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Abstract Background The purpose of this paper is to examine the acceptability, feasibility, reliability and validity of a new decision quality instrument that assesses the extent to which patients are informed and receive treatments that match their goals. Methods Cross-sectional mail survey of recent breast cancer survivors, providers and healthy controls and a retest survey of survivors. The decision quality instrument includes knowledge questions and a set of goals, and results in two scores: a breast cancer surgery knowledge score and a concordance score, which reflects the percentage of patients who received treatments that match their goals. Hypotheses related to acceptability, feasibility, discriminant validity, content validity, predictive validity and retest reliability of the survey instrument were examined. Results We had responses from 440 eligible patients, 88 providers and 35 healthy controls. The decision quality instrument was feasible to implement in this study, with low missing data. The knowledge score had good retest reliability (intraclass correlation coefficient = 0.70) and discriminated between providers and patients (mean difference 35%, p Conclusions The decision quality instrument met the criteria of feasibility, reliability, discriminant and content validity in this sample. Additional research to examine performance of the instrument in prospective studies and more diverse populations is needed.

Abstract Background A high quality decision requires that patients who meet clinical criteria for surgery are informed about the options (including non-surgical alternatives) and receive treatments that match their goals. The aim of this study was to evaluate the psychometric properties and clinical sensibility of a patient self report instrument, to measure the quality of decisions about total joint replacement for knee or hip osteoarthritis. Methods The performance of the Hip/Knee Osteoarthritis Decision Quality Instrument (HK-DQI) was evaluated in two samples: (1) a cross-sectional mail survey with 489 patients and 77 providers (study 1); and (2) a randomized controlled trial of a patient decision aid with 138 osteoarthritis patients considering total joint replacement (study 2). The HK-DQI results in two scores. Knowledge items are summed to create a total knowledge score, and a set of goals and concerns are used in a logistic regression model to develop a concordance score. The concordance score measures the proportion of patients whose treatment matched their goals. Hypotheses related to acceptability, feasibility, reliability and validity of the knowledge and concordance scores were examined. Results In study 1, the HK-DQI was completed by 382 patients (79%) and 45 providers (58%), and in study 2 by 127 patients (92%), with low rates of missing data. The DQI-knowledge score was reproducible (ICC = 0.81) and demonstrated discriminant validity (68% decision aid vs. 54% control, and 78% providers vs. 61% patients) and content validity. The concordance score demonstrated predictive validity, as patients whose treatments were concordant with their goals had more confidence and less regret with their decision compared to those who did not. Conclusions The HK-DQI is feasible and acceptable to patients. It can be used to assess whether patients with osteoarthritis are making informed decisions about surgery that are concordant with their goals.

What subject lines and messages in an e-mailed invitation maximize cooperation for a web survey? Answering this question is ever more important as survey researchers increasingly turn to web surveys to reduce costs. We test respondents' preferences for subject lines and messages in an e-mailed invitation to participate in a Consumer Assessment of Healthcare Providers and Systems survey. Findings suggest that respondents prefer informative and straightforward subject lines that reference the purpose and the sponsor of the survey. Brief and uninformative subject lines should be avoided. In the body of the e-mail, respondents prefer messages that expand on the study's purpose and usefulness and extend a guarantee of confidentiality. Messages that encourage participation for the sake of the study's representativeness or accuracy are unpersuasive to potential respondents. Few differences emerged in preferences among demographic subgroups.

Cognitive testing has become routine for well-designed surveys. However, the protocols for cognitive testing vary widely, and observers have been concerned that analysis of the results is not systematic, that results are not replicable, and that the bases for conclusions are not transparent. To address some of those concerns, in this study the cognitive interviews were structured so that interviewers gathered information specifically about whether there was a problem with any of the four standard issues in question answering: comprehension, retrieval, estimation, and providing an answer. From the tape-recorded interviews, the percentage of respondents who had "no problem" with each element of question answering was tabulated for each question. In addition to being systematic and transparent, a strength of the approach is that it documents the positive features of questions, potentially providing evidence for the validity of answers as well as identifying possible question problems.

