基于德尔菲法构建《甲状腺癌中西医结合诊疗指南》临床问题  

Defining Clinical Queries in Guidelines for Diagnosis and Treatment of Thyroid Cancer with Integrative Medicine Based on Delphi Method

作　　者：陈颖 陈韵如[1] 陆钰原 尚汇渊 乔佳君 夏仲元 CHEN Ying;CHEN Yun-ru;LU Yu-yuan;SHANG Hui-yuan;QIAO Jia-jun;XIA Zhong-yuan(Graduate School,Beijing University of Chinese Medicine,Beijing 100029;Surgery of Traditional Chinese Medicine,China-Japan Friendship Hospital,Beijing 100029)

机构地区：[1]北京中医药大学研究生院,北京100029 [2]中日友好医院中医外科,北京100029

出　　处：《中国中西医结合杂志》2025年第3期268-276,共9页Chinese Journal of Integrated Traditional and Western Medicine

基　　金：中央高水平医院临床业务费专项揭榜挂帅类项目(No.2024-NHLHCRF-JBGS-ZN-02);中央高水平医院临床业务费专项临床研究项目(No.2022-NHLHCRF-LX-02-0115)。

摘　　要：目的确定《甲状腺癌中西医结合诊疗指南》的临床问题与结局指标,为后续进行循证证据检索、证据等级评价及形成推荐意见提供基础。方法通过文献调研、专家访谈和广泛的临床调研,初步整理临床问题和结局指标。在此基础上设计德尔菲法专家调查问卷并开展两轮专家调查。运用Excel 2021和SPSS Statistics 26软件对问卷结果进行统计学处理,计算各临床问题和结局指标的专家积极系数、均分、满分比、变异系数以评估其重要性,将临床问题均分3分、结局指标均分7分、满分比50%、变异系数<30%的条目纳入指南。同时以专家积极系数75%、和谐系数>0.70、格朗巴赫α系数0.70作为标准控制德尔菲问卷质量。结果通过文献调研、专家访谈及广泛的临床调研,初步拟定了30个问题(16个基础问题和14个临床问题)与13个结局指标。对全国18家三甲医院的30名多学科专家进行两轮德尔菲法调查后,形成30个问题(17个基础问题和13个临床问题)与10个关键结局指标。两轮问卷专家的积极系数分别为100%和90%,肯德尔和谐系数为0.73。两轮调查临床问题和结局指标各条目的格朗巴赫α系数分别为0.934、0.942和0.939、0.941。最终,经课题组内专家讨论、并对相似临床问题进行总结归纳后共确定15个问题(9个基础问题和6个临床问题)纳入指南形成推荐意见。结论通本研究提出了《甲状腺癌中西医结合诊疗指南》15个临床问题和10个结局指标,为指南后续制定工作奠定了基础。Objective To construct the clinical queries and outcome indicators of the"Guidelines for the diagnosis and treatment of thyroid cancer with integrative medicine",and to provide a basis for the follow-up evidence-based evidence retrieval,evidence grade evaluation and forming recommendations.Methods First,through literature research,expert interviews and extensive clinical research,clinical queries and outcome indicators were preliminarily collected.Then,on this basis,the Delphi method expert questionnaire was designed and two rounds of expert surveys were carried out.Excel 2021 and SPSS Statistics 26 software were used to statistically process the questionnaire results,and the expert positive coefficient,mean,full score ratio and coefficient of variation of each clinical queries and outcome indicators were calculated for importance evaluation.Entries with average score clinical queries 3,average score of outcome indicators 7,full score ratio 50%,and coefficient of variation<30%were included in the guidelines.At the same time,the expert positive coefficient 75%,harmony coefficient>0.7,Grumbachαcoefficient 0.7 were used for the quality control of Delphi questionnaire.Results Firstly,through literature research,expert interviews and extensive clinical research,30 queries(16 basic queries and 14 clinical queries)and 13 outcome indicators were initially drawn up.Subsequently,after two rounds of Delphi method surveys among 30multidisciplinary experts from 18 top three hospitals in China,30 queries(17 basic queries and 13 clinical queries)and 10 key outcome indicators were formed.The positive coefficients of experts in the two rounds of questionnaires were 100%and 90%,respectively,Kendall concordant coefficient is 0.73.The Grangbachαcoefficients of clinical queries and outcome indicators in the two rounds of investigation were 0.934,0.942 and 0.939,0.941,respectively.Finally,after the discussion of experts in the research group and the summary of similar clinical queries,a total of 15 queries(9 basic queries and 6 clin

关 键 词：甲状腺癌 中西医结合 诊疗指南 德尔菲法 临床问题 结局指标 

分 类 号：R736.1[医药卫生—肿瘤]