individuals and patient advocacy groups, can effectively contribute to the research process as community advisors. This article reviews the studies that used the Delphi method and brings together experts to agree on guidelines for collecting common data elements. The article's findings reveal that experts are healthcare professionals and researchers, leaving out the crucial input from patients and caregivers. This article emphasized that developing a standard set of data elements can improve the standardization of social drivers of health. Common data elements provide the opportunity to improve patients' and social circumstances and their efforts toward health outcomes.

Content of a wound care mobile application for newly graduated nurses: an e-Delphi study.

BACKGROUND: Wound care represents a considerable challenge, especially for newly graduated nurses. The development of a mobile application is envisioned to improve knowledge transfer and facilitate evidence-based practice. The aim of this study was to establish expert consensus on the initial content of the algorithm for a wound care mobile application for newly graduated nurses. METHODS: Experts participated in online surveys conducted in three rounds. Twenty-nine expert wound care nurses participated in the first round, and 25 participated in the two subsequent rounds. The first round, which was qualitative, included a mandatory open-ended question solicitating suggestions for items to be included in the mobile application. The responses underwent content analysis. The subsequent two rounds were quantitative, with experts being asked to rate their level of agreement on a 5-point Likert scale. These rounds were carried out iteratively, allowing experts to review their responses and see anonymized results from the previous round. We calculated the weighted kappa to determine the individual stability of responses within-subjects between the quantitative rounds. A consensus threshold of 80% was predetermined. RESULTS: In total, 80 items were divided into 6 categories based on the results of the first round. Of these, 75 (93.75%) achieved consensus during the two subsequent rounds. Notably, 5 items (6.25%) did not reach consensus. The items with the highest consensus related to the signs and symptoms of infection, pressure ulcers, and the essential elements for healing. Conversely, items such as toe pressure measurement, wounds around drains, and frostbite failed to achieve consensus. CONCLUSIONS: The results of this study will inform the development of the initial content of the algorithm for a wound care mobile application. Expert participation and their insights on infection-related matters have the potential to support evidence-based wound care practice. Ongoing debates surround items without consensus. Finally, this study establishes expert wound care nurses' perspectives on the competencies anticipated from newly graduated nurses.

Developing a pediatric nursing simulation scenario template in South Korea: applying real-time Delphi methods.

PURPOSE: This study aimed to describe the process of developing a validated pediatric nursing simulation scenario template using the real-time Delphi method. METHODS: A panel of 13 pediatric nursing experts participated in a real-time Delphi survey conducted over two rounds. Initially, 83 items were included in the questionnaire focusing on the structure and content of the simulation scenario template. Data analysis involved calculating the content validity ratio (CVR) and the coefficient of variation to assess item validity and stability. RESULTS: Through iterative rounds of the Delphi survey, a consensus was reached among the experts, resulting in the development of a pediatric nursing simulation scenario template comprising 41 items across nine parts. The CVR values ranged from 0.85 to 1.0, indicating a high consensus among experts regarding the inclusion of all items in the template. CONCLUSION: This study presents a novel approach for developing a pediatric nursing simulation scenario template using real-time Delphi methods. The real-time Delphi method facilitated the development of a comprehensive and scientifically grounded pediatric nursing simulation scenario template. Our template aligns with the International Nursing Association for Clinical Simulation and Learning standards, and provides valuable guidance for educators in designing effective simulation scenarios, contributing to enhanced learning outcomes and better preparation for pediatric clinical practice. However, consideration of cultural and contextual adaptations is necessary, and further research should explore alternative consensus criteria.

Development of a minimum clinical dataset for preoperative comprehensive geriatric assessment using a modified Delphi technique.

OBJECTIVE: To construct a standardised, consensus-guided minimum clinical dataset (MCDS) for preoperative comprehensive geriatric assessment and optimisation (CGA) in Australia and Aotearoa New Zealand. METHODS: We conducted a review of the international perioperative literature to identify CGA domains and tools for potential inclusion in the MCDS. We invited members of the Australian and New Zealand Society for Geriatric Medicine to participate in a Delphi study to obtain consensus on MCDS tools. Participants were asked to rate proposed tools using Likert scales (when >2 tools) or make a binary choice between two proposed tools. Consensus was considered to be achieved when there was at least 75% concordance between the two rounds amongst the participants, and at least one variable attaining over 50% of participants' votes. Domains that did not achieve consensus in Round 1 were carried over to Round 2. RESULTS: There were 73 participants in Round 1 of the Delphi study and 47 participants in Round 2. Consensus was achieved on tool/s recommended for every MCDS domain: Clinical Frailty Scale (frailty); sMMSE, RUDAS, MoCA (cognition); 4AT (delirium); timed-up-and-go (physical function); GDS-15 (mood); Barthel Index (functional status); and MUST (malnutrition). CONCLUSIONS: We recommend clinicians delivering preoperative CGA consider the use of the MCDS we have constructed when assessing older people contemplating surgery, as part of a multicomponent and multidisciplinary approach to optimising perioperative outcomes.

