delphi


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The first questions then arose ? what kinds of cases should we collect? Should there be a qualitative assessment of the cases before they are included? How can people be persuaded to submit their cases? Who can access the cases? Will there be financial rewards for the sharing of cases? Who can give permission for the case details to be shared? At the same time, we began to consider how the information within the cases would be used. How can we analyze the cases to confirm or improve our knowledge of remedies? All of these questions led to further clarifications of the project and further questions! The various different workshops and meetings have allowed the project to move forward considerably with regard to these many questions.

The three goals of the DELPHI project are:

1. To build a case library
2. To find common aspects in groups of cases (themes and characteristics)
3. To test the value of these common aspects in homeopathic prescribing

Criteria for cases:

All of this is based on the actual cases submitted by physicians, but some cases seem more useful than others. This led to the development of the Delphi criteria for cases ?
1. Treatment with one single remedy
Evaluation is most important and most feasible for single remedy cases.
2. Stable improvement of the patient
A stable state of improvement has been reached, with special interest for the main complaints and the general state of well-being
3. Not contrary to Hering?s Law
During the period of observation there should not be an aggravation or deterioration of the system.
4. Relevant duration of follow-up
A duration of follow up that is meaningful for the condition treated.
5. It?s evident that it was a homeopathic cure
Other treatments, and important changes in the circumstances of the patient have to be described.
Peer Review: In order to judge the suitability and/or usefulness of a submitted case, the Delphi project began to develop a methodology of peer review. This was a real learning process for both the authors of the cases and the reviewers.

Confidentiality:
After much discussion and medico-legal advice, it was clarified that the simple idea of posting patients? case histories on the internet was a non-starter. There is no way to achieve fully informed consent for patients confidential details to be released on the public stage of the world wide web. This has led to the current position where we have clarified two stages to the confidentiality issue. Firstly, fully informed consent to take part in research project is an essential prerequisite to entering patients into a trial which must be approved by a Medical Ethics Committee. So, the question is ? is the Delphi Project a research project? If so, it requires ethical approvals before commencing its work. The latter two of the three goals of the Delphi project are clearly research projects. However, building the case library is not necessarily so. Secondly, informed consent involves the patient knowing in advance who the information will be shared with. In fact, doctors are encouraged to take part in private and group reflection of their work. This activity is good practice and does not require the same consents as research. However, the group would have to be clearly defined.

Where are we now? In some ways, it would seem that the Delphi project has returned to it?s point of origin. However, there has clearly been an extensive journey since the original departure and this point of arrival brings us back to the first idea with more knowledge and more solutions than we had at the outset. The point we have now reached is the setting up of the case library for members of a group of physicians who wish to reflect on their work collectively. We hope this will lead to the development of a resource which will create the research projects outlined in Goals 2 and 3.