# Methodological reflections to support good practice in using nominal group techniques: Insights from applications in palliative care studies

## TL;DR

This paper discusses how to improve the use of nominal group techniques in palliative care research to ensure high-quality recommendations.

## Contribution

The paper provides methodological insights and practical suggestions to enhance the rigor and quality of recommendations derived from nominal group techniques.

## Key findings

- Pilot meetings should be conducted and reported to improve research quality.
- Cultural factors and meeting dynamics significantly impact the effectiveness of group discussions.
- Qualitative analysis of meeting transcripts can enhance the clarity and applicability of recommendations.

## Abstract

High-quality recommendations require rigorous methods based on strong evidence to improve clinical practice. In palliative and end-of-life care, expert consensus is sometimes achieved through nominal group techniques. However, its practical challenges are often underestimated, potentially compromising the rigour and the quality of the recommendations.

The methodological reflections on developing recommendations using the nominal group technique are discussed in this paper. These reflections are drawn from its theoretical foundations and applications in palliative care research, including a Taiwanese study on preparing families for a relative’s death. We highlight key issues such as the omission of pilot meetings and the underestimation of practical challenges in conducting group meetings, including time constraints and real-world uncertainties, especially during the stages of listing, clarifying, voting and ranking recommendations. Cultural factors are often overlooked, as seen in the example study, where the moderator avoided interruptions to show respect and politeness during the meeting. Additionally, valuable data gathered during meetings is often underutilised. These factors collectively can undermine the quality of recommendations. Based on these insights, we offer suggestions for improvement.

Pilot meetings should be conducted and reported to demonstrate how they inform the main meeting, ensuring research rigour and recommendation quality. Sufficient time should be allocated for listing and clarifying recommendations and in societies with specific etiquettes (e.g. minimising interruptions to show politeness). Further qualitative analysis of meeting transcripts is suggested to better understand the context and rationale behind the recommendations and enhance their applicability and clarity.