Page 123 - Diagnostic delay of endometriosis

reduce diagnostic delay in endometriosis. As a secondary outcome measure, we aimed to detect differences in preferences with regard to possible interventions between patients and professionals.
Materials and Methods
Setting
A modified RAND Delphi procedure20,21 was used to select interventions most suitable for reducing diagnostic delay in endometriosis. The Delphi approach is a structured process to accumulate expert opinion with the use of a series of questionnaires to gather information. The questionnaires are submitted to an expert panel in rounds until group consensus is reached. Expert panels may be composed of stakeholders from different areas of expertise which can be included anonymously, thus avoiding domination of the consensus process by one or a few experts. The Delphi method is a validated instrument to reach consensus in situations where the evidence alone is insufficient. Although it is widely used to develop quality indicators in health care, the use of this method exclusively for the selection of key interventions is relatively new.22-28 In this study, the Delphi procedure was used to achieve consensus on the most preferable interventions for reducing diagnostic delay in endometriosis. Data capturing and management was conducted with Castor EDC.29 Analysis were performed using IBM SPSS Statistics version 25.30 The consensus procedure took place between August 2018 and March 2019.
Extraction of interventions
In the last years, our research group has performed several studies concerning diagnostic delay in endometriosis.7,17-19 Factors contributing to the delay, and corresponding interventions to reduce time to diagnosis were extracted from these studies and incorporated in a list of potential interventions to reduce the diagnostic delay in endometriosis. The list was supplemented with suggestions from experts during a brainstorm session, in which representatives from a national patient interest group and special interest group of the Dutch College of Gynaecologists participated. In addition, two general practitioners and a professor in patient-centred innovation were interviewed for input and a literature search for check on completeness was performed. The complete list consisted of 36 potential interventions, allocated to four domains: patient and professional awareness (n=17), patient behaviour (n=4), medical/scientific (n=10) and miscellaneous (n=5) (Appendix A).
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