Abstract
Purpose: Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing’s disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. Methods: The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after (“second round”) an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: “agreement” if no more than two responses were outside a 2 week window around the median response; “disagreement” if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Results: Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8–24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. Conclusions: With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 422-429 |
| Number of pages | 8 |
| Journal | Pituitary |
| Volume | 20 |
| Issue number | 4 |
| DOIs | |
| State | Published - Aug 1 2017 |
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Keywords
- Biochemical status
- Consensus statements
- Cushing’s disease
- Expert panel
- Follow-up
- Treatment
ASJC Scopus subject areas
- Endocrinology, Diabetes and Metabolism
- Endocrinology
Cite this
Follow-up intervals in patients with Cushing’s disease : recommendations from a panel of experienced pituitary clinicians. / Geer, Eliza B.; Ayala, Alejandro R; Bonert, Vivien; Carmichael, John D.; Gordon, Murray B.; Katznelson, Laurence; Manuylova, Ekaterina; Shafiq, Ismat; Surampudi, Vijaya; Swerdloff, Ronald S.; Broder, Michael S.; Cherepanov, Dasha; Eagan, Marianne; Lee, Jackie; Said, Qayyim; Neary, Maureen P.; Biller, Beverly M.K.
In: Pituitary, Vol. 20, No. 4, 01.08.2017, p. 422-429.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Follow-up intervals in patients with Cushing’s disease
T2 - recommendations from a panel of experienced pituitary clinicians
AU - Geer, Eliza B.
AU - Ayala, Alejandro R
AU - Bonert, Vivien
AU - Carmichael, John D.
AU - Gordon, Murray B.
AU - Katznelson, Laurence
AU - Manuylova, Ekaterina
AU - Shafiq, Ismat
AU - Surampudi, Vijaya
AU - Swerdloff, Ronald S.
AU - Broder, Michael S.
AU - Cherepanov, Dasha
AU - Eagan, Marianne
AU - Lee, Jackie
AU - Said, Qayyim
AU - Neary, Maureen P.
AU - Biller, Beverly M.K.
PY - 2017/8/1
Y1 - 2017/8/1
N2 - Purpose: Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing’s disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. Methods: The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after (“second round”) an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: “agreement” if no more than two responses were outside a 2 week window around the median response; “disagreement” if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Results: Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8–24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. Conclusions: With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.
AB - Purpose: Follow-up guidelines are needed to assess quality of care and to ensure best long-term outcomes for patients with Cushing’s disease (CD). The purpose of this study was to assess agreement by experts on recommended follow-up intervals for CD patients at different phases in their treatment course. Methods: The RAND/UCLA modified Delphi process was used to assess expert consensus. Eleven clinicians who regularly manage CD patients rated 79 hypothetical patient scenarios before and after (“second round”) an in-person panel discussion to clarify definitions. Scenarios described CD patients at various time points after treatment. For each scenario, panelists recommended follow-up intervals in weeks. Panel consensus was assigned as follows: “agreement” if no more than two responses were outside a 2 week window around the median response; “disagreement” if more than two responses were outside a 2 week window around the median response. Recommendations were developed based on second round results. Results: Panel agreement was 65.9% before and 88.6% after the in-person discussion. The panel recommended follow-up within 8 weeks for patients in remission on glucocorticoid replacement and within 1 year of surgery; within 4 weeks for patients with uncontrolled persistent or recurrent disease; within 8–24 weeks in post-radiotherapy patients controlled on medical therapy; and within 24 weeks in asymptomatic patients with stable plasma ACTH concentrations after bilateral adrenalectomy. Conclusions: With a high level of consensus using the Delphi process, panelists recommended regular follow-up in most patient scenarios for this chronic condition. These recommendations may be useful for assessment of CD care both in research and clinical practice.
KW - Biochemical status
KW - Consensus statements
KW - Cushing’s disease
KW - Expert panel
KW - Follow-up
KW - Treatment
UR - http://www.scopus.com/inward/record.url?scp=85014689566&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85014689566&partnerID=8YFLogxK
U2 - 10.1007/s11102-017-0801-2
DO - 10.1007/s11102-017-0801-2
M3 - Article
C2 - 28275992
AN - SCOPUS:85014689566
VL - 20
SP - 422
EP - 429
JO - Pituitary
JF - Pituitary
SN - 1386-341X
IS - 4
ER -