Abstract
Abstract
Background
Interstitial lung diseases (ILDs) are complex, heterogeneous disorders that require accurate diagnosis and coordinated care. Multidisciplinary discussions (MDMs) are considered the gold standard for ILD management; however, in India, the implementation of structured MDMs remains limited and fragmented. This study aimed to develop expert consensus recommendations for implementing ILD multidisciplinary discussions (ILD-MDMs) within the Indian healthcare context.
Methods
A structured expert consensus exercise informed by Delphi principles was conducted involving 19 ILD experts (16 from India, 1 from Sri Lanka, and 2 international advisors). Ten predefined consensus statements on ILD-MDM practices were rated anonymously using a 5-point Likert scale, with consensus predefined as ≥ 70% agreement. Statements not meeting the consensus threshold were revised by the steering committee based on expert feedback, discussed during structured advisory board deliberations, and finalised through expert group agreement.
Results
Of the 10 statements, 8 achieved consensus in the initial survey. Two statements—regarding the role of diffusing capacity of the lung for carbon monoxide (DLCO) testing at the primary care level and tele-supervision of stable ILD patients—did not meet the consensus threshold and were refined following expert deliberations. The final recommendations were confirmed through expert group agreement. Key recommendations included: DLCO not being mandatory at the primary care level; tele-supervision may be considered only for stable patients with an established ILD diagnosis; quarterly state-level ILD-MDMs with provisions for ad hoc reviews; mandatory use of standardised datasets; and annual quality audits.
Conclusion
This consensus statement presents the first India-specific framework for standardising ILD-MDMs. By integrating international best practices with local feasibility, the recommendations provide a pragmatic model for strengthening ILD care in India and may facilitate improvements in multidisciplinary care pathways. However, prospective implementation studies are required to evaluate their impact. The framework may also serve as a template for other low- and middle-income countries, although this wider applicability remains hypothetical until validated prospectively, given considerable variation among LMICs in healthcare organisation, referral pathways, and access to imaging.