Application of Deliberative Democracy Processes in the Healthcare Setting to Determine Optimal Anal Cancer Screening Processes at a Ryan White Clinic.

Introduction: Stakeholder deliberation (SD) methodology can be used to facilitate rapid consensus building around clinical decisions in healthcare settings. This study applied SD methodology to complex decisions around screening methods for human papillomavirus (HPV)-related anal high-grade squamous intraepithelial lesions, which are precursors to anal cancer. Adherence to screening guidelines is crucial for early detection but implementing new anal cancer screening (ACS) guidelines requires robust infrastructure and collaboration across healthcare teams. This study offers an example of SD implementation processes that can be used effectively in complex healthcare settings.

Methods: Three stakeholder meetings were conducted with 7 and 8 participants each, focussing on specific ACS topics. For each topic, participants reviewed background information and considered two alternatives. An initial vote was followed by group discussions to generate a comprehensive list of pros and cons for each alternative, additional deliberation, and a final vote to reach a minimum consensus threshold of 80%.

Results: Seven to eight participants attended each deliberation. Key issues addressed included anal cytology documentation, co-testing with HPV, and histological sample documentation. Consensus levels reached 80%, 100%, and 100% respectively indicating a high level of agreement on decisions reached and suggesting a high likelihood of successful implementation and acceptance.

Conclusion: SD methodology effectively facilitated consensus on the process for implementing ACS guidelines, demonstrating its utility in clinical settings. Decision-makers may consider adopting SD processes to streamline guideline implementation and optimise patient care across disease areas and clinical settings.