Measuring cancer care coordination: development and validation of a questionnaire for patients

BMC Cancer

Joanne Shaw³  Michael J Solomon¹  Phyllis N Butow²  Jennifer Walsh³  Jane M Young³ 

[1]Discipline of Surgery, University of Sydney, Sydney, NSW, Australia

[2]Centre for Medical Psychology and Evidence-based Decision Making (CeMPED), School of Psychology, University of Sydney, Sydney, NSW, Australia

[3]Surgical Outcomes Research Centre, University of Sydney and Sydney Local Health Network, Sydney, NSW, Australia

关键词: psychometrics;    questionnaire;    coordination of cancer care;    cancer;   

Others  :  1080837
DOI  :  10.1186/1471-2407-11-298

 received in 2011-01-14, accepted in 2011-07-15,  发布年份 2011

【 摘 要 】

Background

Improving the coordination of cancer care is a priority area for service improvement. However, quality improvement initiatives are hindered by the lack of accurate and reliable measures of this aspect of cancer care. This study was conducted to develop a questionnaire to measures patients' experience of cancer care coordination and to assess the psychometric properties of this instrument.

Methods

Questionnaire items were developed on the basis of literature review and qualitative research involving focus groups and interviews with cancer patients, carers and clinicians. The draft instrument was completed 686 patients who had been recently treated for a newly diagnosed cancer, including patients from metropolitan, regional and rural areas of New South Wales, Australia. To assess test-retest reliability, 119 patients completed the questionnaire twice. Unreliable items those with limited variability or high levels of missing data were eliminated. Exploratory factor analysis was conducted to define the underlying factor structure of the remaining items and subscales were constructed. Correlations between these and global measures of the experience of care coordination and the quality of care were assessed.

Results

Of 40 items included in the draft questionnaire, 20 were eliminated due to poor test-retest reliability (n = 4), limited response distributions (n = 8), failure to load onto a factor (n = 7) or detrimental effect on the internal consistency of the scale (n = 1). The remaining 20 items loaded onto two factors named 'Communication' and 'Navigation', which explained 91% of the common variance. Internal consistency was with high for the instrument (Cronbach's alpha 0.88) and each subscale (Cronbach's alpha 0.87 and 0.73 respectively). There was no apparent 'floor' or 'ceiling' effect for the total score or the Communication subscale, but evidence of a ceiling effect for the Navigation subscale with 21% of respondents achieving the highest possible score. There were moderate positive associations between the total score and global measures of care coordination (r = 0.57) and quality of care (r = 0.53).

Conclusions

The instrument developed in this study demonstrated consistency and robust psychometric properties. It may provide a useful tool to measure patients' experience of cancer care coordination in future surveys and intervention studies.

【 授权许可】

   
2011 Young et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Institute of Medicine: Crossing the Quality Chasm: a New Health System for the 21st Century. Washington DC: National Academy Press; 2001.
• [2]Bowles EJ, Tuzzio L, Wiese CJ, et al.: Understanding high-quality cancer care: a summary of expert perspectives. Cancer 2008, 112:934-42.
• [3]Department of Health: The NHS Cancer Reform Strategy. London, Department of Health; 2007.
• [4]National Health Priority Action Council: National Service Improvement Framework for Cancer. Canberra: National Health Priority Action Council; 2004.
• [5]King M, Jones L, Richardson R, et al.: The relationship between patients' experiences of continuity of cancer care and health outcomes: a mixed methods study. Br J Cancer 2008, 98:529-536.
• [6]Clinical Oncological Society of Australia, the Cancer Council Australia and the National Cancer Control Initiative: Optimising Cancer Care in Australia. NCCI, Melbourne; 2003.
• [7]National Cancer Institute: The NCI strategic plan for leading the nation to eliminate the suffering and death due to cancer. US Department of Health and Human Services, National Institutes of Health, NIH Publication No 06-5773; 2006.
• [8]McDonald KM, Sundaram V, Bravata DM, et al.: Technical Review 9. In Care coordination. Volume 7. Edited by Shojania KG, McDonald KM, Watcher RM, Owens DK. AHRQ Publication No. 04(04)-0051-7. Rockville, MD: Agency for Healthcare Research and Quality; 2007.
• [9]Yates P: Cancer care coordinators: realising the potential for improving the cancer journey. Cancer Forum 2004, 28:128-132.
• [10]Saultz JW: Defining and measuring interpersonal continuity of care. Ann Fam Med 2003, 1:134-143.
• [11]Coleman EA, Mahoney E, Parry C: Assessing the quality of preparation for post hospital care from the patient's perspective: the care transitions measure. Med Care 2005, 43:246-55.
• [12]McGuiness C, Sibthorpe B: Development and initial validation of a measure of coordination of health care. Int J Qual Health Care 2003, 15:309-18.
• [13]Glasgow RE, Wagner EH, Schaefer J, et al.: Development and validation of the Patient Assessment of Chronic Illness Questionnaire. Med Care 2005, 43:436-44.
• [14]Walsh J, Young JM, Harrison J, Butow P, Solomon MJ, Masya L, White K: What is essential in cancer care coordination: a qualitative investigation. Eu J Cancer Care 2011, 20:220-7.
• [15]Altman D: Practical statistics for medical research. London, Chapman and Hall; 1991.
• [16]Streiner DL, Norman GR: Health measurement scales: a practical guide to their development and use. 3rd edition. Oxford, UK: Oxford University Press; 2003.
• [17]Kim JO, Mueller CW: Factor analysis: statistical methods and practical issues. Beverly Hills, CA: Sage; 1978.
• [18]Hatcher L: A step-by-step approach to using SAS for factor analysis and structural equation modelling. Cary, NC: SAS Institute; 2004.
• [19]SAS Institute Inc: The SAS System for Windows Version 9.1.3. Cary, NC: SAS Institute Inc; 2002.
• [20]Hair MJF, Anderson RE, Tatham RL, Black WC: 'Factor analysis'. In Multivariate data analysis. Volume 3. 5th edition. NJ: Prentice-Hall; 1998::98-99.
• [21]Nazareth I, Jones L, Irving A, et al.: Perceived concepts of continuity of care in people with colorectal and breast cancer - a qualitative case study analysis. Eu J Cancer 2008, 17:569-77.
• [22]Haggerty JL, Reid RJ, Freeman GK, Starfield BH, Adair CE, McKendry R: Continuity of care: a multidisciplinary review. BMJ 2003, 327:1219-21.
• [23]Guthrie B, Saultz JW, Freeman GK, Haggerty JL: Continuity of care matters. BMJ 2008, 337:548-9.
• [24]Eriksson EA, Mattsson LG: Quantitative measurement of continuity of care: measures in use and an alternative approach. Med Care 1983, 21:858-875.
• [25]Harley C, Adams J, Booth L, et al.: Patient experiences of continuity of cancer care: development of a new Medical Care Questionnaire (MCQ) for oncology outpatients. Value in Health 2009, 12:1180-6.
• [26]Hadjistavropoulos H, Biem H, Sharpe , et al.: Patient perceptions of hospital discharge: reliability and validity of a Patient Continuity of Care Questionnaire. Int J Qual Health Care 2008, 20:314-323.
• [27]Teno JM, Lima JC, Doyle Lyons K: Cancer patient assessment and reports of excellence: reliability and validity of advanced cancer patient perceptions of the quality of care. J Clin Oncol 2009, 27:1621-6.
• [28]Trask PC, Tellefsen C, Espindle D, Getter C, Hsu M-A: Psychometric validation of the Cancer Therapy Satisfaction Questionnaire. Value in Health 2008, 11:669-79.