Co-designing a Structured Expert Elicitation with Clinicians to Enhance Health Care Decision Making in Exercise Oncology

Background: While structured expert elicitation (SEE) is gaining traction in health technology assessment in situations in which data are scarce, its application in practice remains limited. Co-designing a practical and fit-for-purpose SEE with experts could enhance its acceptability and feasibility in clinical research. 

Objectives: An SEE was co-designed with clinicians to elicit expert opinions on 3 uncertain quantities of interest (QoIs) for a decision-analytic model in exercise oncology. 

Methods: A series of co-design meetings was convened to design 6 elicitation stages. Individual elicitation was conducted using the variable interval method (VIM), via videoconferencing. Linear pooling was adopted to generate group estimates. Semi-structured interviews were conducted after the elicitation exercise to gather the experts’ first-hand experience of the elicitation process and to identify areas for improvement. Qualitative data were transcribed and content analyzed. 

Results: Twelve experts participated in the co-designed SEE. Three beta distributions were derived and estimated from the experts’ responses: the relative risk reduction of cardiovascular events of exercise for women who survived early-stage endometrial cancer (Mean: 0.362, SD: 0.15), the probability that a clinician would refer a patient to the exercise program (Mean: 0.457, SD: 0.218), and the probability that a cancer patient would use such a health service upon referral (Mean: 0.446, SD: 0.203). Most of the experts’ first-hand experience of the co-designed SEE was positive. The qualitative feedback highlighted critical aspects of the elicitation process that should be designed and executed with caution when targeting clinicians with no prior experience of SEE. 

Conclusions: This is the first expert elicitation conducted in exercise oncology. Engaging diverse stakeholders through co-design meetings and incorporating qualitative feedback proved effective and practical in introducing expert elicitation into clinical research. 

Highlights: Recent SEE guidelines aim to facilitate the conduct of expert elicitation in model-based economic evaluation, but its application in practice remains limited. 

Engaging experts in the design of SEE could enhance its acceptability and feasibility in clinical research. 

This is the first co-designed expert elicitation involving clinicians in the field of exercise oncology. 

This practical approach to conducting SEE could promote a wider adoption to inform health care policy decisions when the evidence is lacking or uncertain.