TABLE 1. Continued Round 1 (n=53) Round 2 (n=47) Trauma- and stressor related disorders 8 (15) 6 (13) Neurobiological development disorders 9 (17) 7 (15) Neurodegenerative disorders 10 (19) 9 (19) Obsessive-compulsive disorders 11 (21) 9 (19) Personality disorders 18 (34) 16 (34) Schizophrenia and related psychotic disorders 20 (38) 16 (34) Somatic symptom disorders 8 (15) 6 (13) Eating disorders 5 (9) 4 (9) Other psychiatric disorders 15 (28) 13 (28) Experience with physician assisted death (PAD)**** (%) Received a PAD-request from a patient under their care 48 (91) 42 (89) Performed an independent consultation 43 (81) 39 (83) Have performed PAD themselves 12 (23) 11 (23) Views on performing PAD (%) Would consider performing PAD 29 (55) 28 (60) Would not consider performing PAD 12 (23) 9 (19) Unsure about performing PAD 11 (21) 9 (19) I would rather not answer 1 (2) 1 (2) * This option was selected from a list containing all major religions. ** Since it is possible to life in one country and work in the other, we focused on the country of occupation, rather than nationality. It is possible for clinicians to work in both countries. *** Counted from the moment they became a psychiatrist. **** Categories are not mutually exclusive. Criteria After two Delphi rounds, consensus was reached for 13 criteria, which can be subdivided into 5 diagnostic and 8 treatment-related criteria (table 2). Below we summarize the iterative process resulting in the consensus-criteria. Open definition At the beginning of round one the participants were asked to give an open definition of IPS in the context of PAD. 52 participants gave detailed definitions. Through thematic analysis, recurrent themes were identified which are summarized below. A full report of the qualitative analysis can be found in supplement one. Most participants’ definitions specified that a psychiatric disorder should cause suffering which is persistent, long lasting, chronic or constant. Also, almost all definitions contained a criterion that the prognosis should be poor, or as one participant defines it: “[IPS is] severe suffering that stems from a psychiatric disorder and cannot be alleviated by any available treatment options.” - P16, Dutch, age 50, has experience with PAD as an independent expert. A DELPHI STUDY ON IRREMEDIABILITY | 103 6
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