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Indicators for palliative care integration in primary health care: how expert profile shapes consensus in a modified Delphi study.

Overview

Authors: Carolina Muñoz Olivar1,2,3, Juan Sebastián Gómez Quintero4, Fernando Pastrana Rendon1, Carla Taramasco Toro5,2, Miguel Antonio Sánchez-Cárdenas6, Carlos Javier Avendaño-Vásquez7
ORCID iDs: Juan Sebastián Gómez Quintero
  1. Health Sciences, Faculty of Medicine, Antonio Nariño University,Bogotá, Colombia
  2. Center for Cancer Prevention and Control (CECAN), Santiago, Chile
  3. Faculty of Nursing (Postgraduate Programs), Andres Bello University,Santiago, Chile
  4. Faculty of Engineering, Andrés Bello University,Santiago, Chile
  5. Faculty of Engineering, Institute of Technologies for Innovation in Health and Well-Being, Andrés Bello University,Viña del Mar, Chile
  6. Faculty of Nursing, El Bosque University,Bogotá, Colombia
  7. Escuela de enfermería, Universidad Industrial de Santander,Bucaramanga, Colombia
Institutions: Universidad Antonio Nariño (Colombia); Universidad Andrés Bello (Chile); Universidad El Bosque (Colombia); Industrial University of Santander (Colombia)
Journal: BMC health services research, volume 26, issue 1, article 1119
Dates: received 31 October 2025; accepted 18 May 2026; published online 8 June 2026
Type: Research article · Language: English
License: CC BY
Identifiers: DOI 10.1186/s12913-026-14781-y · PMID 42260481 · PMCID PMC13474756 · OpenAlex W7163877188
Open access: gold, a free copy (OpenAlex)
Status: data only
Categories: human (organism)
Methods: Spectral & time-frequency, Statistics
Keywords: Delphi technique, Palliative care, Primary health care, Indicators, Self-organizing maps, Neural network
MeSH: Consensus*, Delivery of Health Care, Integrated*, Palliative Care*, Primary Health Care*, Quality Indicators, Health Care*, Colombia, Delphi Technique, Humans (* major topic)
Topic: Delphi Technique in Research (Sociology and Political Science, Social Sciences), according to OpenAlex
Funding: Ministerio de Salud y Protección Social; Agencia Nacional de Investigación y Desarrollo (152220002); Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias (152220002)
Citations: cited by 1 paper (Europe PMC); 70 references in the paper

Abstract

Background: Integrating palliative care into primary health care requires clear, feasible, and valid indicators. Consensus-based methods such as Delphi are commonly used for this purpose, but they may overlook differences in how heterogeneous expert panels prioritize indicators. This study aimed to strengthen the methodological approach used to select indicators for assessing the integration of palliative care into primary health care. This study aimed to strengthen the methodological approach used to select indicators for assessing the integration of palliative care into primary health care.

Methods: A two-round modified Delphi was conducted with 23 experts from different regions of Colombia. Each indicator was rated for relevance, feasibility, and validity. A priori consensus was defined as ≥70% of ratings ≥7/10 and IQR ≤2. Global content validity indices (S-CVI) and Lawshe’s content validity ratio (CVR) were calculated as supportive evidence. Expert profile was quantified using the Metric for Assessing Knowledge and Understanding (MAKU) and used to stratify analyses, To explore data patterns, separate 2×2 SOMs were trained for Strategic and Operational profiles using normalized medians and robust coefficients of variation. Neurons with higher median scores and lower dispersion were interpreted as favorable.

Results: Global S-CVI increased from 0.86 in Round 1 to 0.88 in Round 2. By dimension, relevance rose from 0.82 to 0.85, feasibility remained stable at 0.72, and validity increased from 0.62 to 0.71. Stratification by expert profile revealed meaningful differences in consensus patterns. SOM analysis showed both shared and differing prioritization patterns across profiles. After removing overlaps, a final set of eighteen indicators was retained from the dominant neurons of the profile-specific SOMs.