Content validation of the defining characteristics of the nursing diagnosis "impaired swallowing" using the Delphi technique: A study with dysphagia nursing experts in Japan.

PURPOSE: Nurses' clinical reasoning skills regarding impaired swallowing can help prevent patient complications and maintain quality of life. Clinical reasoning skills need content-validated defining characteristics (DCs). We aimed to validate the content of these DCs for nursing diagnosis "impaired swallowing." METHODS: Content validation of the DCs was performed by 275 dysphagia nursing experts in Japan, using 3 rounds of the Delphi technique and Fehring's Diagnostic Content Validation (DCV) model. Three rounds of questionnaires on 84 DCs were completed via printed mail. FINDINGS: The valid response rates for each round were as follows: round 1, 90.2%; round 2, 77.8%; and round 3, 71.3%. Of the 84 DCs, 77 that met the consensus criteria were categorized as major (n = 18), minor (n = 45), and excluded (n = 14). There were four minor DCs other than the oral, pharyngeal, and esophageal phases. DCs listed from outside NANDA-I included 12 major, 16 minor, and 3 excluded characteristics. Of the NANDA-I DCs, 5 were no consensus and 11 were excluded. The total DCV score for the 63 major and minor DCs was 0.8. CONCLUSIONS: Our results recommend the addition of 28 DCs and the exclusion of 11 for the NANDA-I nursing diagnosis "impaired swallowing" (00103). Major DCs were prominent indicators of impaired swallowing and signs of aspiration or pharyngeal residuals. Minor DCs included not only the three phases but also other signs necessary for a comprehensive understanding of impaired swallowing. IMPLICATIONS FOR NURSING PRACTICE: This validation study strengthens the clinical usefulness of the DCs for impaired swallowing, which can improve nurses' clinical reasoning skills. Major and minor DCs can increase the awareness of impaired swallowing and enable accurate intervention, thereby preventing patient complications and maintaining quality of life.

Revising the Pragmatics Profile of Everyday Communication Skills for traumatic brain injury: An international Delphi study.

BACKGROUND: Assessment tools that assess pragmatic skills in adults with a mild-severe traumatic brain injury (TBI) are hard to access, not person-centred and have a high risk of clinician bias. The Pragmatics Profile is an informant report tool that was originally designed to assess pragmatic skills in people with a developmental disability. AIMS: The aim of this study was to seek consensus from a panel of experts and create a version of the Pragmatics Profile for the TBI population. METHODS AND PROCEDURES: A three-round modified Delphi methodology panel of 13 experts were invited to comment anonymously on the suitability of each question from the Pragmatics Profile modified for those with TBI until ≥ 80% agreement was reached. OUTCOMES AND RESULTS: The Pragmatics Profile (TBI) included 66 questions that achieved consensus after three rounds of the Delphi panel. Qualitative analysis illuminated themes relating to adults with TBI and the need to include contextual factors. CONCLUSIONS AND IMPLICATIONS: The outcome of this project was a revised version of the Pragmatics Profile which is suitable for adults with a mild-severe TBI, informed by experts and freely available online. Future research exploring the tool's utility and acceptability is the next step in its evaluation. WHAT THIS PAPER ADDS: What is already known on this subject Assessment of the everyday functional use of language is challenging but vital. This is particularly true for those who have traumatic brain injury (TBI) where the communication outcomes can be highly variable and may include difficulties with conversational turn-taking, topic maintenance and reading social cues. There are limited tools available to clinicians and those tend to be rating scales or checklists which have a high risk of clinician bias. Available tools have a limited ability to capture the individual's personal social communication goals. What this paper adds to existing knowledge This study created an online Pragmatics Profile (PP) for TBI based on experts' opinions. This paper details the themes that emerged during the process of revising the PP for those with TBI. What are the potential or actual clinical implications of this work? The PP-TBI adds to the toolkit for speech and language therapists working with people with TBI. It meets recent recommendations in the literature to create an interview-based tool. The versatility of an online tool combined with revised input from a panel of experts increases the likelihood that clinicians will utilise this tool. Given the long-term use of the original PP by clinicians for almost 30 years and a focus on personalised care, the format and approach are also likely to be acceptable to clinicians.

A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study.

BACKGROUND: Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM: To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN: International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS: Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS: Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION: A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.