Prioritising research for patients requiring surgery in low- and middle-income countries: a modified Delphi process

Introduction: The National Institute for Health Research Global Health Research Unit on Global Surgery is establishing research Hubs in low- and middle-income countries (LMICs). The aim of this study was for the Hubs to prioritise future research into areas of unmet clinical need for
LMIC patients requiring surgery.
Methods: A modified Delphi process was overseen by the research Hub leads and engaged
LMIC clinicians, patients, and expert methodologists. A four stage iterative process was
delivered to prioritise research topics. This included anonymous electronic voting,
teleconference discussions, and a two-day priority-setting workshop.
Result: In stage one, Hub leads proposed 32 topics across six domains: access to surgery,
cancer, perioperative care, research methods, acute care surgery, and communicable disease.
In stages two and three a total of 210 stakeholders representing 62 countries participated in
online voting, leading to identification of three priority research topics: (1) access to surgery, (2)
outcomes of cancer surgery, and (3) perioperative care. During stage four, specific research
plans to address each topic were developed by Hub leads at a priority-setting workshop.
Conclusion: This process identified three priority areas for future research relevant to surgery
in LMICs. It was driven by frontline LMIC clinicians, patients, and other stakeholders
representing a diverse range of settings. The results of the prioritisation exercise provide a
future framework for researchers and funders.