Guidelines for management of urgent symptoms in patients with cholangiocarcinoma and biliary stents or catheters using the modified RAND/UCLA Delphi Process
AuthorsIyer, R. V.
Acquisto, S. G.
Bridgewater, J. A.
Choti, M. A.
Hong, T. S.
Mead, P. A.
Parikh, N. D.
Roberts, L. R.
Sicklick, J. K.
Siegel, R. S.
Whisenant, J. R.
Broder, M. S.
Valle, Juan W
AffiliationRoswell Park Cancer Institute, Buffalo, NY 14263, USA.
MetadataShow full item record
AbstractBackground: Patients with cholangiocarcinoma often have indwelling biliary stents or catheters which are prone to obstructions and/or infections; studies show that 20-40% present with fever and/or jaundice requiring urgent treatment in the outpatient setting for which there are no uniform guidelines. The goal was to develop an expert panel consensus on this topic using the modified RAND/UCLA Delphi process to rate treatment appropriateness. Methods: Thirteen expert physicians from relevant specialties, geography, and practice settings were recruited for the panel. Patient scenarios were developed and panelists rated the therapies before and after a face-to-face discussion. The appropriateness of various therapies was rated on a scale from 1-9 and classified as appropriate, inappropriate, or uncertain. Scenarios with greater than 2 (>2) ratings of 1-3 (inappropriate) and greater than 2 (>2) ratings of 7-9 (appropriate) were considered to have disagreement and were not assigned an appropriateness rating. Results: Panelists were from all US regions and the UK (8%) and had practiced for a mean 16.5 years (4-33 years). Panelists rated 480 scenarios before the meeting and re-rated 288 of the clinical scenarios after the meeting. The panelists agreed that ongoing treatment with chemotherapy did not influence decision-making and, therefore, 192 scenarios were excluded from the final list. Disagreement decreased from 37.5% before to 10.4% after the meeting. Consensus on stent/tube manipulation and inpatient antibiotic therapy was obtained and summarized in patients as "appropriate" or "maybe appropriate" based on a patient's bilirubin level at presentation. Conclusions: The Delphi process produced consensus guidelines to fill an unmet need in the urgent management of ascending cholangitis in patients with cholangiocarcinoma.
CitationIyer RV, Acquisto SG, Bridgewater JA, Choti MA, Hong TS, Kis B, et al. Guidelines for Management of Urgent Symptoms in Patients with Cholangiocarcinoma and Biliary Stents or Catheters Using the Modified RAND/UCLA Delphi Process. Cancers. 2020;12(9):2375.
- Appropriateness of systemic treatments in unresectable metastatic well-differentiated pancreatic neuroendocrine tumors.
- Authors: Strosberg JR, Fisher GA, Benson AB, Anthony LB, Arslan B, Gibbs JF, Greeno E, Iyer RV, Kim MK, Maples WJ, Philip PA, Wolin EM, Cherepanov D, Broder MS
- Issue date: 2015 Feb 28
- Determining the appropriateness of selected surgical and medical management options in recurrent stroke prevention: a guideline for primary care physicians from the National Stroke Association work group on recurrent stroke prevention.
- Authors: Hanley D, Gorelick PB, Elliott WJ, Broder MS, Saver JL, Kidwell CS, Fagan SC, Wilson A, Lennihan L, Schwer WA, Rubenstein LZ, Crowell RM, Haines SJ, Lopez CC, Zorowitz R, Dubois RW
- Issue date: 2004 Sep-Oct
- The consistency of panelists' appropriateness ratings: do experts produce clinically logical scores for rectal cancer treatment?
- Authors: Hodgson DC, Brierley JD, Cernat G, Bondy S, Slaughter PM, Pinfold SP, Paszat LF
- Issue date: 2005 Jan
- For which glaucoma suspects is it appropriate to initiate treatment?
- Authors: Appropriateness of Treating Glaucoma Suspects RAND Study Group.
- Issue date: 2009 Apr
- The Ann Arbor Criteria for Appropriate Urinary Catheter Use in Hospitalized Medical Patients: Results Obtained by Using the RAND/UCLA Appropriateness Method.
- Authors: Meddings J, Saint S, Fowler KE, Gaies E, Hickner A, Krein SL, Bernstein SJ
- Issue date: 2015 May 5