title: Guidance: The practical management of the gastrointestinal symptoms of pelvic radiation disease.
abstract: BACKGROUND
  A recent randomised trial suggested that an algorithmic approach to investigating and managing gastrointestinal symptoms of pelvic radiation disease (PRD) is beneficial and that specially trained nurses can manage patients as effectively as a gastroenterologist.
  
  
  OBJECTIVE
  The aim of the development and peer review of the guide was to make the algorithm used in the trial accessible to all levels of clinician.
  
  
  METHODS
  Experts who manage patients with PRD were asked to review the guide, rating each section for agreement with the recommended measures and suggesting amendments if necessary. Specific comments were discussed and incorporated as appropriate, and this process was repeated for a second round of review.
  
  
  RESULTS
  34 gastroenterologists, 10 nurses, 9 dietitians, 7 surgeons and 5 clinical oncologists participated in round one. Consensus (defined prospectively as 60% or more panellists selecting 'strongly agree' or 'agree') was reached for 27 of the original 28 sections in the guide, with a median of 75% of panellists agreeing with each section. 86% of panellists agreed that the guide was acceptable for publication or acceptable with minor revisions. 55 of the original 65 panellists participated in round two. 89% agreed it was acceptable for publication after the first revision. Further minor amendments were made in response to round two.
  
  
  CONCLUSIONS
  Development of the guide in response to feedback included ▸ improvement of occasional algorithmic steps ▸ a more user-friendly layout ▸ clearer timeframes for referral to other teams ▸ expansion of reference list ▸ addition of procedures to the appendix.
authors.affiliation: The GI and Nutrition Team , The Royal Marsden NHS Foundation Trust , London and Surrey , UK.
authors.forename: H Jervoise N
authors.initials: HJ
authors.lastname: Andreyev
authors.affiliation: The GI and Nutrition Team , The Royal Marsden NHS Foundation Trust , London and Surrey , UK.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Muls
authors.affiliation: King's College London , London , UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Norton
authors.affiliation: The GI and Nutrition Team , The Royal Marsden NHS Foundation Trust , London and Surrey , UK.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ralph
authors.affiliation: The GI and Nutrition Team , The Royal Marsden NHS Foundation Trust , London and Surrey , UK.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Watson
authors.affiliation: The GI and Nutrition Team , The Royal Marsden NHS Foundation Trust , London and Surrey , UK.
authors.forename: Clare
authors.initials: C
authors.lastname: Shaw
authors.affiliation: Digestive Diseases Clinical Academic Unit , Barts and The London School of Medicine and Dentistry, Queen Mary University of London , London , UK.
authors.forename: James O
authors.initials: JO
authors.lastname: Lindsay
keywords: RADIATION ENTERITIS