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BackgroundMaternal weight gain during pregnancy is one of the few potentially modifiable risk factors for many adverse maternal and child health outcomes. Defining the optimal pregnancy weight gain range is difficult because, while lower weight gain may prevent some outcomes, such as maternal and child obesity, it may increase the risk of others such as fetal growth restriction and infant death. These health outcomes vary in their seriousness to mothers and their health care providers, and these differences in seriousness should be taken into account when determining optimal weight gain ranges. However, the relative seriousness that women and their care providers place on different health outcomes is unknown. ObjectiveWe will determine the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain. We will achieve this by engaging patients and maternal and child health professionals using an online modified Delphi panel process. MethodsWe aim to recruit a racially/ethnically and geographically diverse group of 90 US maternal and child health professionals and 90 women who are pregnant or less than 2 years postpartum. We will conduct 3 concurrent panels using the ExpertLens system, a previously evaluated online modified Delphi system that combines 2 rounds of rating with 1 round of feedback and moderated online discussion. In Round 1, panelists are asked to rate the seriousness of each health outcome on a scale of 0-100 and to provide a rationale for their scores. In Round 2, panelists will review their responses relative to those of other panelists. They will discuss their seriousness ratings anonymously using a moderated online discussion board. In Round 3, participants will revise their Round 1 responses based on group feedback and discussion. Each round will be open for 1-2 weeks. ResultsThe study protocol was reviewed by our ethics boards and did not require approval as human research. A pilot study of 6 professionals and 7 patients was completed in December 2019. ConclusionsOur numeric estimates of the seriousness of maternal and child health outcomes will enable future studies to determine pregnancy weight gain ranges that balance the risks of low and high weight gain for mothers and children. International Registered Report Identifier (IRRID)DERR1-10.2196/16478

Patients with suspected or confirmed high-consequence infectious diseases (HCIDs) may present for care at any acute care facility. However, there are limited data to inform recommendations for the design, maintenance, and operation of isolation spaces for patients with suspected or confirmed HCIDs. To address this gap, we developed consensus statements by convening a group of 29 subject matter experts to participate in a modified Delphi process facilitated by a validated tool (the RAND-developed ExpertLens system). The subject matter experts participated in 3 consensus rounds, providing feedback and rating the appropriateness of 36 draft consensus statements. These draft statements were then revised based on their feedback. As a result, we developed 36 consensus statements addressing 5 domains: (1) patient room physical space, (2) doors and windows, (3) air handling, (4) electrical and plumbing, and (5) soiled utility rooms and waste management. These statements could inform the approaches of frontline acute care facilities when building new spaces or modifying existing spaces to enable appropriate HCID patient isolation and care. [ABSTRACT FROM AUTHOR]

Background: Physician treatment preference may influence how risks are communicated in prostate cancer consultations. We identified persuasive language used when describing cancer prognosis, life expectancy, and side effects in relation to a physician's recommendation for aggressive (surgery/radiation) or nonaggressive (active surveillance/watchful waiting) treatment. Methods: A qualitative analysis was performed on transcribed treatment consultations of 40 men with low- and intermediate-risk prostate cancer across 10 multidisciplinary providers. Quotes pertaining to cancer prognosis, life expectancy, and side effects were randomized. Coders predicted physician treatment recommendations from isolated blinded quotes. Testing characteristics of consensus predictions against the physician's treatment recommendation were reported. Coders then identified persuasive strategies favoring aggressive/nonaggressive treatment for each quote. Frequencies of persuasive strategies favoring aggressive/nonaggressive treatment were reported. Logistic regression quantified associations between persuasive strategies and physician treatment recommendations. Results: A total of 496 quotes about cancer prognosis (n = 127), life expectancy (n = 51), and side effects (n = 318) were identified. The accuracy of predicting treatment recommendation based on individual quotes containing persuasive language (n = 256/496, 52%) was 91%. When favoring aggressive treatment, persuasive language downplayed side effect risks and amplified cancer risk (recurrence, progression, or mortality). Significant predictors (P < 0.05) of aggressive treatment recommendation included favorable side effect interpretation, downplaying side effects, and long time horizon for cancer risk due to longevity. When favoring nonaggressive treatment, persuasive language amplified side effect risks and downplayed cancer risk. Significant predictors of nonaggressive treatment recommendation included unfavorable side effect interpretation, favorable interpretation of cancer risk, and short time horizon for cancer risk due to longevity. Conclusions: Physicians use persuasive language favoring their preferred treatment, regardless of whether their recommendation is appropriate. Implications: Clinicians should quantify risk so patients can judge potential harm without solely relying on persuasive language. Highlights: Physicians use persuasive language favoring their treatment recommendation when communicating risks of prostate cancer treatment, which may influence a patient's treatment choice. Coders predicted physician treatment recommendations based on isolated, randomized quotes about cancer prognosis, life expectancy, and side effects with 91% accuracy. Qualitative analysis revealed that when favoring nonaggressive treatment, physicians used persuasive language that amplified side effect risks and downplayed cancer risk. When favoring aggressive treatment, physicians did the opposite. Providers should be cognizant of using persuasive strategies and aim to provide quantified assessments of risk that are jointly interpreted with the patient so that patients can make evidence-based conclusions regarding risks without solely relying on persuasive language. [ABSTRACT FROM AUTHOR]

