Patient surveys found lacking in measuring range of their experiences

The surveys patients take after medical appointments may not give useful information to providers, signaling a need for revised tools to measure patient experience, research published in Psychological Assessment found.

"When I started looking at the instruments currently being used to assess doctor-patient relationships, it became apparent they were highly problematic and not providing useful information," said researcher Keith Sanford, PhD, professor of psychology and neuroscience in Baylor's College of Arts & Sciences in Waco, Texas.

Dr. Sanford, a psychometrics scholar who creates assessment instruments, conducted several studies to gain insight into issues with scales used to evaluate physician-patient relationships. He then created a tool to measure patient experience during consultations. The study findings suggest the tool he created works better than others.

The tool, called the Medical Consultation Experience Questionnaire, measures two aspects of patient experience — "alliance" and "confusion." It addresses the consultation itself as opposed to treatment results, the researchers said.

Providers aim for a good alliance, where their patients see them as committed, competent and dedicated to understanding their desires and views. Providers also focus on avoiding confusion by ensuring a good exchange of information.

By trying to measure how well those goals are being met, previous questionnaires have limited options that may lead to skewed results, Dr. Sanford said.

One survey, for example, gives patients a four-point scale, where answers range from "always" to "never" to such questions as "How often did doctors listen carefully to you?"

The problem with surveys like these is that most patients pick the top response for each item, with fewer than 5 percent picking the bottom option, previous research found. Although these surveys can identify "highly disgruntled" patients, "it cannot make reliable distinctions between patients having experiences ranging from marginally acceptable to extremely positive," the researchers wrote.

The researchers conducted three studies with 576 participants to evaluate the new questionnaire. They then compared responses to the new survey with the same participants' responses to other questionnaires.

The study found the new questionnaire allowed for measuring a wider range of patient experiences with more extensive and specific responses, making for better assessment of "alliance" and "confusion" — as opposed to only finding  the most dissatisfied or angry patients, Dr. Sanford said.

"One of the reasons this is so important is if you don't form an alliance with your practitioner, they may give you all the wonderful advice in the world, but you might not follow it, or you might be skeptical," Dr. Sanford said. "And if you don't quite understand what you are supposed to do, that will interfere with your doing the recommended actions."

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