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Delphi poll to assess consensus on issues influencing long-term adherence to treatments in cystic fibrosis among Italian health care professionals

Authors Colombo C, Catastini P, Brivio A, Acone B, Dang P, Quattrucci S

Received 25 April 2018

Accepted for publication 16 August 2018

Published 26 October 2018 Volume 2018:12 Pages 2233—2241


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Johnny Chen

Carla Colombo,1 Paola Catastini,2 Anna Brivio,1,3 Benedetto Acone,4 Patricia Dang,5 Serena Quattrucci6

1Cystic Fibrosis Center, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy; 2Cystic Fibrosis Regional Center, Anna Meyer Children’s Hospital, Florence, Italy; 3UOC DPS Department for Health Professional, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, Italy; 4Cartesio Solutions S.r.l., Venice, Italy; 5Vertex Pharmaceuticals S.r.l., Rome, Italy; 6Cystic Fibrosis Lazio Regional Center, Pediatrics Department, “Sapienza” University, Rome, Italy

Purpose: The aim of this study was to determine the level of consensus among Italian health care professionals (HCPs) regarding factors that influence adherence to cystic fibrosis (CF) treatments.
Methods: A Delphi questionnaire with 94 statements of potential factors influencing adherence was developed based on a literature review and in consultation with a board of experts (n=4). This was distributed to a multidisciplinary expert panel of HCPs (n=110) from Italian CF centers. A Likert scale was used to indicate the level of agreement (1= no agreement to 9= maximum agreement) with each statement. Three rounds were distributed to establish a consensus (≥80% of participant ratings within one 3-point region) and, at the third round, assign a ranking to each statement with a high level of agreement (consensus in the 7–9 range) only.
Results: Of 110 HCPs (from 31 Italian CF centers who were surveyed), responses were obtained from 85 (77%) in the first, 78 (71%) in the second, and 72 (65%) in the third round. The highest degree of agreement (95.8%) was reached with the statement that the HCP needs to build a relationship with the patient to influence adherence. A high level of agreement was not reached for statements that morbidity and mortality are influenced by the level of adherence to therapy, and no consensus was reached on the statement that age of the patient influences adherence to treatment.
Conclusion: We found that Italian HCPs endorsed a strong relationship with the patient as being a key driver in improving adherence. There were several areas, such as the influence of adherence on morbidity and mortality, where the consensus of Italian HCPs differed from the published literature. These areas require investigation to determine why these discrepancies exist.

Keywords: cystic fibrosis, long-term adherence, Delphi technique

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