Tzelepis Flora, Rose Shiho K, Sanson-Fisher Robert W, Clinton-McHarg Tara, Carey Mariko L, Paul Christine L
Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle & Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
BMC Cancer. 2014 Jan 25;14:41. doi: 10.1186/1471-2407-14-41.
BACKGROUND: The Institute of Medicine (IOM) has endorsed six dimensions of patient-centredness as crucial to providing quality healthcare. These dimensions outline that care must be: 1) respectful to patients' values, preferences, and expressed needs; 2) coordinated and integrated; 3) provide information, communication, and education; 4) ensure physical comfort; 5) provide emotional support-relieving fear and anxiety; and 6) involve family and friends. However, whether patient-reported outcome measures (PROMs) comprehensively cover these dimensions remains unexplored. This systematic review examined whether PROMs designed to assess the quality of patient-centred cancer care addressed all six IOM dimensions of patient-centred care and the psychometric properties of these measures. METHODS: Medline, PsycINFO, Current Contents, Embase, CINAHL and Scopus were searched to retrieve published studies describing the development and psychometric properties of PROMs assessing the quality of patient-centred cancer care. Two authors determined if eligible PROMs included the six IOM dimensions of patient-centred care and evaluated the adequacy of psychometric properties based on recommended criteria for internal consistency, test-retest reliability, face/content validity, construct validity and cross-cultural adaptation. RESULTS: Across all 21 PROMs, the most commonly included IOM dimension of patient-centred care was "information, communication and education" (19 measures). In contrast, only five measures assessed the "involvement of family and friends." Two measures included one IOM-endorsed patient-centred care dimension, two measures had two dimensions, seven measures had three dimensions, five measures had four dimensions, and four measures had five dimensions. One measure, the Indicators (Non-small Cell Lung Cancer), covered all six IOM dimensions of patient-centred care, but had adequate face/content validity only. Eighteen measures met the recommended adequacy criteria for construct validity, 15 for face/content validity, seven for internal consistency, three for cross-cultural adaptation and no measure for test-retest reliability. CONCLUSIONS: There are no psychometrically rigorous PROMs developed with cancer patients that capture all six IOM dimensions of patient-centred care. Using more than one measure or expanding existing measures to cover all six patient-centred care dimensions could improve assessment and delivery of patient-centred care. Construction of new comprehensive measures with acceptable psychometric properties that can be used with the general cancer population may also be warranted.
背景:美国医学研究所(IOM)认可了以患者为中心的六个维度,认为这些维度对于提供高质量医疗保健至关重要。这些维度概述了医疗必须:1)尊重患者的价值观、偏好和表达的需求;2)协调和整合;3)提供信息、沟通和教育;4)确保身体舒适;5)提供情感支持——减轻恐惧和焦虑;6)让家人和朋友参与。然而,患者报告结局测量(PROMs)是否全面涵盖这些维度仍未得到探索。本系统评价考察了旨在评估以患者为中心的癌症护理质量的PROMs是否涵盖了IOM以患者为中心护理的所有六个维度以及这些测量工具的心理测量特性。 方法:检索了Medline、PsycINFO、Current Contents、Embase、CINAHL和Scopus数据库,以获取已发表的研究,这些研究描述了评估以患者为中心的癌症护理质量的PROMs的开发和心理测量特性。两位作者确定符合条件的PROMs是否包括IOM以患者为中心护理的六个维度,并根据内部一致性、重测信度、表面/内容效度、结构效度和跨文化适应性的推荐标准评估心理测量特性的充分性。 结果:在所有21项PROMs中,最常包含的IOM以患者为中心护理维度是“信息、沟通和教育”(19项测量工具)。相比之下,只有五项测量工具评估了“家人和朋友的参与”。两项测量工具包含一个IOM认可的以患者为中心护理维度,两项测量工具有两个维度,七项测量工具有三个维度,五项测量工具有四个维度,四项测量工具有五个维度。一项名为“指标(非小细胞肺癌)”的测量工具涵盖了IOM以患者为中心护理的所有六个维度,但仅具有充分的表面/内容效度。18项测量工具符合结构效度的推荐充分性标准,15项符合表面/内容效度标准,7项符合内部一致性标准,3项符合跨文化适应性标准,没有测量工具符合重测信度标准。 结论:目前尚未开发出在心理测量学上严谨的、能涵盖IOM以患者为中心护理所有六个维度的针对癌症患者的PROMs。使用多种测量工具或扩展现有测量工具以涵盖所有六个以患者为中心护理维度,可能会改善以患者为中心护理的评估和提供。或许也有必要构建具有可接受心理测量特性、可用于一般癌症人群的新的综合测量工具。
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