title: Three nested randomized controlled trials of peer-only or multiple stakeholder group feedback within Delphi surveys during core outcome and information set development.
abstract: Methods for developing a core outcome or information set require involvement of key stakeholders to prioritise many items and achieve agreement as to the core set. The Delphi technique requires participants to rate the importance of items in sequential questionnaires (or rounds) with feedback provided in each subsequent round such that participants are able to consider the views of others. This study examines the impact of receiving feedback from different stakeholder groups, on the subsequent rating of items and the level of agreement between stakeholders.
  
  
  
  Randomized controlled trials were nested within the development of three core sets each including a Delphi process with two rounds of questionnaires, completed by patients and health professionals. Participants rated items from 1 (not essential) to 9 (absolutely essential). For round 2, participants were randomized to receive feedback from their peer stakeholder group only (peer) or both stakeholder groups separately (multiple). Decisions as to which items to retain following each round were determined by pre-specified criteria.
  
  
  
  Whilst type of feedback did not impact on the percentage of items for which a participant subsequently changed their rating, or the magnitude of change, it did impact on items retained at the end of round 2. Each core set contained discordant items retained by one feedback group but not the other (3-22 % discordant items). Consensus between patients and professionals in items to retain was greater amongst those receiving multiple group feedback in each core set (65-82 % agreement for peer-only feedback versus 74-94 % for multiple feedback). In addition, differences in round 2 scores were smaller between stakeholder groups receiving multiple feedback than between those receiving peer group feedback only. Variability in item scores across stakeholders was reduced following any feedback but this reduction was consistently greater amongst the multiple feedback group.
  
  
  
  In the development of a core outcome or information set, providing feedback within Delphi questionnaires from all stakeholder groups separately may influence the final core set and improve consensus between the groups. Further work is needed to better understand how participants rate and re-rate items within a Delphi process.
  
  
  
  The three randomized controlled trials reported here were each nested within the development of a core information or outcome set to investigate processes in core outcome and information set development. Outcomes were not health-related and therefore trial registration was not applicable.
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK. Sara.T.Brookes@bristol.ac.uk.
authors.forename: Sara T
authors.initials: ST
authors.lastname: Brookes
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Rhiannon C
authors.initials: RC
authors.lastname: Macefield
authors.affiliation: MRC North West Hub for Trials Methodology Research, Department of Biostatistics, University of Liverpool, 1st floor Duncan Building, Daulby Street, Liverpool, L69 3GA, UK.
authors.forename: Paula R
authors.initials: PR
authors.lastname: Williamson
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Angus G
authors.initials: AG
authors.lastname: McNair
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Shelley
authors.initials: S
authors.lastname: Potter
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.|Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Upper Mauldin Street, Bristol, BS2 8HW, UK.
authors.forename: Natalie S
authors.initials: NS
authors.lastname: Blencowe
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
authors.forename: Sean
authors.initials: S
authors.lastname: Strong
authors.affiliation: School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.|Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Upper Mauldin Street, Bristol, BS2 8HW, UK.
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000601:surgery; D032921:Consensus; D003299:Cooperative Behavior; D003697:Delphi Technique; D004938:Esophageal Neoplasms / Q000601:surgery; D030141:Feedback, Psychological; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D033183:Interdisciplinary Communication; D007902:Length of Stay; D008297:Male; D016462:Mammaplasty; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D010379:Peer Group; D011183:Postoperative Complications / Q000209:etiology; D012107:Research Design; D000073597:Stakeholder Participation / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014945:Wound Healing
keywords: Consensus; Core information set; Core outcome set; Delphi; Feedback