Growth hormone deficiency (GHD) is a licensed and NICE approved indication for growth hormone (GH) treatment but there are no nationally agreed standards for investigation of suspected GHD. Variable practice across the UK could have governance issues and impact on patient experience and equality of access to specialist GH investigation and treatment. Some GH provocation tests carry significant risk and it is therefore essential that these specialist investigations are carried out in centres with appropriate expertise and infrastructure.
Aim: BSPED clinical committee initiated process to identify consensus for UK standards for investigation of suspected GHD.
Method: DELPHI consensus process in two rounds (R1 and R2). R1: 10 statements with four fixed responses and free text comments regarding standard practice for investigation of GHD were developed by the clinical committee and a group of experts. These were sent to the 21 BSPED UK specialist endocrine centres. Each had identified colleagues to complete the online survey including tertiary endocrine consultants, general paediatricians with an endocrine interest, and paediatric endocrine clinical nurse specialists. Conflicts of interest were recorded. Consensus was considered to be achieved when 70% of respondents agreed with the statement.
Results: R1: 141 surveys were sent out: 21 were blocked by NHS firewalls. R1 response rate of remaining 120 was 57% (n=68). Consensus was achieved for seven statements, with useful free text comments. Common themes include the recognition that investigation should be carried out by experienced personnel to improve safety and that sex steroid priming should be included in the standards. R2 will address the outstanding statements modified using the free text comments.
Conclusion: Seven consensus statements for standards to investigate GHD have been identified using Delphi methodology, a further three are under consideration. Implementing standards will allow an evolving process amenable to audit to ensure best clinical practice and patient experience, and optimise the use of resources.