Objectives: To explore experiences of U.S. (United States) nursing home leadership during the COVID-19 pandemic in their efforts to address resident loneliness and social isolation and to elicit stories about personal and professional impacts on themselves and staff. Design: Qualitative inquiry via three optional open-ended questions appended to a national self-administered survey of American nursing home leaders was employed. Textual data was analyzed using an iterative reflexive thematic approach. Setting and participants: A stratified sample frame defined by facility size (beds: 30–99, 100+) and quality ratings (1, 2–4, 5) was employed. Web survey links and paper surveys were sent to 1,676 nursing home directors of nursing between February and May 2022. Results: Open text responses were collected from 271 nursing homes. Broad themes included: 1) Addressing needs of residents & families; 2) Challenges; and 3) Personal experiences of nursing home leadership/staff. Respondents described trauma to residents, staff, and leadership. Resident loneliness was addressed using existing and newer technologies and innovative indoor and outdoor activities. Residents experienced fear, illness, loss, and sometimes death. Isolation from family and lack of touch were particularly difficult. Regulations were seen as punitive while ignoring emotional needs of residents. Staffing challenges and pressures to do more with less created additional stress. Leadership and staff made significant sacrifices resulting in physical, social, and emotional consequences. Beneficial outcomes included staff bonding, professional growth, and permanent implementation of new interventions. Conclusions and implications: New and creative interventions were successfully implemented to address social isolation and loneliness. Improved Wi-Fi and other nursing home infrastructure upgrades are needed to maintain them. Reimagining often conflicting overlapping federal, state, and local regulations, grounding them in good clinical judgement, and incentivizing performance improvement should be considered. Trauma experienced by staff needs to be addressed to deal with current and future workforce needs. [ABSTRACT FROM AUTHOR]

We report on a federal initiative to develop a CAHPS[R] (The Consumer Assessment of Healthcare Providers and Systems) survey to measure residents' experiences with quality-of-care and quality-of- life in nursing homes (known as NHCAHPS). We focus on how we created and tested questions for inclusion in the instrument and tested a possible cognitive screener to determine which residents could participate in a NHCAHPS interview. The major lessons learned were: (1) In contrast to other CAHPS surveys, ratings were more useful than reports because of the difficulty that residents had with summarizing over time and people; (2) consistent with other CAHPS surveys, the 0 to 10 response scale appeared to work well with nursing home residents for many of the quality-of-care questions; however, a different response scale was needed for many of the quality-of-life items; and (3) in contrast with typical survey methodology and other CAHPS surveys where explicit time reference periods are used, a non-specific present reference period in questions seemed to work best. doi: 10.1300/J031v19n02_04 KEYWORDS. Patient experience, satisfaction survey, quality-of-care, quality-of-life

Background: The Shared Decision Making (SDM) Process scale is a brief, patient-reported measure of SDM with demonstrated validity in surgical decision making studies. Herein we examine the validity of the scores in assessing SDM for cancer screening and medication decisions through standardized videos of good-quality and poor-quality SDM consultations. Method: An online sample was randomized to a clinical decision—colon cancer screening or high cholesterol—and a viewing order—good-quality video first or poor-quality video first. Participants watched both videos, completing a survey after each video. Surveys included the SDM Process scale and the 9-item SDM Questionnaire (SDM-Q-9); higher scores indicated greater SDM. Multilevel linear regressions identified if video, order, or their interaction predicted SDM Process scores. To identify how the SDM Process score classified videos, area under the curve (AUC) was calculated. The correlation between SDM Process score and SDM-Q-9 assessed construct validity. Heterogeneity analyses were conducted. Results: In the sample of 388 participants (68% white, 70% female, average age 45 years) good-quality videos received higher SDM Process scores than poor-quality videos (P s < 0.001), and those who viewed the good-quality high cholesterol video first tended to rate the videos higher. SDM Process scores were related to SDM-Q-9 scores (r s > 0.58; P s < 0.001). AUC was poor (0.69) for the high cholesterol model and fair (0.79) for the colorectal cancer model. Heterogeneity analyses suggested individual differences were predictive of SDM Process scores. Conclusion: SDM Process scores showed good evidence of validity in a hypothetical scenario but were lacking in ability to classify good-quality or poor-quality videos accurately. Considerable heterogeneity of scoring existed, suggesting that individual differences played a role in evaluating good- or poor-quality SDM conversations. [ABSTRACT FROM AUTHOR]

Cognitive testing has become routine for well-designed surveys. However, the protocols for cognitive testing vary widely, and observers have been concerned that analysis of the results is not systematic, that results are not replicable, and that the bases for conclusions are not transparent. To address some of those concerns, in this study the cognitive interviews were structured so that interviewers gathered information specifically about whether there was a problem with any of the four standard issues in question answering: comprehension, retrieval, estimation, and providing an answer. From the tape-recorded interviews, the percentage of respondents who had “no problem” with each element of question answering was tabulated for each question. In addition to being systematic and transparent, a strength of the approach is that it documents the positive features of questions, potentially providing evidence for the validity of answers as well as identifying possible question problems. [ABSTRACT FROM AUTHOR]