Murphy Mairead, Hollinghurst Sandra, Salisbury Chris
Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.
BMC Fam Pract. 2018 Sep 27;19(1):162. doi: 10.1186/s12875-018-0850-2.
Standardised generic patient-reported outcome measures (PROMs) which measure health status are often unresponsive to change in primary care. Alternative formats, which have been used to increase responsiveness, include individualised PROMs (in which respondents specify the outcomes of interest in their own words) and transitional PROMs (in which respondents directly rate change over a period). The objective of this study was to test qualitatively, through cognitive interviews, two PROMs, one using each respective format.
The individualised PROM selected was the Measure Yourself Medical Outcomes Profile (MYMOP). The transitional PROM was the Patient Enablement Instrument (PEI). Twenty patients who had recently attended the GP were interviewed while completing the questionnaires. Interview data was analysed using a modification of Tourangeau's model of cognitive processing: comprehension, response, recall and face validity.
Patients found the PEI simple to complete, but for some it lacked face validity. The transitional scale was sometimes confused with a status scale and was problematic in situations when the relevant GP appointment was part of a longer episode of care. Some patients reported a high enablement score despite verbally reporting low enablement but high regard for their GP, which suggested hypothesis-guessing. The interpretation of the PEI items was inconsistent between patients. MYMOP was more difficult for patients to complete, but had greater face validity than the PEI. The scale used was open to response-shift: some patients suggested they would recalibrate their definition of the scale endpoints as their illness and expectations changed.
The study provides information for both users of PEI/MYMOP and developers of individualised and transitional questionnaires. Users should heed the recommendation that MYMOP should be interview-administered, and this is likely to apply to other individualised scales. The PEI is open to hypothesis-guessing and may lack face-validity for a longer episode of care (e.g. in patients with chronic conditions). Developers should be cognisant that transitional scales can be inconsistently completed: some patients forget during completion that they are measuring change from baseline. Although generic questionnaires require the content to be more general than do disease-specific questionnaires, developers should avoid questions which allow broad and varied interpretations.
用于衡量健康状况的标准化通用患者报告结局指标（PROMs）在初级保健中往往对变化不敏感。为提高反应性而采用的替代形式包括个性化PROMs（即受访者用自己的语言指定感兴趣的结局）和过渡性PROMs（即受访者直接对一段时间内的变化进行评分）。本研究的目的是通过认知访谈对两种PROMs进行定性测试，每种形式各使用一种。
选择的个性化PROM是自我测量医疗结局概况（MYMOP）。过渡性PROM是患者赋能工具（PEI）。20名近期看过全科医生的患者在完成问卷时接受了访谈。访谈数据采用对图兰热认知加工模型的修改进行分析：理解、回答、回忆和表面效度。
患者发现PEI易于完成，但对一些患者来说它缺乏表面效度。过渡性量表有时会与状态量表混淆，并且在相关全科医生预约是较长护理过程一部分的情况下存在问题。一些患者尽管口头报告赋能程度低，但对全科医生评价很高，却报告了较高的赋能得分，这表明存在猜测假设的情况。患者之间对PEI项目的解释不一致。MYMOP对患者来说完成起来更困难，但比PEI具有更高的表面效度。所使用的量表容易出现反应转移：一些患者表示，随着病情和期望的变化，他们会重新校准对量表端点的定义。
该研究为PEI/MYMOP的使用者以及个性化和过渡性问卷的开发者提供了信息。使用者应注意MYMOP应由访谈者实施的建议，这可能也适用于其他个性化量表。PEI容易出现猜测假设的情况，并且对于较长护理过程（如慢性病患者）可能缺乏表面效度。开发者应认识到过渡性量表的完成可能不一致：一些患者在完成过程中会忘记他们是在测量相对于基线的变化。尽管通用问卷要求内容比疾病特异性问卷更具普遍性，但开发者应避免使用允许有广泛多样解释的问题。
