Patient, family and clinician priorities for critical care research in Asia and Africa: a James Lind Alliance Priority Setting Partnership using modified Delphi and nominal group techniques

BACKGROUND: This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions important to adult patients, their families and health professionals with lived experience of critical care across Asia and Africa. METHODS: Modified Delphi techniques were used to generate suggestions using an online survey. Following verification, literature review and content analysis, these suggestions were iteratively codified into emergent topics. Topics were presented in a second online survey for ranking, prior to an online workshop where nominal group technique was used to identify top priority questions across stakeholder groups. Surveys were disseminated using snowballing techniques. FINDINGS: The project was coordinated by a representative steering group independently overseen by the JLA. The initial survey generated 432 candidacy suggestions from 17 countries. Review, content analysis and codification resulted in 51 candidacy questions, spanning 16 topics. A second shortlisting survey reached 124 clinicians and 86 patient-carer stakeholders, who ranked the most important topics and produced a shortlist of 18 candidacy topic questions. Representative stakeholders attending an online workshop prioritised the questions, with a tie for 10th and 11th place, resulting in a top 10+1 priority list. These spanned four themes: cost of care, infection and long-term recovery including psychological and socio-economic recovery following critical illness. INTERPRETATION: Cost, who would benefit from intensive care unit admission and organisation of healthcare dominated discussions irrespective of disease, injury or illness. Priorities were consistent between stakeholder groups. The JLA methodology enabled contributions from those with lived experience of critical care. The results of the prioritisation partnership provide a roadmap for researchers and funders seeking to address stakeholder priorities.