Development of consensus-based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study

摘要

Background: In November 2019, the Australian government introduced reforms to increase the number of sessions of Medicare-subsidised dietetic treatment individuals with an eating disorder (ED) are able to access. However, there currently is a lack of detailed guidance for dietitians regarding what outpatient dietetic treatment for EDs should encompass and poor consensus amongst specialist dietitians regarding best practice recommendations for treating this patient group. Aim: To generate consensus-based guidelines for outpatient dietetic treatment of patients with an ED using Delphi methodology. Methods: A modified Delphi method was used to develop guidelines in several categories: referral to a dietitian; essential components of dietetic treatment; strategies to promote collaboration between dietitians and other clinicians; and skills dietitians should possess if treating patients with an ED. Participants (n = 162) were coded into three panels: ED specialists (n = 79), non-ED specialists (n = 28) and consumers and carers with lived experience (n = 55). N = 122 statements were rated across three rounds. Results: N = 81 statements reached consensus level (66.4%). A high proportion of endorsed statements were consistent with current clinical guidelines, though some statements for which evidence exists were not endorsed as essential components of dietetic treatment. Compared to consumers and carers, ED specialists were less likely to endorse assessment or involvement by a dietitian as a standard component of treatment and a number of discrepancies were observed between these panels regarding essential components of dietetic treatment. Conclusions: This study provides consensus-based guidelines in the current absence of clinical practice guidelines for dietetic treatment of EDs.