Abstract 117: Application Of A Delphi Method To Develop A Patient Decision Aid For Implantable Cardioverter Defibrillator Candidates
Authors: Carroll Sandra L , McGillion Michael , McGrath Colleen , Stacey Dawn , Healey Jeff S , Browne Gina , Thabane Lehana , Arthur Heather M 
Published: July 2021

Background:
Development of patient decision aids (PtDA) requires decision making about the facts, risks, and benefits to present to patients. Delphi process methodology has been employed successfully as a consensus-building tool across several disciplines. This work represents the first phase of a Canadian study that is developing a PtDA for prophylactic implantable cardioverter defibrillator (ICD) candidates. Our aim was to engage healthcare providers, ICD stakeholders, and patients in decisions about the content and format of the PtDA, using a modified Delphi process.

Method:
Twenty healthcare professionals, 1 stakeholder representative, and 16 people living with ICDs were invited to participate. Our Delphi approach utilized electronic and paper based response systems that included 1) anonymity, 2) iteration, 3) controlled feedback and, 4) statistical group response options. The first Delphi round comprised 39 evidence-based survey items including ICD facts, risks, benefits, and values. A review panel of decision aid experts, cardiovascular researchers, and electrophysiologists selected the content items. Participants completed the survey by rating each category item on a 5-point likert scale from “1= not important” to “5 = extremely important”. A predetermined cut-off of
>
75%, wherein participants rated an item as “very important” or higher, guided the selection of items during the two Delphi rounds completed. To provide participants with statistical group responses, the second round participants received the anonymous first round item rankings prior to rating the 11 remaining items.

Results:
Twenty-seven participants completed round one of the Delphi (14 ICD patients). Mean (SD) age of ICD patients was 66.8 (7.1) years. The number of years of experience in healthcare reported by non-ICD respondents ranged from 2 to30 years. Of the 39 items included in round one, 14 items were retained (
>
75% agreement), 14 items were removed (<60% agreement), and 11 items proceeded to the second round (60-74% agreement). During the second Delphi round (n=27), 6 of the 11 items that did not reach agreement in round one were retained (
>
75% agreement). Examples from item categories include:

1) Risk items -
i
) Lead problems over the long term,
ii
) Possible complications during the surgical procedure to insert the ICD.

2) Benefit items-
i
) Prevent cardiac arrest from a dangerous heart rhythm,
ii
) Assurance that a dangerous heart rhythm can be corrected.

3) Fact, Value & Preferences -
i
) What a standard ICD cannot do,
ii
) The wish for a natural death,
iii
) Driving restrictions if the ICD delivers a shock.

Conclusion:
The results from this Delphi survey informed the content that will be incorporated into a PtDA for new ICD candidates. The next phase will include field-testing of the PtDA. Ultimately, the goal is to support quality decision making in ICD candidates.