The Thymoma Working Group (TWG; the authors of this report) used a modified Delphi approach to develop draft guideline recommendations through consensus. The steps in the process are outlined in Figure 1 in the original guideline document. In the first phase, the TWG drafted and confirmed a preliminary set of thirty-eight recommendations related to key treatment issues in the management of thymoma. In this phase, discussions were conducted through teleconference and email communication and were informed by the evidence presented in the systematic review above, additional evidence provided in narrative reviews of the topic, and the clinical experience of members. The objective of the second phase, Round One Consensus, was to obtain consensus on the draft recommendations by clinicians who treat thymoma. The larger group is referred to as the Consensus Group (CG; Figure 1 in the original guideline document). Prior to the first consensus round, a letter was sent to prospective members of the CG requesting their participation in the consensus process. This group consisted of members of the TWG, members of the Program in Evidence-based Care (PEBC) Provincial Lung Disease Site Group (DSG) (n=28), members of the PEBC Hematology DSG for whom this type of practice was thought to be relevant (n=14), and thoracic surgeons (n=27) from across Canada who were identified by the TWG as physicians involved in the management of thymoma. Subsequently, the systematic review, draft recommendations, and questionnaire were mailed to the CG. In the questionnaire, respondents were asked to provide their opinion on general questions about the report and were also asked to rate their agreement with each recommendation on a seven-point Likert scale, ranging from "strongly agree" at 1, through "neither agree or disagree" at 4, to "strongly disagree" at 7.
The first round feedback was analysed and distributed to the TWG, and the members revised the initial recommendations in response. In the second consensus round, a package was again sent to the CG, consisting of the original recommendations, the results of the first consensus round, the modified recommendations in response to the first round feedback, and a questionnaire. For revised recommendations, CG members were asked to rate their preference for both the original Round One recommendation, and a modification to that recommendation. The questionnaire used for Round Two is included as Appendix 1 of the original guideline document. The responses to the second round consultation were analyzed and reviewed by the TWG and final recommendations established. See the original guideline document for additional details.