xRead - Swallowing Disorders in the Adult Patient (October 2024)

10976817, 2023, 4, Downloaded from https://aao-hnsfjournals.onlinelibrary.wiley.com/doi/10.1002/ohn.302, Wiley Online Library on [08/07/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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oncology, speech ‐ language pathology, and nutrition. The stakeholders were contacted regarding the consensus statement project and the requirements and desired quali fi ca tions for development group membership; each group then nominated its own representative content expert to participate. The ECS development group included representa tives from the American Society for Radiation Oncology; the Society of Otorhinolaryngology and Head ‐ Neck Nurses; the American Broncho ‐ Esophagological Association; the American Head and Neck Society (AHNS); the American Society of Clinical Oncology; the American Speech ‐ Language ‐ Hearing Association; the Dysphagia Research Society; the Academy of Nutrition and Dietetics (AND); and appropriate committees within the AAO ‐ HNS, including the Head and Neck Surgery and Oncology Committee, the Airway and Swallowing Committee, the Board of Governors, and the Section for Residents and Fellows. The methodologists and the representa tive from the AND were the only nonvoting members of the development group. All proposed nominees for the development group practiced in the United States. All development group members are in active clinical practice, are content experts in dysphagia, and agreed in advance of the appointment to participate in all verbal discussions (performed via teleconference) and votes. Once the development group was assembled, the complete disclosure of potential con fl icts of interest was reported and vetted. Con fl icts of interest were managed consistent with the Council of Medical Specialty Societies Code for Interactions With Companies , 14 which requires that the chair and a majority of the participants do not have a direct con fl ictwith the deliberations. The development group chair and assistant chair led the development of the consensus statements and the Delphi process with input from 2 methodologists from AAO ‐ HNSF leadership and GTF, and with administrative support from an AAO ‐ HNSF staff liaison. The title of the ECS was adjusted to remove the word “ prevention ” as the development group felt that “ prevention ” was fully encompassed in “ management. ” The target audience of the ECS was de fi ned as otolaryngologists, radiation oncologists, speech ‐ language pathologists (SLP), oncology nurses, registered dietitian nutritionists (RDN), and medical oncologists who manage dysphagia, in HNC populations. The target population was de fi ned as adults with HNC who are 18 years or older. “ Dysphagia ” was de fi ned as swallowing impairment. Once the target popula tion and scope of practice were determined, the development group used the results of the literature reviews, combined with their expert opinion and stakeholder needs, to propose topics and questions for which knowledge gaps, uncertainty, or opportunities for quality improvement existed. Topics were focused on areas with signi fi cant practice variation that would most bene fi t from consensus from expert clinicians. These topics and questions were used as the basis for

formulating the initial statements, which were then evaluated through the Delphi survey method.

Delphi Survey Method Process and Administration A modi fi ed Delphi survey method was utilized to assess consensus for the proposed statements, 13 with multiple anonymous surveys completed to minimize bias within the development group and facilitate consensus. Web ‐ based software (www.surveymonkey.com) was used to administer con fi dential surveys to development group members. A potential topic list of 60 questions and draft statements was put together by the development group during the fi rst call and each development group member was invited to provide 1 draft statement for each of their top 5 ranked topic list choices. The survey period was divided into 2 Delphi rounds. All answers were deidenti fi ed and remained con fi dential to development group members; however, names were collected by staff to ensure proper follow ‐ up, if needed. Based on the outcomes of the top ‐ ranked topic list choices and resulting discussion, the development group chair and assistant chair developed the fi rst Delphi survey, which consisted of 60 statements. Prior to dissemination to the development group, the Delphi surveys were reviewed by the methodologist for content and clarity. Questions in the survey were answered using a 9 ‐ point Likert scale, where 1 = strongly disagree, 3 = dis agree, 5 = neutral, 7 = agree, and 9 = strongly agree. The surveys were distributed, and responses were aggregated, distributed back to the development group, discussed via teleconference, and revised if warranted. The purpose of the teleconference was to provide an opportunity to clarify any ambiguity, propose revisions, or drop any statements recommended by the development group. Criteria for consensus were established a priori as follows 1 : • Consensus : Statements achieving a mean score of 7.00 or higher and having no more than 1 outlier, de fi ned as any rating of 2 or more Likert points from the mean in either direction. • Near consensus : Statements achieving a mean score of 6.50 or higher and having no more than 2 outliers. • No consensus : Statements that did not meet the criteria of consensus or near consensus. Two iterations of the Delphi survey were performed. All group members completed all survey items in the fi rst Delphi survey; in the second iteration, there were 2 items that were only completed by 10 of the 12 voting members of the panel. The development group reviewed the results of all 60 items via teleconference after the fi rst Delphi survey. Twenty ‐ four statements were revised for improved clarity. Eight items did not reach consensus and were not discussed further. There were 10 statements that reached near consensus and were discussed thoroughly. Four of