We will compare the prioritised outcomes at the end of both surveys as well as other parameters such as feedback, initial condition and iteration effects.

Stakeholders will rate the importance of the same set of outcomes in both arms. One hundred and eighty stakeholders (parents/caregivers of infants diagnosed and treated with neonatal encephalopathy, healthcare providers and researchers) will be randomised using stratified randomisation to take part in either the Multi-Round or Real-Time Delphi. This trial is embedded within the COHESION study which is developing a COS for interventions treating neonatal encephalopathy. We will compare a three-round with a Real-Time Delphi approach on prioritised outcomes. Challenges with participant retention have been highlighted in previous COS. This usually involves participating in multiple rounds of a survey that can span several weeks or months. In a COS setting, participants prioritise the importance of outcomes for inclusion in a COS. the minimum agreed set of standardised outcomes that should be measured and reported in studies on a specific health condition. For this reason, the Delphi method is popular as a consensus building approach in developing core outcome sets (COS), i.e. By informing participants about how others answer a question or prioritise specific topics, it allows for diverse opinions to inform the consensus process. Traditionally, the Delphi method uses multiple rounds of a survey to allow for feedback of other participants’ survey responses in between rounds.

The Delphi method is used in a wide variety of settings as a method of building consensus on important issues.

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