Background: Clinicians treating cancer‐related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence‐based management guidance. The aim of the study is to identify expert consensus on opioid management strategies for an individual with advanced cancer and cancer‐related pain with nonmedical stimulant use according to prognosis. Methods: The authors conducted two modified Delphi panels with palliative care and addiction experts. In Panel A, the patient's prognosis was weeks to months and in Panel B the prognosis was months to years. Experts reviewed, rated, and commented on the case using a 9‐point Likert scale from 1 (very inappropriate) to 9 (very appropriate) and explained their responses. The authors applied the three‐step analytical approach outlined in the RAND/UCLA to determine consensus and level of clinical appropriateness of management strategies. To better conceptualize the quantitative results, they thematically analyzed and coded participant comments. Results: Consensus was achieved for all management strategies. The 120 Experts were mostly women (47 [62%]), White (94 [78%]), and physicians (115 [96%]). For a patient with cancer‐related and nonmedical stimulant use, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering. Buprenorphine/naloxone transition was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. Conclusion: Study findings provide urgently needed consensus‐based guidance for clinicians managing cancer‐related pain in the context of stimulant use and highlight a critical need to develop management strategies to address stimulant use disorder in people with cancer. Plain Language Summary: Among palliative care and addiction experts, regardless of prognosis, it was deemed appropriate to continue opioids, increase monitoring, and avoid opioid tapering in the context of cancer‐related pain and nonmedical stimulant use.Buprenorphine/naloxone transition as a harm reduction measure was inappropriate for a patient with a short prognosis and of uncertain appropriateness for a patient with a longer prognosis. Clinicians treating cancer‐related pain with opioids regularly encounter nonmedical stimulant use (i.e., methamphetamine, cocaine), yet there is little evidence‐based management guidance. The study findings provide urgently needed consensus‐based guidance for clinicians managing cancer‐related pain in the context of nonmedical stimulant use. [ABSTRACT FROM AUTHOR]

The Delphi method is an iterative, anonymous, group-based process for eliciting and aggregating opinion on a topic to explore the existence of consensus among experts. The year 2023 marks the 60th anniversary of the first peer-reviewed journal article on the Delphi method. Originally developed for operations research, this method is now applied extensively by researchers representing diverse scientific fields. We used a bibliometric analysis to describe general trends in the expansion of its use across disciplines over time. We conducted a systematic literature search for all English-language, peer-reviewed journal articles on the Delphi method through its first 60 years. We found 19,831 articles: 96.8% (n = 19,204) on the actual use of the Delphi method in an empirical study and 3.2% (n = 627) describing, examining, or providing some guidance on how to use the Delphi method. Almost half (49.9%) of all articles were published in the 2010s and an additional third (32.5%) in the first few years of the 2020s. Nearly two-thirds (65%, n = 12,883) of all published articles have appeared in medical journals, compared to 15% in science and technology (n = 3,053) or social science (n = 3,016) journals. We conclude that the expanded use of the Delphi method has been driven largely by the medical field, though social scientists and technologists continue to be at the forefront of methodological work on the Delphi method. Therefore, we call for greater transdisciplinary collaboration on methodological guidance and standards for the Delphi method. [ABSTRACT FROM AUTHOR]

Active participation of community partners in research aspects of community-academic partnered projects is often assumed to have a positive impact on the outcomes of such projects. The value of community engagement in research, however, cannot be empirically determined without good measures of the level of community participation in research activities. Based on our recent evaluation of community-academic partnered projects centered around behavioral health issues, this article uses semistructured interview and survey data to outline two complementary approaches to measuring the level of community participation in research--a "three-model" approach that differentiates between the levels of community participation and a Community Engagement in Research Index (CERI) that offers a multidimensional view of community engagement in the research process. The primary goal of this article is to present and compare these approaches, discuss their strengths and limitations, summarize the lessons learned, and offer directions for future research. We find that whereas the three-model approach is a simple measure of the perception of community participation in research activities, CERI allows for a more nuanced understanding by capturing multiple aspects of such participation. Although additional research is needed to validate these measures, our study makes a significant contribution by illustrating the complexity of measuring community participation in research and the lack of reliability in simple scores offered by the three-model approach. (Contains 3 tables, 2 figures, and 3 notes.)

