Development of a multidisciplinary service-delivery framework for venous thromboembolism prevention in hospitalized medical patients with lung cancer: a mixed-methods modified Delphi study

Background Venous thromboembolism (VTE) is a common and potentially preventable complication in patients with lung cancer. Although clinical guidelines recommend risk assessment and appropriate prophylaxis, hospitals often lack operational frameworks for translating these recommendations into multidisciplinary workflows, quality monitoring, and continuous improvement. This study aimed to develop a hospital-based multidisciplinary service-delivery framework for VTE prevention and management among hospitalized medical patients with lung cancer. Methods A mixed-methods modified Delphi study was conducted. Candidate framework items were generated from a structured literature review and semi-structured interviews with physicians, nurses, clinical pharmacists, and hospital managers, and were organized using Donabedian’s Structure–Process–Outcome model. A two-round Delphi survey was then conducted with 15 experts from respiratory medicine, oncology, clinical pharmacy, nursing management, and hospital quality management. Experts rated the importance and feasibility of each candidate item, and the framework was refined using predefined consensus criteria and qualitative feedback. Results The response rate was 100% in both Delphi rounds. Expert authority coefficients were 0.943 and 0.953 in rounds 1 and 2, respectively. Kendall's W ranged from 0.249 to 0.292, indicating low-to-moderate concordance despite statistically significant tests. The final framework included 3 first-level domains, 11 second-level components, and 34 third-level indicators covering structural capacity, care processes, and outcome monitoring. Importance ratings were generally higher than feasibility ratings, particularly for indicators requiring information system support, multidisciplinary coordination, and post-discharge continuity of care. Conclusion This study developed a preliminary, consensus-based multidisciplinary service-delivery framework for hospital-based VTE prevention in patients with lung cancer. The framework may support the operationalization of guideline recommendations, standardization of care processes, and prioritization of quality improvement efforts. Prospective implementation studies are needed to evaluate its feasibility, transferability, and impact on care quality and patient outcomes.