Delphi-based consensus studies: persistent challenges of bias.

Delphi methodology plays an important role in consensus development in areas where evidence is limited, ambiguous, or heterogeneous. However, the process remains inherently vulnerable to cognitive and methodological biases involving principal investigators, expert panellists, and other stakeholders. Recognising and proactively addressing these biases is essential to improve the rigour, transparency, and credibility of Delphi-based consensus research. Future efforts should focus on developing structured frameworks for transparent reporting and systematic implementation of bias mitigation strategies throughout the Delphi process.