Background: The Swedish Stroke Guidelines issued by the National Board of Health and Welfare are a support for decision makers to allocate resources efficiently within the healthcare system. The guideline process contains four main steps; 1) identification of key clinical PICOs (Patient Intervention Control Outcome); 2) review of the scientific evidence and, in case of insufficient evidence, compilation of best practice/consensus; 3) priority-setting; and, 4) key recommendations.
Priority-settings are made by a multi-professional group of clinical experts and patient representatives. They rank the intervention based on disease severity (patients’ needs), effect of intervention, evidence, and cost-effectiveness. Highly ranked interventions should receive more resources than those with lower rank.

Objectives: The main goal was to further refine the priority-setting procedure in the Stroke Guidelines, by using a modified Delphi method in the current guideline revision round.

Methods: The 25 members of the priority-setting group reviewed background information and evidence summaries and gave their preliminary priority votes through a web questionnaire. Ratings and comments were aggregated and anonymised, and present to the group for a second Delphi round. Priority ratings were finalised at four face-to-face meetings.

Results: About 110 PICO-questions were assessed, divided in four batches. For the vast majority of items, the priority score did not change more than marginally from the second Delphi round to the final decision. However, for 17 items, the face-to-face meeting led to a substantially different priority setting, a decision to await further upcoming scientific evidence, or a decision to discard the PICO-item from the guidelines. Experiences from the priority-setting group members will be systematically evaluated and presented.

Conclusions: The method of a modified Delphi process, with feedback from two anonymous survey rounds combined with face-to-face meetings, appeared well feasible and effective for priority setting in the Swedish Stroke Guidelines.