Matthew L Carlson1,2, Michael J Link1,2, Colin L W Driscoll1,2, David S Haynes3, Heather A Billings4, Christine M Lohse5, Elissa R Hall4, Siviero Agazzi6, Frederick G Barker7, Derald E Brackmann8, Roberto A Cueva9, John G Golfinos10, Richard K Gurgel11, Douglas Kondziolka10, J Walter Kutz12, Brian A Neff1, Jason P Sheehan13, Jamie J Van Gompel1,2, Chung Ping Yu14. 1. Department of Otolaryngology-Head and Neck Surgery. 2. Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota. 3. Department of Otolaryngology-Head and Neck Surgery, The Otology Group of Vanderbilt University, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Office of Applied Scholarship and Education Science. 5. Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. 6. Department of Neurosurgery, University of South Florida, Tampa, Florida. 7. Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts. 8. House Clinic, Los Angeles. 9. Department of Otolaryngology-Head and Neck Surgery, Southern California Kaiser Permanente Medical Group, San Diego, California. 10. Department of Neurosurgery, Department of Radiation Oncology, NYU Langone Health, New York, New York. 11. Division of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, Utah. 12. Department of Otolaryngology, Department of Neurosurgery, University of Texas Southwestern Medical Center, Dallas, Texas. 13. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA. 14. Hong Kong Neurosurgical Associates, Hong Kong SAR, People's Republic of China.
Abstract
OBJECTIVE: To address variance in clinical care surrounding sporadic vestibular schwannoma, a modified Delphi study was performed to establish a general framework to approach vestibular schwannoma care. A multidisciplinary panel of experts was established with deliberate representation from key stakeholder societies. External validity of the final statements was assessed through an online survey of registered attendees of the 8th Quadrennial International Conference on Vestibular Schwannoma. STUDY DESIGN: Modified Delphi method. METHODS: The panel consisted of 16 vestibular schwannoma experts (8 neurotology and 8 neurosurgery) and included delegates representing the AAOHNSF, AANS/CNS tumor section, ISRS, and NASBS. The modified Delphi method encompassed a four-step process, comprised of one prevoting round to establish a list of focus areas and three subsequent voting rounds to successively refine individual statements and establish levels of consensus. Thresholds for achieving moderate consensus, at ≥67% agreement, and strong consensus, at ≥80% agreement, were determined a priori. All voting was performed anonymously via the Qualtrics online survey tool and full participation from all panel members was required before procession to the next voting round. RESULTS: Through the Delphi process, 103 items were developed encompassing hearing preservation (N = 49), tumor control and imaging surveillance (N = 20), preferred treatment (N = 24), operative considerations (N = 4), and complications (N = 6). As a result of item refinement, moderate (4%) or strong (96%) consensus was achieved in all 103 final statements. Seventy-nine conference registrants participated in the online survey to assess external validity. Among these survey respondents, moderate (N = 21, 20%) or strong (N = 73, 71%) consensus was achieved in 94 of 103 (91%) statements, and no consensus was reached in 9 (9%). Of the four items with moderate consensus by the expert panel, one had moderate consensus by the conference participants and three had no consensus. CONCLUSION: This modified Delphi study on sporadic vestibular schwannoma codifies 100% consensus within a multidisciplinary expert panel and is further supported by 91% consensus among an external group of clinicians who regularly provide care for patients with vestibular schwannoma. These final 103 statements address clinically pragmatic items that have direct application to everyday patient care. This document is not intended to define standard of care or drive insurance reimbursement, but rather to provide a general framework to approach vestibular schwannoma care for providers and patients.
OBJECTIVE: To address variance in clinical care surrounding sporadic vestibular schwannoma, a modified Delphi study was performed to establish a general framework to approach vestibular schwannoma care. A multidisciplinary panel of experts was established with deliberate representation from key stakeholder societies. External validity of the final statements was assessed through an online survey of registered attendees of the 8th Quadrennial International Conference on Vestibular Schwannoma. STUDY DESIGN: Modified Delphi method. METHODS: The panel consisted of 16 vestibular schwannoma experts (8 neurotology and 8 neurosurgery) and included delegates representing the AAOHNSF, AANS/CNS tumor section, ISRS, and NASBS. The modified Delphi method encompassed a four-step process, comprised of one prevoting round to establish a list of focus areas and three subsequent voting rounds to successively refine individual statements and establish levels of consensus. Thresholds for achieving moderate consensus, at ≥67% agreement, and strong consensus, at ≥80% agreement, were determined a priori. All voting was performed anonymously via the Qualtrics online survey tool and full participation from all panel members was required before procession to the next voting round. RESULTS: Through the Delphi process, 103 items were developed encompassing hearing preservation (N = 49), tumor control and imaging surveillance (N = 20), preferred treatment (N = 24), operative considerations (N = 4), and complications (N = 6). As a result of item refinement, moderate (4%) or strong (96%) consensus was achieved in all 103 final statements. Seventy-nine conference registrants participated in the online survey to assess external validity. Among these survey respondents, moderate (N = 21, 20%) or strong (N = 73, 71%) consensus was achieved in 94 of 103 (91%) statements, and no consensus was reached in 9 (9%). Of the four items with moderate consensus by the expert panel, one had moderate consensus by the conference participants and three had no consensus. CONCLUSION: This modified Delphi study on sporadic vestibular schwannoma codifies 100% consensus within a multidisciplinary expert panel and is further supported by 91% consensus among an external group of clinicians who regularly provide care for patients with vestibular schwannoma. These final 103 statements address clinically pragmatic items that have direct application to everyday patient care. This document is not intended to define standard of care or drive insurance reimbursement, but rather to provide a general framework to approach vestibular schwannoma care for providers and patients.