title: Consensus in controversy: The modified Delphi method applied to Gynecologic Oncology practice.
abstract: OBJECTIVE
  To determine the degree of consensus regarding the probabilities of outcomes associated with IP/IV and IV chemotherapy.
  
  
  METHODS
  A survey was administered to an expert panel using the Delphi method. Ten ovarian cancer experts were asked to estimate outcomes for patients receiving IP/IV or IV chemotherapy. The clinical estimates were: 1) probability of completing six cycles of chemotherapy, 2) probability of surviving five years, 3) median survival, and 4) probability of ER/hospital visits during treatment. Estimates for two patients, one with a low comorbidity index (patient 1) and the other with a moderate index (patient 2), were included. The survey was administered in three rounds, and panelists could revise their subsequent responses based on review of the anonymous opinions of their peers.
  
  
  RESULTS
  The ranges were smaller for IV compared with IP/IV therapy. Ranges decreased with each round. Consensus converged around outcomes related to IP/IV chemotherapy for: 1) completion of 6 cycles of therapy (type 1 patient, 62%, type 2 patient, 43%); 2) percentage of patients surviving 5 years (type 1 patient, 66%, type 2 patient, 47%); and 3) median survival (type 1 patient, 83 months, type 2 patient, 58 months). The group required three rounds to achieve consensus on the probabilities of ER/hospital visits (type 1 patient, 24%, type 2 patient, 35%).
  
  
  CONCLUSIONS
  Initial estimates of survival and adverse events associated with IP/IV chemotherapy differ among experts. The Delphi process works to build consensus and may be a pragmatic tool to inform patients of their expected outcomes.
authors.affiliation: The Ohio State University, Columbus, OH, United States. Electronic address: david.cohn@osumc.edu.
authors.forename: David E
authors.initials: DE
authors.lastname: Cohn
authors.affiliation: Duke University School of Medicine, Durham, NC, United States.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
authors.affiliation: University of California at Irvine, Irvine, CA, United States.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Osann
authors.affiliation: Emory University Rollins School of Public Health and Winship Cancer Institute, Atlanta, GA, United States.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lipscomb
authors.affiliation: University of California at Irvine, Irvine, CA, United States.
authors.forename: Susie
authors.initials: S
authors.lastname: Hsieh
authors.affiliation: The University of Oklahoma, Oklahoma City, OK, United States.
authors.forename: Joan L
authors.initials: JL
authors.lastname: Walker
authors.affiliation: Dana-Farber Cancer Institute/Harvard Medical School, Boston, MA, United States.
authors.forename: Alexi A
authors.initials: AA
authors.lastname: Wright
authors.affiliation: University of Alabama at Birmingham, Birmingham, AL, United States.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Alvarez
authors.affiliation: Cedars Sinai Medical Center, Los Angeles, CA, United States.
authors.forename: Beth Y
authors.initials: BY
authors.lastname: Karlan
authors.affiliation: University of California at Irvine, Irvine, CA, United States.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Bristow
authors.affiliation: Women & Infants Hospital, Brown University, Providence, RI, United States.
authors.forename: Paul A
authors.initials: PA
authors.lastname: DiSilvestro
authors.affiliation: City of Hope, Duarte, CA, United States.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Wakabayashi
authors.affiliation: City of Hope, Duarte, CA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Morgan
authors.affiliation: University of California Irvine, School of Medicine, Orange, CA, United States.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.affiliation: University of California at Irvine, Irvine, CA, United States.
authors.forename: Lari
authors.initials: L
authors.lastname: Wenzel
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000188:drug therapy*
keywords: Delphi technique; Intraperitoneal (IP); Opinion; Ovarian cancer