Modified Delphi survey for decision analysis for prophylaxis of post-radiation osteonecrosis.
OBJECTIVE
to augment epidemiological data from the literature, assist Bayesian perspectives and a decision analytic framework for the minimization of post-radiation osteonecrosis (PRON; osteoradionecrosis) and its impacts in irradiated head and neck cancer patients.


METHODS
a modified Delphi process survey of 15 international clinical experts was used to identify and assess outcome data and factors related to PRON risk, extraction, and factor suitability for formal decision analysis. Clinimetric pain and function outcome scales were created and assessed for relevance to quality of life.


CONCLUSIONS
expert opinion qualitative assessments were generally adequate and consistent between open- and close-ended items, but many quantitative (e.g. PRON risk rate) estimates were not. A research agenda advocated to validate the epidemiological database for minimization of PRON and decision analysis includes: adoption of a uniform definition of PRON, and ICD code for non-experimental databases; more detailed, consistent data reporting in articles; and quality of life studies.
Cramer
Carl K
CK
Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, BC, Vancouver, Canada. c.k.cramer@shaw.ca
Epstein
Joel B
JB
Sheps
Samuel B
SB
Schechter
Martin T
MT
Busser
James R
JR
D003661:Decision Support Techniques; D003697:Delphi Technique; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D010025:Osteoradionecrosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D011788:Quality of Life; D011878:Radiotherapy / Q000009:adverse effects; D012307:Risk Factors; D014081:Tooth Extraction