Box 1.
Nominal group process
| Phase | Description |
|---|---|
| 1. Introduction and explanation | Experts were introduced to the main objective of the study using a PowerPoint presentation, namely identifying and prioritising forms of support, presented with the problems as reported by GPs and care physicians for older people in a qualitative interview study on the same topic.17 These problems concerned pressure from and expectations of relatives, the consequences of society’s negative view of dementia on their practice in combination with the growing ‘right to die’ conviction of many people, the interpretation of the law and of AEDs, ethical considerations, communication with PWDs and their relatives, timing, and workload. The experts were asked to approach the period from the moment a patient expresses a euthanasia wish or request until a decision has been made as one process, regardless of the outcome. Furthermore, the different phases of the NGT were explained. |
| 2. Silent generation | The research question was presented: ‘What forms of support should be used or implemented to help GPs confronted with euthanasia requests from PWDs?’ Experts were asked to individually make a list of favourable forms of support, such as (improvement of) existing conditions, as well as new alternatives. Suggestions based on the present qualitative study17 and other literature on this topic were in both meetings presented to the group on a large screen. |
| 3. Round robin | Experts were asked to share their favourable forms of support one at a time, which were then written on a flipchart. When every idea was shared and no new ideas were mentioned, this phase ended. Explanation and discussion during this phase were kept to a minimum. |
| 4. Discussion/clarification | Experts were invited to clarify and discuss all suggested forms of support. Items were removed, reworded, merged, or added to the list. At the end experts were asked if they agreed with the final list. |
| 5. Voting | Experts were provided with a ranking sheet and asked to select and rank their top five favourable forms of support as presented in phase 4 from 5 to 1 points. The moderator specified and emphasised that higher numbers represented more importance. |
AED = advance euthanasia directive. NGT = nominal group technique. PWD = patients with dementia.