METHODS Ethical approval, data-management, study design and preregistration Ethical approval for this study was obtained in the form of a non-WMO declaration from the Medical Ethical Examination Board of Amsterdam UMC / VUmc under registration number D326. Furthermore, a privacy impact assessment was performed, assuring compliance with European privacy laws. For data-management, the survey tool Survalyzer was used, quantitative analysis was performed using SPSS v25.0, and for qualitative analysis Maxqda v18.2.4 was used. Also, the ‘Conducting and REporting of DElphi Studies’ (CREDES) guidelines were followed. (Jünger et al., 2017) The study protocol was preregistered at the Open Science Framework under project code: qx5hy. Inclusion criteria In order to be included in the study (1) participants had to have at least five years of clinical experience as a psychiatrist and (2) they had to have experience with assessing PPD requesting PAD. This could mean that they had investigated a persistent PADrequest from one of their own patients, that they acted as an independent clinical expert in a PAD-procedure, or both. It was not required for them to have actually assisted a patient in dying. No specific exclusion criteria were used. Participant selection First the project group was formed, consisting of the authors of this article, who are Dutch and Belgian experts in PAD in PPD with backgrounds in psychiatry and ethics and different views on PAD for PPD. Through criterion recruitment from the clinical and scientific network of the project group, participants were selected in the Netherlands and Belgium. Diverse perspectives were aimed for by purposely inviting psychiatrists who are known proponents, opponents, or hold a moderate stance on PAD for PPD. Participants in the study were also asked to recommend other experts that met the inclusion criteria (snowballing). An information letter was sent describing that participation will not yield direct benefits and that the main burden is the time investment. Informed consent was obtained from all participants, and everyone gave permission to be acknowledged for their efforts in the final publication, adding to the transparency of the study. Participants were sent an email with a personal link to the online survey. At the beginning of the study, all round one participants were explicitly asked to participate in all subsequent rounds, and during both rounds two reminders were sent. Survey design and data analysis The round one survey was developed during project group meetings using insights from a systematic review and a qualitative interview study among psychiatrists, both on the topic of irremediable psychiatric suffering. (van Veen et al., 2020; van Veen, Ruissen 100 | PART III - CHAPTER 6 6
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