Page 138 - Diagnostic delay of endometriosis

the different subtypes of professionals, which yielded rich and in-depth information regarding the value and feasibility of interventions. During the subsequent stages of the Delphi procedure, these differences appeared to diminish. One of the strengths of the study is the size and diversity of the expert panel, in which both patients and medical professionals with a variable background participated. In different contexts, the value of involving patients in the development of quality indicators has been established previously.32,33 The literature shows that diversity of expert panel members leads to better performance as this may allow the consideration of different perspectives.34,35 The differences seen in the rating of interventions between patients and professionals confirm the importance of involving this diversity of panel members. Although two of the “other professionals” are affected by endometriosis themselves, they were classified as professionals instead of patients because they are occupationally involved in endometriosis, and therefore considered capable of representing not merely their own personal opinion but to reflect on the matter from a wider perspective. They were instructed to complete the questionnaires from the professional perspective, although their personal experience might have influenced their appraisal to a certain degree.
The fact that that specialists tend to favour the interventions with which they are most familiar,35 was apparent during the rating of potential interventions but did not obstruct panel agreement. Some of the interventions were rather specific and therefore difficult to evaluate by specific subgroups. For example, the content of the medical education or quality of correspondence letters are impossible to assess by patients. On these occasions, the subgroup analysis and structured feedback is of great importance for fine-tuning the intervention strategy. One of the interventions, which was supported in particular by the patients but did not make it to the final set of interventions was “increase awareness by education at secondary schools”. Given the strong patient preference related to this item, and the fact that other countries have implemented comparable initiatives with seemingly positive results, it will be of interest to keep this in mind.13 Another example of the value of the subgroup analysis is the fact that GPs appear to appreciate the quality of information given on the primary care layman’s website more than the other professionals. This may be explained by the fact that they will probably benefit more from the effect of such an intervention than the gynaecologists or other professionals. The particular website, which is a high quality evidence- based health information website launched by the Dutch College of General
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