Behavioral & Policy Sciences Department, RAND Corporation, Boston, Massachusetts, USA.
University of Vermont, Department of Family Medicine, Burlington, Vermont.
J Pain Symptom Manage. 2022 May;63(5):689-697.e1. doi: 10.1016/j.jpainsymman.2022.01.002. Epub 2022 Jan 10.
Patient experience of palliative care serves as an important indicator of quality and patient-centeredness.
To develop a novel patient-reported scale measuring ambulatory palliative care patients' experience of feeling heard and understood by their providers.
We used self-reported patient experience data collected via mixed-mode survey administration. We conducted an exploratory factor analysis (EFA) and an expert panel ranking exercise to reduce the 10-item set based on underlying dimensionality. We then used item response theory (IRT) to calibrate remaining items based on psychometric properties and test information and precision. We considered item-level fit and examined the standardized local dependence chi-square statistics. We evaluated candidate items for differential item functioning by survey mode. We evaluated the test-retest reliability and validity of the final scale.
The EFA yielded a single factor (9/10 items had loadings > 0.80 on the single factor). We removed two items with the lowest factor loadings and ranked by the expert panel as being least reflective of the overall construct. IRT calibration of the remaining eight items showed high slopes (range 2.66 - 5.18); location parameters were all negative (range -0.90 - -0.36). We removed two more items based on local dependence indices and item-level fit. Combining psychometric information with the expert ratings we established the final 4-item scale, which was reliable (Cronbach's alpha = 0.84; polychoric correlation coefficient = 0.72) and had good convergent validity.
This novel multi-item Feeling Heard and Understood scale can be used to measure and improve ambulatory palliative care patient experience.
患者对姑息治疗的体验是衡量质量和以患者为中心的重要指标。
开发一种新的患者报告量表，用于衡量门诊姑息治疗患者对其提供者的倾听和理解程度。
我们使用通过混合模式调查管理收集的自我报告患者体验数据。我们进行了探索性因素分析（EFA）和专家小组排名练习，根据潜在的维度减少 10 项设置。然后，我们使用项目反应理论（IRT）根据心理测量特性和测试信息和精度来校准剩余的项目。我们考虑了项目级别的拟合度，并检查了标准化局部依赖卡方统计量。我们通过调查模式评估候选项目的差异项目功能。我们评估了最终量表的重测信度和效度。
EFA 产生了一个单一因素（9/10 个项目在单一因素上的负荷>0.80）。我们删除了两个具有最低负荷的项目，并由专家小组排名为最不反映整体结构的项目。IRT 对剩余八项项目的校准显示出较高的斜率（范围 2.66-5.18）；位置参数均为负值（范围-0.90 至-0.36）。我们根据局部依赖指数和项目级拟合度进一步删除了两个项目。将心理测量信息与专家评分相结合，我们建立了最终的 4 项量表，该量表具有可靠性（Cronbach's alpha = 0.84；多元相关系数 = 0.72）和良好的收敛效度。
这种新的多项目“感觉被倾听和理解”量表可用于衡量和改善门诊姑息治疗患者的体验。