Conclusion: Combining a modified Delphi with MAKU-based stratification and self-organizing maps provided a transparent and profile-sensitive approach to strengthen consensus-based indicator selection in a heterogeneous expert panel. Differences in expert profile influenced how indicators were prioritized. This approach supports more rigorous and context-aware selection of indicators for monitoring palliative care integration in primary health care.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12913-026-14781-y.

Reproduced under the paper's license (CC BY), from the paper cited above.

Code

The paper links to its data, not to its authors' code: see the Data section.

Code availability

All analysis code used in this study is openly available in the Mendeley Data repository under the same (10.17632/gpgnzkx3bf.3 and 10.17632/7msgr64wz9.1).

Reproduced under the paper's license (CC BY), from the paper cited above.

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A tracing map links a paper to the code its authors published: this paper has none, so it has no map.

Data

Datasets cited

Data availability

All data and study materials are available in the Supplementary Information files and in the Mendeley Data repository (10.17632/gpgnzkx3bf.3 and 10.17632/7msgr64wz9.1).

Reproduced under the paper's license (CC BY), from the paper cited above.

Materials availability

All supplementary materials described in this article are also available in the Mendeley Data repository (10.17632/gpgnzkx3bf.3 and 10.17632/7msgr64wz9.1).

Reproduced under the paper's license (CC BY), from the paper cited above.

Versions

The history of this record: each version stored by the harvester or made by a correction of its authors or of the maintainers of its code, and what changed in its facts. The texts of the paper (its abstract, its availability statements) are not part of it; versions that changed only those are not listed.

Version 2, 28 September 2026

  • Funding: added Ministerio de Salud y Protección Social; Agencia Nacional de Investigación y Desarrollo: 152220002; Fondo de Financiamiento de Centros de Investigación en Áreas Prioritarias: 152220002

Version 1, 27 September 2026: the first record

Recorded: type, language, journal, volume, issue, pages, dates, 6 authors, 6 keywords, 8 MeSH terms, 50 references.

Cite

This paper

Muñoz Olivar, C., Gómez Quintero, J. S., Pastrana Rendon, F., Taramasco Toro, C., Sánchez-Cárdenas, M. A., & Avendaño-Vásquez, C. J. (2026). Indicators for palliative care integration in primary health care: how expert profile shapes consensus in a modified Delphi study. BMC health services research, 26(1), 1119. https://doi.org/10.1186/s12913-026-14781-y

BibTeX

@article{munozolivar2026indicators,
author = {Muñoz Olivar, Carolina and Gómez Quintero, Juan Sebastián and Pastrana Rendon, Fernando and Taramasco Toro, Carla and Sánchez-Cárdenas, Miguel Antonio and Avendaño-Vásquez, Carlos Javier},
title = {{Indicators for palliative care integration in primary health care: how expert profile shapes consensus in a modified Delphi study}},
journal = {BMC health services research},
year = {2026},
month = jun,
volume = {26},
number = {1},
pages = {1119},
publisher = {BMC},
issn = {1472-6963},
doi = {10.1186/s12913-026-14781-y},
url = {https://doi.org/10.1186/s12913-026-14781-y},
pmid = {42260481},
pmcid = {PMC13474756}
}

RIS

TY - JOUR
AU - Muñoz Olivar, Carolina
AU - Gómez Quintero, Juan Sebastián
AU - Pastrana Rendon, Fernando
AU - Taramasco Toro, Carla
AU - Sánchez-Cárdenas, Miguel Antonio
AU - Avendaño-Vásquez, Carlos Javier
TI - Indicators for palliative care integration in primary health care: how expert profile shapes consensus in a modified Delphi study
T2 - BMC health services research
J2 - BMC Health Serv Res
PY - 2026
DA - 2026/06/08
VL - 26
IS - 1
SP - 1119
SN - 1472-6963
PB - BMC
DO - 10.1186/s12913-026-14781-y
UR - https://doi.org/10.1186/s12913-026-14781-y
LA - en
ER -

CSL-JSON

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