Development of a Preliminary Question Prompt List as a Communication Tool for Adults with Achalasia: A Modified Delphi Study

Justin Zhuo, George Triadafilopoulos, Albert J. Bredenoord, John O. Clarke, Ronnie Fass, Chandra P. Gyawali, Mary Hawn, Joo Ha Hwang, Peter J. Kahrilas, David A. Katzka, Donald Low, Benson T. Massey, Dhyanesh Patel, Roberto Penagini, Sabine Roman, Edoardo Savarino, André J. Smout, Lee Swanstrom, Roger Tatum, Marcelo F. VelaGiovanni Zaninotto, Afrin N. Kamal

Research output: Contribution to journalArticlepeer-review


Background: Question prompt lists (QPLs) are structured sets of disease-specific questions that enhance patient-physician communication by encouraging patients to ask questions during consultations. Aim: The aim of this study was to develop a preliminary achalasia-specific QPL created by esophageal experts. Methods: The QPL content was derived through a modified Delphi method consisting of 2 rounds. In round 1, experts provided 5 answers to the prompts "What general questions should patients ask when given a new diagnosis of achalasia" and "What questions do I not hear patients asking, but given my expertise, I believe they should be asking?" In round 2, experts rated questions on a 5-point Likert scale. Questions considered "essential" or "important" were accepted into the QPL. Feedback regarding the QPL was obtained in a pilot study wherein patients received the QPL before their consultation and completed surveys afterwards. Results: Nineteen esophageal experts participated in both rounds. Of 148 questions from round 1, 124 (83.8%) were accepted into the QPL. These were further reduced to 56 questions to minimize redundancy. Questions were categorized into 6 themes: "What is achalasia," "Risks with achalasia," "Symptom management in achalasia," "Treatment of achalasia," "Risk of reflux after treatment," and "Follow-up after treatment." Nineteen patients participated in the pilot, most of whom agreed that the QPL was helpful (84.2%) and recommended its wider use (84.2%). Conclusions: This is the first QPL developed specifically for adults with achalasia. Although well-received in a small pilot, follow-up studies will incorporate additional patient feedback to further refine the QPL content and assess its usability, acceptability, and feasibility.

Original languageEnglish
Pages (from-to)159-164
Number of pages6
JournalJournal of Clinical Gastroenterology
Issue number2
StatePublished - Feb 18 2023


  • achalasia
  • attitudes
  • booklets
  • health knowledge
  • patient satisfaction
  • physician-patient relations
  • practice


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