Cancer patient and staff perceptions of caring and clinical care in free versus forced choice response formats.

Two questions were investigated: whether cancer patients (n = 32) and staff (n = 30) have different cognitive representations of the concepts 'caring' (Swedish: 'omvårdnad') and 'clinical care' (Swedish: 'vård'), and whether results differ between forced vs. free choice response formats. Two Swedish versions of the CARE-Q instrument were used: (i) a CARE-Q sorting (forced format) and (ii) a CARE-Questionnaire (free format). Four groups of patients and 4 groups of staff completed (i) the forced format/caring, (ii) the forced format/clinical care, (iii) the free format/caring and (iv) the free format/clinical care versions, respectively. Participants were asked to rank the importance of 50 CARE-Q behaviours for the specific method/concept combination. Results demonstrated that neither patients nor staff, to any great extent, valued CARE-Q subscales differently when regarded as examples of 'caring' vs. 'clinical care'. Further, the free vs. forced choice format did not influence patient and staff perceptions of the importance of CARE-Q subscales, except that both groups gave higher values to all subscales in the free choice response format. The assumptions that different cognitive representations of the concepts or the response formats had affected previous CARE-Q results were not substantiated.