Seeking an oracle: using the Delphi process to develop practice guidelines for the treatment of endometriosis with Chinese herbal medicine

Andrew Flower, Flower A, George Lewith, George T Lewith, Paul Little
Journal of alternative and complementary medicine (New York, N.Y.) · 2007 · vol. 13(9) , pp. 969–976 · doi:10.1089/acm.2006.6283 · PMID:18047443 · W1965156089
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This modified Delphi process established consensus guidelines for Chinese herbal medicine treatment of endometriosis, which largely aligned with existing Chinese language database information.

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Abstract

BACKGROUND: For most complementary and alternative medicine interventions, the absence of a high-quality evidence base to define good practice presents a serious problem for clinicians, educators, and researchers. The Delphi process may offer a pragmatic way to establish good practice guidelines until more rigorous forms of assessment can be undertaken. OBJECTIVES: To use a modified Delphi to develop good practice guidelines for a feasibility study exploring the role of Chinese herbal medicine (CHM) in the treatment of endometriosis. To compare the outcomes from Delphi with data derived from a systematic review of the Chinese language database. DESIGN: An expert group was convened for a three-round Delphi that initially produced key statements relating to the CHM diagnosis and treatment of endometriosis (round 1) and then anonymously rated these on a 1-7 Likert scale (rounds 2 and 3). Statements with a median score of 5 and above were regarded as demonstrating positive group consensus. The differential diagnoses within Chinese Medicine and rating of the clinical value of individual herbs were then contrasted with comparable data from a review of Chinese language reports in the Chinese Biomedical Retrieval System (1978-2002), and China Academy of Traditional Chinese Medicine (1985-2002) databases and the Chinese TCM and magazine literature (1984-2004) databases. RESULTS: Consensus (good practice) guidelines for the CHM treatment of endometriosis relating to common diagnostic patterns, herb selection, dosage, and patient management were produced. The Delphi guidelines demonstrated a high degree of congruence with the information from the Chinese language databases. CONCLUSIONS: In the absence of rigorous evidence, Delphi offers a way to synthesize expert knowledge relating to diagnosis, patient management, and herbal selection in the treatment of endometriosis. The limitations of the expert group and the inability of Delphi to capture the subtle nuances of individualized clinical decision-making limit the usefulness of this approach.

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Condition tags

endometriosis

MeSH descriptors

Delphi Technique Delphi Technique Drugs, Chinese Herbal Endometriosis Medicine, Chinese Traditional Phytotherapy Practice Guidelines as Topic Practice Guidelines as Topic Consensus Consensus Data Interpretation, Statistical Data Interpretation, Statistical Drugs, Chinese Herbal Drugs, Chinese Herbal Endometriosis Endometriosis Evidence-Based Medicine Evidence-Based Medicine Female Female

Citation neighborhood (2-hop)

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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