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Purpose <p>Transanal irrigation (TAI) is used in a range of functional digestive disorders; however, its clinical implementation remains notably heterogeneous. The absence of clear operational definitions for discontinuation, refusal, and adherence hampers the interpretation of outcomes and comparison across centres. The aim of this study was to reach a national consensus on these concepts through a structured Delphi process.</p> Methods <p>A national Delphi study was conducted following the RAND/UCLA methodology over two consecutive rounds. The questionnaire included 46 items distributed across four thematic sections and two exploratory parts. RAND/UCLA criteria were applied to determine appropriateness and degree of consensus, and items without consensus were reconsidered in the second round.</p> Results <p>A total of 111 professionals with experience in TAI were invited to participate; 100 completed the first round and 91 the second. Of the 46 items, 24 (52.17%) reached consensus: 17 in the first round and 7 in the second. The strongest agreements were found around the differentiation between discontinuation and refusal, the behavioural definition of adherence, and the importance of initial information, systematic identification of discontinuation causes, and the need for structured follow-up programmes. Areas without consensus included logistical aspects, temporal criteria, and certain operational interventions, as well as professional profile–based discrepancies in specific items.</p> Conclusions <p>This study provides consensus-based operational definitions and clinical criteria applicable to TAI practice in Spain. The agreements reached offer a solid foundation for standardising key concepts, improving outcome evaluation, and guiding the development of more consistent clinical guidelines and care pathways.</p>

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Consensus on discontinuation, refusal, and adherence to transanal irrigation in coloproctology: a national Delphi study in Spain

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月3日

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  • Franco Marinello,
  • Elena Bermejo,
  • María José Alcaide,
  • Milagros Carrasco,
  • Ane Etxart,
  • Vicent Primo,
  • Alberto Parajó,
  • Sara Tavares-Nogueira,
  • Pere Planellas,
  • Ana Margarita Valencia,
  • Luis Miguel Ruano,
  • Ana Belen Flores,
  • Noelia García,
  • Elena Yagüe,
  • Luis García,
  • Rosa Costa,
  • Cristobal Cañete,
  • Irene Ávila,
  • Loris Trenti,
  • Marta Climent,
  • Mireia Lázaro,
  • Belén Bueno,
  • Elvira Sánchez,
  • Iván Blasco,
  • Francisco José García,
  • Francisco Javier Alarcón,
  • Natalia Zaragoza,
  • Alejandro García,
  • Ana Fernández,
  • Verónica Cañete,
  • Mercedes Granados,
  • Nerea Salas,
  • Luis Alberto Campos,
  • María Pilar Martínez,
  • Francesca Rico,
  • Jorge Expósito,
  • Andrés Vargas,
  • José María Jiménez,
  • Roberto Sacristán,
  • Marina González,
  • Ana Isabel Sanz,
  • Sara Romero,
  • Lucía Pérez,
  • Diego García,
  • Javier Serrano,
  • Javier Hernáez,
  • Gregorio Ruiz,
  • Ana López,
  • José Antonio Martínez,
  • Susana Pérez,
  • Luis Miguel Martín,
  • Patricia Martín,
  • Isabel Sánchez,
  • Santiago Gómez,
  • Eduardo Martínez,
  • Rosa María Pérez,
  • Laura García,
  • Blanca Moreno,
  • María José García,
  • Sandra Pérez,
  • Belén Rodríguez,
  • Jesús García,
  • María del Mar García,
  • Antonio Pérez,
  • Javier García,
  • Paula López,
  • Patricia Sánchez,
  • Irene García,
  • Alberto González,
  • Marta Sánchez,
  • Paula Pérez,
  • Cristina López,
  • María Ruiz,
  • Laura Martínez,
  • Cristina Pérez,
  • María Sánchez,
  • Sara García,
  • Marta Pérez,
  • Paula Martínez,
  • Laura Pérez,
  • María López,
  • Cristina Martínez,
  • Ana Ruiz,
  • Sara Pérez,
  • Laura Sánchez,
  • María Pérez,
  • Cristina García,
  • Ana Sánchez,
  • Marta García,
  • Sara Martínez,
  • Laura Ruiz,
  • María Martínez,
  • Cristina Sánchez,
  • Ana Pérez,
  • Sara Ruiz,
  • Vicente Simó,
  • Goizalde Cabello,
  • Mª Paz Vicario,
  • Maider Zubiaga,
  • Olga Naverán

摘要

Purpose

Transanal irrigation (TAI) is used in a range of functional digestive disorders; however, its clinical implementation remains notably heterogeneous. The absence of clear operational definitions for discontinuation, refusal, and adherence hampers the interpretation of outcomes and comparison across centres. The aim of this study was to reach a national consensus on these concepts through a structured Delphi process.

Methods

A national Delphi study was conducted following the RAND/UCLA methodology over two consecutive rounds. The questionnaire included 46 items distributed across four thematic sections and two exploratory parts. RAND/UCLA criteria were applied to determine appropriateness and degree of consensus, and items without consensus were reconsidered in the second round.

Results

A total of 111 professionals with experience in TAI were invited to participate; 100 completed the first round and 91 the second. Of the 46 items, 24 (52.17%) reached consensus: 17 in the first round and 7 in the second. The strongest agreements were found around the differentiation between discontinuation and refusal, the behavioural definition of adherence, and the importance of initial information, systematic identification of discontinuation causes, and the need for structured follow-up programmes. Areas without consensus included logistical aspects, temporal criteria, and certain operational interventions, as well as professional profile–based discrepancies in specific items.

Conclusions

This study provides consensus-based operational definitions and clinical criteria applicable to TAI practice in Spain. The agreements reached offer a solid foundation for standardising key concepts, improving outcome evaluation, and guiding the development of more consistent clinical guidelines and care pathways.