The taming of the chameleon – guidance on Conducting and REporting DElphi Studies (CREDES)


Dr Saskia Jünger, senior research associate at the Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), Germany, explains the background to her longer article selected as ‘Editor’s Choice’ in the September 2017 issue of Palliative Medicine.

Dr Saskia Jünger

The Delphi technique1 is widely used for the development of guidance in palliative care, having an impact on decisions with relevance for patient care. Having been involved in the realisation of diverse international consensus-building processes using the Delphi technique – either as the coordinator or as a co-researcher – I have had the opportunity to witness the power of this method for the production of scientific knowledge in palliative care, and I have come to value its fascinating nature.

Due to its methodological versatility, the Delphi technique reminds me of a chameleon; its design can be flexibly adapted to diverse research needs. This characteristic may have contributed to a certain arbitrariness regarding its application: “In their enthusiasm, some analysts have urged Delphi for practically every use except cure of the common cold.”

However, the credibility of a Delphi study depends on the rigour of its implementation. We need to be mindful of this when using the technique since any decisions made as a result of a Delphi study may impact on clinical practice. The technique is widely applied in palliative care research, e.g. for the development of clinical guidance and standards for service delivery; health policy recommendations; for curriculum development; or for the identification of quality indicators. Therefore, a sound study conduct, as well as transparent reporting of methodological details and (interim) results, is key for the reliability of the resulting ‘product’. While some guidance had been proposed in the literature for enhancing the quality of Delphi studies, clear recommendations and a reporting standard for their publication had not been available. This motivated my co-authors and me to examine more systematically the use of the Delphi technique for the production of consensus, knowledge, and guidance on good clinical practice in palliative care.

“The Delphi technique reminds me of a chameleon; its design can be flexibly adapted to diverse research needs. “
(Photo courtesy Shobhan Tudu via Wikimedia Commons).

In our systematic review, we found substantial variation about how thoroughly studies were conducted and how transparently these were described in the published articles. In particular, the crucial moment between two Delphi rounds – what happens with the outcomes of the previous round and how these inform the preparation of the next survey round – was not always clearly set out. However, we also identified examples of good practice among the studies included in our review. These were encouraging models of how to design and present a Delphi study, even in view of restricted time, funding, or the word limits of scientific articles.

Our findings inspired us to propose a standard for Conducting and REporting of DElphi Studies (CREDES). We hope that the recommendations can serve as a guide for researchers undertaking and publishing Delphi studies, as well as for reviewers and journal editors when evaluating the quality of the study design and the transparency of reporting. It was a particular honour for my co-authors and me that our guidance was included in the reporting guideline database of the Equator Network.

References and Links


Read the full article in Palliative Medicine . . .

This post relates to a longer article, ‘Guidance on Conducting and REporting Delphi Studies (CREDES) in palliative care – recommendations based on a methodological systematic review’ by Saskia Jünger, Sheila Payne, Jenny Brine, Lukas Radbruch and Sarah Brearley, published in Palliative Medicine, Vol 31 (8): September 2017, p684-706. First published online: February 13, 2017; DOI: 10.1177/0269216317690685.


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Read earlier Editor’s Choice posts on the EAPC Blog

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