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Moving Forward Through Consensus: A Modified Delphi Approach to Determine the Top Research Priorities in Orthopaedic
Patricia Jacqueline Schneider1, Nathan Evaniew2, Paula McKay1
1Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
Background:
Several challenges presently impede the conduct of prospective clinical studies in orthopaedic oncology, including limited financial resources to support their associated costs and inadequate patient volume at most single institutions. This study was conducted to prioritize research questions within the field so that the Musculoskeletal Tumor Society (MSTS), and other relevant professional societies, can direct the limited human and fiscal resources available to address the priorities that the stakeholders involved believe will have the most meaningful impact on orthopaedic oncology patient care.
Questions/Purposes:
The purpose of this study was to use a formal consensus-based approach involving clinician-scientists and other stakeholders to identify the top priority research questions for future international prospective clinical studies in orthopaedic oncology.
Methods:
A three-step modified Delphi process involving multiple stakeholder groups (including orthopaedic oncologists, research personnel, funding agency representation, and patient representation) was conducted. First, we sent an electronic questionnaire to all participants to solicit clinically relevant research questions (61 participants; 54% of the original 114 individuals invited to participate returned the questionnaires). Then, participants rated the candidate research questions using a 5-point Likert scale for five criteria (60 participants; 53% of the original group participated in this portion of the process). Research questions that met a priori consensus thresholds progressed for consideration to an in-person consensus meeting, which was attended by 44 participants (39% of the original group; 12 countries were represented at this meeting). After the consensus panel's discussion, members individually assigned scores to each question using a 9-point Likert scale. Research questions that met preset criteria advanced to final ranking, and panel members individually ranked their top three priority research questions, resulting in a final overall ranking of research priorities.
Results:
A total of 73 candidate research questions advanced to the consensus meeting. In the end, the consensus panel identified four research priorities: (1) Does less intensive surveillance of patients with sarcoma affect survival? (2) What are the survival outcomes over time for orthopaedic oncology implants? (3) Does resection versus stabilization improve oncologic and functional outcomes in oligometastatic bone disease? (4) What is the natural history of untreated fibromatosis?
Conclusions:
The results of this study will assist in developing a long-term research strategy for the MSTS and, possibly, the orthopaedic oncology field as a whole. Furthermore, the results of this study can assist researchers in guiding their research efforts and in providing a justified rationale to funding agencies when requesting the resources necessary to support future collaborative research studies that address the identified orthopaedic oncology priorities.
Insights
This study prioritized research questions in orthopaedic oncology to guide future clinical studies. Key priorities include sarcoma surveillance, implant survival, oligometastatic bone disease treatment, and fibromatosis natural history.
Area of Science:
- Orthopaedic Oncology
- Clinical Research Prioritization
- Musculoskeletal Oncology
Background:
- Limited resources and patient volume challenge prospective clinical studies in orthopaedic oncology.
- This study aimed to identify high-impact research questions for the Musculoskeletal Tumor Society (MSTS) and other organizations.
- Prioritization ensures efficient allocation of human and fiscal resources for maximum patient benefit.
Framework:
- A modified Delphi process involving multiple stakeholder groups was employed.
- Stakeholders included orthopaedic oncologists, research staff, funding agencies, and patients.
- A three-step consensus-building approach ensured comprehensive input and rigorous evaluation.
Implementation:
- An electronic questionnaire solicited initial research questions from 61 participants.
- A 5-point Likert scale assessed candidate questions based on five criteria.
- An in-person meeting with 44 international participants refined and ranked the top research priorities.
Implications:
- Four key research priorities were identified: sarcoma surveillance, orthopaedic implant survival, oligometastatic bone disease management, and fibromatosis natural history.
- The findings will inform a long-term research strategy for the MSTS and the broader orthopaedic oncology field.
- This study provides a rationale for funding agencies to support collaborative research addressing critical patient needs.
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