Seeking an oracle: using the Delphi process to develop practice guidelines for the treatment of endometriosis with Chinese herbal medicine.
BACKGROUND
For most complementary and alternative medicine interventions, the absence of a high-quality evidence base to define good practice presents a serious problem for clinicians, educators, and researchers. The Delphi process may offer a pragmatic way to establish good practice guidelines until more rigorous forms of assessment can be undertaken.


OBJECTIVE
To use a modified Delphi to develop good practice guidelines for a feasibility study exploring the role of Chinese herbal medicine (CHM) in the treatment of endometriosis. To compare the outcomes from Delphi with data derived from a systematic review of the Chinese language database.


METHODS
An expert group was convened for a three-round Delphi that initially produced key statements relating to the CHM diagnosis and treatment of endometriosis (round 1) and then anonymously rated these on a 1-7 Likert scale (rounds 2 and 3). Statements with a median score of 5 and above were regarded as demonstrating positive group consensus. The differential diagnoses within Chinese Medicine and rating of the clinical value of individual herbs were then contrasted with comparable data from a review of Chinese language reports in the Chinese Biomedical Retrieval System (1978-2002), and China Academy of Traditional Chinese Medicine (1985-2002) databases and the Chinese TCM and magazine literature (1984-2004) databases.


RESULTS
Consensus (good practice) guidelines for the CHM treatment of endometriosis relating to common diagnostic patterns, herb selection, dosage, and patient management were produced. The Delphi guidelines demonstrated a high degree of congruence with the information from the Chinese language databases.


CONCLUSIONS
In the absence of rigorous evidence, Delphi offers a way to synthesize expert knowledge relating to diagnosis, patient management, and herbal selection in the treatment of endometriosis. The limitations of the expert group and the inability of Delphi to capture the subtle nuances of individualized clinical decision-making limit the usefulness of this approach.
University of Southampton, Southampton, United Kingdom. flower.power@which.net
Andrew
A
Flower
George T
GT
Lewith
Paul
P
Little
D032921:Consensus; D003627:Data Interpretation, Statistical; D003697:Delphi Technique; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D004715:Endometriosis / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008516:Medicine, Chinese Traditional / Q000295:instrumentation* / Q000379:methods; D010348:Patient Care Team / Q000458:organization & administration; D008517:Phytotherapy / Q000379:methods*; D017410:Practice Guidelines as Topic; D016730:Program Development / Q000379:methods; D011594:Psychometrics / Q000295:instrumentation; D015203:Reproducibility of Results; D012107:Research Design
D004365:Drugs, Chinese Herbal