Page 137 - Shared Guideline Development Experiences in Fertility Care

(Guideline-based) indicators for patient-centredness
reduce the set is to integrate them in a further consensus procedure. However, we think that the integration of the two developed sets in a further consensus process should be considered carefully: there is a risk of patients being “snowed under” in the discussion and most of the indicators developed by professionals would dominate the nal indicator set. Another option is to only use the ve similar indicators within both nal sets in practice. We do think that these ve indicators are important for quality improvement initiatives, but they do not include the whole concept of patient-centredness. In our opinion, the nal indicator set consisting of 29 indicators represents a balanced set that is based on the expertise of all stakeholders, including patients. A next step should be the application of this set in a future practice test to assess the feasibility in daily practice. By evaluating its measurability and the intra- and inter-observer reliability the core set of indicators might be reduced with 10-20% [11, 32, 33].
Besides, we also need to address some other potential methodological limitations
of this study. First, the worldwide used RAND-modi ed Delphi method has
previously proved its e ectiveness for developing quality indicators, but the
in uence of the panel composition and type of feedback on the legitimacy of the
results have been questioned regularly [11, 18, 34, 35]. However, in this study
we included a balanced group of fertility care professionals mandated by their professional societies and reliably re ecting the opinions of all Dutch professionals
involved in fertility care. Regarding the type of feedback, panel members in our
study received overall and individual scores, which ensured good consensus
formation within the panels. Additionally, panellists received written feedback
instead of face-to-face feedback, which may have minimized the in uence on the 6 selection of indicators in step 2 by intimidation [11, 35]. In addition, regarding
the patient panel, we do not know if these patients are representative of the general infertile population. e majority of all female members su ered from secondary infertility, which may explain the relatively high median age and duration of infertility compared with the used and valid Dutch cohort of infertile patients described by Brandes and colleagues [36]. Nevertheless, both age and duration of infertility are comparable with a larger group used in a study to assess patient-centredness in Europe [29]. Moreover, they are eligible since they have completed one or more phases within the clinical pathway of fertility care, enabling them to appraise indicators regarding di erent phases of fertility care. Finally, the number of patients’ participants might be small, but comparable to panels used in other studies developing quality indicators and larger than the involvement of one
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