Peer-reviewed article
Assessing and investigating children with suspected soft tissue sarcomas: an e-Delphi consensus process.
Ni Cheallaigh L, Ritzmann TA, Liu JF, Ball-Gamble A, Walker D et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study used a Delphi consensus process to develop clinical guidelines for healthcare professionals assessing children with suspected soft tissue sarcoma, a cancer that is difficult to diagnose early. Researchers asked 87 healthcare professionals across two rounds to agree or disagree with 48 statements based on evidence review. Nearly all statements achieved consensus, with strong agreement that suspected cases need urgent referral, investigation, and discussion with specialist care. The resulting guidelines will be used in primary and secondary care settings and translated into public awareness materials.
Key points
- 47 out of 48 statements achieved consensus in the first round, with 33% gaining more than 90% agreement
- Strong consensus existed for urgent referral and investigations when clinical suspicion of soft tissue sarcoma is high
- Participants agreed that urgent discussion with secondary care should occur if clinical uncertainty exists
- Consensus supported increasing healthcare professional education and institutional support to reduce barriers to timely diagnosis
- Disagreement mainly related to logistical and systemic barriers and concerns about misinterpretation if settings were not clearly specified
Limitations
The document does not specify the countries or healthcare systems represented by participants, nor does it provide data on whether implementing these guidelines actually improves diagnostic timeliness or survival outcomes in practice. The study establishes expert consensus but does not evaluate whether the resulting guidelines are effective when applied.
Abstract
Background The clinical presentation of childhood soft tissue sarcoma (STS) creates a diagnostic challenge; however, time to diagnosis is significantly associated with survival. This Delphi consensus process aims to contribute to the development of clinical guidelines for healthcare professionals (HCPs) assessing children and young people presenting with signs/symptoms suggestive of STS. Methods Invitation emails were sent to HCPs to join the Delphi panel. 48 statements were derived from an evidence review by a multidisciplinary team. Participants ranked their level of agreement with each statement on a 9-point Likert scale (1=strongly agree, 9=strongly disagree), with responses ≥7 indicating agreement. Statements not reaching consensus were rewritten and reissued in a subsequent round. Results In round 1 (R1), 87/117 (74%) participants responded and 68/87 (78%) completed round 2 (R2).In R1, 47/48 (98%) statements achieved consensus, with 16/48 (33%) gaining more than 90% consensus. One statement did not reach consensus, with 26/87 (29%) scoring <7. All statements reached numerical consensus at the end of R2.There was strong consensus for urgent referral and investigations in cases with strong clinical suspicion, urgent discussion with secondary care if clinical uncertainty exists, increasing HCP education and institutional support to overcome potential barriers to timely diagnosis. Dissent was due to logistical and systematic barriers and a concern for misinterpretation if intended setting is not clearly specified. Conclusions These statements will be included in a clinical guideline for suspected STS for use in both primary and secondary care and translated into public awareness tools as part of the Child Cancer Smart national awareness campaign.