Using a qualitative approach, I study two processes of intra-organizational cooperation and coordination--control and trust--in creative organizations. Specifically, I analyze the complex nature of trust-control relationships in Orpheus orchestra, the world's largest contemporary conductorless orchestra. I discuss how it rehearses and performs without a baton holder and benefits from the creativity of all musicians. This study supports the duality perspective of trust-control relationships. While competence trust and goodwill trust enable musicians to participate in organizational decision-making and be creative, it is behavioral, input, output and social control strategies that facilitate the development of trust and help ensure the orchestra's longterm success. Trust-control duality allows Orpheus to achieve "optimal distinctiveness," which aligns creativity and artistic freedoms with the goals of economic stability. (Contains 5 notes.)

Dying persons are encouraged to name as durable power of attorney for health care (DPAHC) someone who will thus be empowered to make end-of-life treatment decisions for them in the event that they become incapacitated. We use data from the Wisconsin Longitudinal Study to investigate whether and whom older adults designate as their DPAHC. DPAHC appointments are affected by recent hospitalizations, personal beliefs (including religion, fear of death, and the belief that doctors rather than patients should control health care decisions), and personal experience with the recent painful death of a loved one. The selections of DPAHC designees are generally consistent with the hierarchical compensatory model: Married persons overwhelmingly name their spouses, while unmarried parents appoint their children. Women are more likely than men to rely on children. Parents of one or two children tend to bypass their children for another relative. Unmarried, childless persons show considerable heterogeneity in their choices. We discuss implications of these findings for health care policy and practice. (Contains 4 notes and 4 tables.)

Purpose: Men with prostate cancer prefer patient-specific, quantitative assessments of longevity in shared decision making. We sought to characterize how physicians communicate the 3 components of competing risksdlife expectancy (LE), cancer prognosis and treatment-related survival benefitdin treatment consultations. Materials and Methods: Conversation related to LE, cancer prognosis and treatment-related survival benefit was identified in transcripts from treatment consultations of 42 men with low- and intermediate-risk disease across 10 multidisciplinary providers. Consensus of qualitative coding bymultiple reviewers noted the most detailed mode of communication used to describe each throughout the consultation. Results: Physicians frequently failed to provide patient-specific, quantitative estimates of LE and cancer mortality. LE was omitted in 17% of consultations, expressed as a generalization (eg "long"/"short") in 17%, rough number of years in 31%, probability of mortality/survival at an arbitrary timepoint in 17% and in only 19% as a specific number of years. Cancer mortality was omitted in 24% of consultations, expressed as a generalization in 7%, years of expected life in 2%, probability at no/arbitrary timepoint in 40% and in only 26% as the probability at LE. Treatment-related survival benefit was often omitted; cancer mortality was reported without treatment in 38%, with treatment in 10% and in only 29% both with and without treatment. Physicians achieved "trifecta" d1) quantifying probability of cancer mortality 2) with and without treatment 3) at the patient's LEdin only 14% of consultations. Conclusions: Physicians often fail to adequately quantify competing risks. We recommend the "trifecta" approach, reporting 1) probability of cancer mortality 2) with and without treatment 3) at the patient's LE. [ABSTRACT FROM AUTHOR]

The authors examined whether the effect of parental death on adults siblings' relationship quality varies on the basis of the presence and perceived effectiveness of a deceased parent's formal preparations for end-of-life care. The authors used data from the Wisconsin Longitudinal Study and focused on the relationship quality of a bereaved adult child and his or her randomly selected sibling. Parental death was associated with a decrease in sibling closeness. The parent's use of advance directives (living will and durable power of attorney for health care) did not have uniformly positive effects on adult siblings' relationship quality. Sibling relationships suffered when the living will was believed to 'cause problems,' but relationships improved when the deceased parent named someone other than his or her spouse or a child as durable power of attorney for health care. The authors discuss the implications for developing effective end-of-life preparations that benefit both the decedent and surviving kin. Keywords: advance directives; bereavement; durable power of attorney for health care; living, will; sibling relationships

Objective: The authors sought to identify the most promising strategies for improving the mental health guardianship process in Los Angeles County for adults with mental illness who are gravely disabled.Methods: In May and June 2019, 56 experts, working in hospitals or outpatient facilities or representing legal, advocacy, policy, or forensic organizations, participated in an online modified-Delphi panel, rating the ethical appropriateness, impact on care quality, efficiency, and feasibility of nine strategies for improvement of mental health guardianship. Agreement was determined with the RAND/UCLA appropriateness method, and comments were thematically analyzed.Results: The strategy ranked highest by the participating experts was improving the administrative functioning and judicial processes of entities involved in mental health guardianship proceedings-it was the only strategy that achieved agreement among panelists and was rated highly on all four criteria. Other preferred strategies were enhancing the ability of assertive outpatient mental health teams to serve individuals before they experience a crisis and expanding the continuum of unlocked residential treatment settings.Conclusions: Opportunities exist to improve all stages of the mental health guardianship process. Experts favored strategies that streamline administrative processes, facilitate community integration into treatment, and ensure fidelity to best practices. Improving the mental health guardianship process has the potential to speed up delivery of services, better manage resources, and increase access to treatment for individuals with mental illness who are gravely disabled. [ABSTRACT FROM AUTHOR]