The Cancer Patient Experiences Questionnaire (CPEQ): reliability and construct validity following a national survey to assess hospital cancer care from the patient perspective

Abstract

ObjectivesPatient experience questionnaires have been criticised owing to the lack of supporting psychometric evidence. The objective of this study was to describe the development and psychometric evaluation of the Cancer Patient Experiences Questionnaire (CPEQ) in Norway.DesignQuestionnaire development was based on a literature review of existing questionnaires, patient interviews, expert-group consultations, pretesting of questionnaire items and a national survey. Psychometric evaluation included exploratory and confirmatory factor analysis, and tests of internal consistency reliability and test–retest reliability.SettingData were collected using a postal survey of cancer patients attending 54 hospitals in all 4 health regions. The subjects were 14 227 adult cancer patients who had attended an outpatient clinic or who had been discharged from an inpatient ward. Patients with all types of cancer were included. Data quality, internal consistency reliability and construct validity were assessed.ResultsOf the 13 846 patients who received the CPEQ, 7212 (52%) responded. Exploratory factor analysis identified six scales of outpatient experiences relating to nurse contact, doctor contact, information, organisation, patient safety and contact with next of kin, and seven scales of inpatient experiences, with the addition of hospital standard to the aforementioned scales. All but two of the scales met the criterion of 0.70 for Cronbach's α testing, and test–retest correlations ranged from 0.57 to 0.85. Confirmatory factor analysis supported the interpretation of six and seven scales for outpatients and inpatients, respectively. Statistically significant associations based on explicit hypotheses provided evidence for the construct validity of the scales. One additional scale measuring the hospital level was identified (α=0.85).ConclusionsThe CPEQ is a self-report instrument that includes the most important aspects of patient experiences with cancer care at hospitals. The instrument was tested following a national survey in Norway; good evidence is provided herein for the internal consistency reliability, test–retest reliability and construct validity.

The family experiences of in-hospital care questionnaire in severe traumatic brain injury (FECQ-TBI): a validation study

“…As illustrated in Table 1, four of the overall single-item questions were identical to the overall questions in the PEPC questionnaire, and three were added in this study: regarding transfer between departments, economical needs and care of involved children. These overall single-item questions were not suitable for factor analysis, as they were never meant to be included in factors or scales [12, 13, 22]. …”

“…The concepts of satisfaction and experiences are positively related and often used interchangeably [14]. Asking patients about their specific experience with concrete events is more valid and easier to interpret than satisfaction ratings [13, 15, 16]. The evidence-based knowledge of patients’ treatment experiences following severe traumatic brain injury (TBI) is limited [17, 18] Important areas for quality of care include information from staff and the organization of services.…”

“…An intention, not covered in the PEPC questionnaire, was to evaluate separately the acute care and the inpatient rehabilitation phases, and to use a multidisciplinary approach with information about experiences with “staff” rather than “nursing” and “doctor services”. Moreover the development of questionnaires for new groups must incorporate their specific experiences, which focus group interviews may provide [13]. …”

The Patient-Reported Incident in Hospital Instrument (PRIH-I): assessments of data quality, test–retest reliability and hospital-level reliability

“…The conceptual approach was further developed and refined as part of the project, but the study did not follow our standard development and validation process. [12][13][14][15] An internal reference group was used instead of an external group, and we only conducted cognitive interviews with patients, not indepth interviews. The inclusion of the PRIH-I within an existing patient-experience questionnaire gave rise to space restrictions.…”

“…Our standard development and validation process was the starting point for this project, [12][13][14][15] including multiple activities to ensure content validity in the development phase, and a set of psychometric tests in the quantitative phase to assess instrument quality. Adjustments had to be made because of time restrictions and the measurement construct, the latter in particular resulting in substantial changes.…”