Table 3.

Modified Delphi consensus process

Consensus voting was conducted through the website. Consensus was reached using a modified Delphi technique. Each working group member anonymously scored their level of agreement with draft measures using a 1 to 5 scale: 1 = Strongly agree, 2 = Agree, 3 = Neither agree nor disagree, 4 = Disagree, 5 = Strongly disagree.

Space was provided to include comments and additional references that were felt to require consideration. Commenting was mandatory for undecided or disagree votes.

At least 80% agreement (scores of 1 or 2) was required for consensus to be reached. Where consensus was not reached, measures were reviewed in light of comments made and any additional evidence identified, and were adjusted if required. Further voting rounds then took place for these measures.

If 80% agreement was not reached after a maximum of three rounds of voting, consensus was considered reached if >50% of participants voted in favor and <20% voted against the measure, in accordance with the GRADE process.37 Failure to meet this criterion resulted in the measure being discarded.