Dunja Dreesens

55 overlap with the tools ‘patient leaflet’ and ‘patient information’. Concerning the definitions, some participants felt it important that the definition also stated which organisation(s) developed or owned (i.e. is responsible for, of maintaining) the tool, which would increase the trustworthiness of the tool. Another frequent comment was to change the wording in such a way that the definition not only covered curative care but also long-term care. Because of the participants’ suggestions regarding the similarity of some tools, the second round we asked them whether they agreed or disagreed on merging some of these tool types (marked with an asterisk in Appendix B). In the second round, the scoring option ‘no opinion’ was removed, as the project group felt that the Likert scores 3-5 (neutral) should cover this option. In the second Delphi round, every question was scored by at least nine participants, making the results valid. Again, there was consensus on the importance of nine tools (see table 4), of which eight were identical to the ones in the first round. More than 85% agreement on importance was reached on five tool types (see table 4): ‘summary’, ‘flowchart’, ‘clinical practice guideline’, ‘patient information’ and ‘patient decision aid’. A notable score was the 100% consensus on the importance of the tool ‘clinical practice guideline’ (see Appendix B). In this round, there was consensus on the definitions of five tools (bold in Appendix B and C). The overlap with the first round amounted to four tools, while the overlap regarding the consensus on importance and definitions comprised five tools. There was overall consensus on the merging of the five suggested tools (70-94% agreement (Likert score 6-8) with a median score of 8 for all the tool types). Recently introduced tool types had low levels of consensus on importance (and definition), which could be due to lack of familiarity or that other tool types were considered more important. As was reflected in the consensus scores regarding the definitions, the experts in round one reached agreement on more definitions than they did on the adjusted definitions in round two. The experts were aware of this discrepancy and commented on it in the discussion phase of the Delphi. Except for minor differences in wording, they indicated they preferred the definitions of round one. Furthermore, the main suggestion in the second round was to broaden the scope from health care to include the whole spectrum of care, notably public health. The project group concluded that not all adjustments to the definitions were perceived as improvements, or perhaps participants were being more forward in the second round. Chapter 3