title: Identifying opportunities for nature engagement in cancer care practice and design: protocol for four-round modified electronic Delphi.
abstract: Opportunities to engage with nature have shown relevance in experiences of health and recovery of patients with cancer and are attracting interest in cancer care practice and design. Such healthcare innovations can widen the horizon of possible supportive care solutions but require deliberate and rigorous investigation to ensure responsible action is taken and wastage avoided. This protocol outlines a study designed to solicit knowledge from relevant experts drawn from a range of healthcare practitioners, management representatives, designers and researchers to explore levels of opinion consensus for determining opportunities for, and barriers to, providing helpful nature engagement in cancer care settings.
  
  
  
  A 4-round modified electronic Delphi methodology will be used to conduct a structured, iterative feedback process for querying and synthesising expert opinion. Round 1 administers an open-ended questionnaire to a panel of selected, relevant experts who will consider the own recommendations of patients with cancer for nature engagement (drawn from a preceding investigation) before contributing salient issues (items) with relevance to the topic. Round 2 circulates anonymised summaries of responses back to the experts who verify and, if they wish, reconsider their own responses. Rounds 3 and 4 determine and rank experts' top 10 items using a 10-point Likert-type scale. Descriptive statistics (median and mean scores) will be calculated to indicate the items' relative importance. Levels of consensus will be explored with consensus defined as 75% agreement.
  
  
  
  Ethics approval for this study was obtained from the Institution's Human Research Ethics Committee (blinded for review). It is anticipated that the results will be published in peer-reviewed journals and presented in a variety of forums.
authors.affiliation: Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.|Faculty of Medicine, Sir Peter MacCallum Department of Oncology, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blaschke
authors.affiliation: Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.|Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.|Palliative Care Service, Cabrini Health, Melbourne, Victoria, Australia.
authors.forename: Clare C
authors.initials: CC
authors.lastname: O'Callaghan
authors.affiliation: Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.|Faculty of Medicine, Sir Peter MacCallum Department of Oncology, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.|Faculty of Health Sciences, Department of Psychology, Swinburne University of Technology, Melbourne, Victoria, Australia.
authors.forename: Penelope
authors.initials: P
authors.lastname: Schofield
mesh_terms: D032921:Consensus; D003697:Delphi Technique; D004777:Environment; D005843:Geography; D007722:Health Knowledge, Attitudes, Practice; D000070497:Healthy Lifestyle; D006801:Humans; D019368:Nature; D009369:Neoplasms / Q000517:prevention & control / Q000628:therapy*; D012107:Research Design; D011795:Surveys and Questionnaires
keywords: Delphi; Environment; ONCOLOGY; Supportive cancer care