Co-designing a structured referral template to enhance dementia diagnosis: a modified e-Delphi study

BACKGROUND: Dementia care is a health and social care priority, with rising prevalence driven by ageing populations worldwide. Timely and accurate diagnosis improves quality of life, enables access to support and is becoming even more critical due to the emergence of disease-modifying therapies for Alzheimer's disease. Complex referral pathways can contribute to diagnostic delays and under-diagnosis. A structured, evidence-based referral template could enhance diagnostic efficiency and care quality. METHODS: This study was conducted in two phases. First, a two-round e-Delphi survey was used to achieve consensus on items for inclusion in a dementia referral template. In the second phase, a modified Nominal Group Technique was employed with a multidisciplinary panel and Public and Patient Involvement (PPI) contributors to discuss, refine and prioritise items, ensuring clinical relevance and practical applicability. RESULTS: The consensus process refined and prioritised 76 potential referral items into a final set of 11 essential components. The resulting concise template balances clinical relevance with usability, potentially supporting more efficient referral and triage. Items achieving the highest consensus included cognitive screening scores, rapid deterioration, problems with daily activities and patient safety concerns. CONCLUSION: The findings demonstrate the value of structured consensus methods in developing a practical, evidence-based referral template, tailored to optimise dementia diagnostic pathways. This is particularly important in the current evolving therapeutic landscape, to ensure that people with suspected dementia receive timely diagnosis and access to appropriate care and treatment options.