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Abtahi et al. | Journal of Clinical and Translational Research 2024; 10(2): 119-140 121
of possible outcomes for each patient were defined based on the 2.3. Expert consensus and questionnaire-based survey
clinicians’ views and agreement. The six potential areas of decision-
making were considered through expert consultation to classify the Expert consensus refers to the collective opinions of clinical
influential factors extracted from the reviewed publications. The experts on a clinical topic and it is employed to provide quantitative
flow of the literature review process is displayed in Figure 1. and reliable data (e.g., recommendations of best practices) in
clinical areas that are not well-defined by research [29,30].
2.2.5. Identifying potential factors and questionnaire preparation
2.3.1. Validating the contents of the questionnaire
To determine the essential and critical factors of decision-
making for COVID-19 patients based on the severity, a datasheet/ The clinical experts who participated in the survey were
form (prepared based on the PRISMA checklist) was used to affiliated with various medical universities, clinics, and hospitals in
identify data elements (i.e., factors) in the articles of the systematic Iran. The selected participants in this study comprised specialized
review. This datasheet included four sections; name of the data physicians in internal medicine, pulmonary and infectious disease,
element, P-value, category, and description. emergency medicine, and related clinical fields with experience in
The full-text eligible studies were assessed thoroughly by four COVID-19 patient management for more than 6 months.
reviewers to extract potential datasets related to each category. If Five clinical experts were invited to assess the grammar,
the P-value was reportedly <0.05, the factor was considered as a language, and item allocations for validating the questionnaire.
potential data element. If there was a disagreement between the The experts were requested to suggest a correction for items that
authors in the selection of relevant studies, the final decision was they deemed were incorrect. Each question (data element) was to
made by another author (i.e., S.R.N.K.). be evaluated by the participants over a five-point scale, ranging
Thereafter, a five-point Likert-based questionnaire was created from “essential” (score: 1) to “highly critical” (score: 5).
based on the potential factors identified through the literature 2.3.2. Recruitment of experts for consensus-based survey
review. The questionnaire was finalized with reference to the
factors identified from the systematic review and the six outcomes. Some criteria referred to specific clinical experts, warranting
The questionnaire consisted of two parts; the demographic their invitation to the study. These clinical experts had experience
characteristics of experts and a list of factors that was scaled working in COVID-19 wards or ICUs in multiple hospitals in
according to the Likert score. Iran. In addition, a general practitioner with relevant experience

Records identified through scientific databases:
PubMed = 118, Scopus = 116,
Web of Science = 44,
Manual = 15
Identification Total: 273
(n = 2712)

Records after duplicates removed
(n = 223)

Records excluded in
Titles and abstracts screened after abstract screening
eliminate non-original articles
Screening (n = 187) (n = 150)

Full-text articles assessed Full-text articles excluded
for eligibility according to criteria
(n = 142) (n = 9)

Included Studies included in

synthesis
(n = 136)

Figure 1. The flow of the literature review process.
DOI: https://doi.org/10.36922/jctr.22.00226