Background
Methods
Search strategy
Selection criteria
Identification of eligible instruments
Data extraction
Quality assessment
Results
Included instruments
Characteristics of the included instruments
Name of the instrument (First author, year of publication) | Origin of first author | Main purpose (Measurement aim, clinical domain and context of use envisioned by author) | Description (number of dimensions and items) | Response scale | Patient version | Number of citations |
---|---|---|---|---|---|---|
Physician Satisfaction Scale (Shore, 1986) [54, 76, 83] | Department of Preventive, Family and Rehabilitation Medicine | -To study physician satisfaction in encounter-specific situations. -Non-specific clinical problem. -Clinical and educational (the authors thought that the use of this instrument could serve as a possible pathway to changing providers' behaviour through self-awareness). | -2 dimensions/16 items -understanding the patient's problem, having a sense that the patient understood what the physician said, affective reactions to the interaction with the patient and satisfaction of physician and patient were included. | 5 pt Likert | No | 14 |
Mental Work-Load Instrument (Bertram, 1992) [55, 56, 59, 74] | Department of Social and Preventive Medicine | -To assess the subjective experience or cost incurred by a physician in performing patient care tasks that reflect the combined effect of demands imposed by task requirements, the support personnel, information and equipment resources provided the physician's skill and experience, strategies adopted by the physician, effort exerted, and emotional responses to the situation. -Non-specific clinical problem. -Quality improvement (the authors aimed at taking into account the cognitive processes involved in physician work so that physicians could be trained or patient care settings structured to minimize the physician limitations and improve their performance as well as the productivity of the organization). | -5 dimensions/6 items -mental effort, physical effort, difficulty, performance and psychological stress (each with 1 item except performance with 2). | 0.0 – 10.0 visual analogue scale with bipolar descriptors. | No | 8 |
Questionnaire concerning the sources of frustration physicians experience in their work with patients (Levinson, 1993) [72] | Department of Medicine | -To identify specific aspects of patient visits that cause physician frustration and to develop a self-assessment instrument for physicians -Non-specific clinical problem. -Quality improvement (the authors thought that through reflection, this instrument would assist physicians to identify areas of their experience with patients that are frustrating and that need improvement and that ultimately, patient care would be improved). | -7 dimensions/25 items -lack of trust, too many problems, feeling distressed, lack of adherence, lack of understanding, demanding/controlling patients, and special problems (each with 3–4 items). | 5 pt Likert | No | 49 |
Physician Satisfaction Questionnaire (Suchman, 1993) [84, 85] | Department of Medicine and Psychiatry | -To assess physician satisfaction with primary care office visits in encounter-specific contexts, and to identify determinants of physician satisfaction. -Non-specific clinical problem. -Research, clinical and educational (the authors thought that this instrument could be used to guide the preparation of future physicians with skills, knowledge and attitudes they will need to practice in a manner that is satisfying both to their patients and to themselves). | -4 dimensions/20 items -quality of the patient doctor relationship, adequacy of the data collection process during the visit, appropriate use of time during the visit and patient's non-demanding, cooperative nature. | 5 pt Likert | No | 44 |
Collaboration and Satisfaction about Care Decisions (Baggs, 1994) [49–53, 75] | School of Nursing | -To measure nurse-physician collaboration in making specific patient care decisions in intensive care units. -Intensive Care Unit (ICU) settings (the author assumed that it could be used in non-ICU settings or to refer to other type of patient care decisions as well). -Research and quality improvement (the author thought ultimately, responses to this instrument could be linked to patient and provider outcomes). | -2 dimensions/9 items -level of collaboration between the physician and the nurse in making the decision (7 items) and satisfaction with the decision and decision-making process (2 items) | 7 pt Likert | No | 20 |
Medical Communication Competence Scale (Cegala, 1998) [60–63] | Department of Communication | -To measure doctor's and patient's perceptions of self and other communication competence during a general medical interview. -Non-specific clinical problem. -Research. | -4 dimensions/37 items -information giving, seeking and verifying and socio emotional communication. | 7 pt Likert | Yes | 10 |
Provider Decision Process Assessment Instrument (Dolan, 1999) [57, 64–67, 69–71] | Department of Medicine | -To measure physicians' degree of comfort with a clinical treatment decision. -Non-specific clinical problem. -Quality improvement and research (The author asserts that combining it with an equivalent patient-oriented measure would make it possible to comprehensively assess the clinical decision making process). | -4 dimensions/12 items -uncertainty, knowledge, value, effectiveness. Note: the English version of the questionnaire was translated into French by a professional translator and then back-translated into English by a family physician who was not associated with the authors. | 5 pt Likert | Yes | 7 |
Patient-Physician Discordance Scale (Sewitch, 2003) [77–82]. | Department of Medicine | -To assess discordance between physicians and their patients on evaluations of health-related information. -Chronic diseases, most specifically inflammatory bowel diseases. -Clinical and research. | -3 dimensions/10 items -symptoms and treatment, well-being and communication and satisfaction. Note: the English version of the questionnaire was translated into French by an independent bilingual medical translator and a bilingual psychology student, and then back-translated into English by two other bilingual graduate students who were not associated with the authors. | 100-mm visual analogue scale | Yes | 9 |
Mutual Understanding Scale (Harmsen, 2005) [68] | Department of Health policy and management and Department of general practice | -To develop a reliable measure of mutual understanding between general practitioners and patients. -Non-specific clinical problem. -Research or professional training. | -3 dimensions/8 criteria -perception of one's own ability to explain to the patient, perception of the patient's ability to explain to the physician, and perception of patient's understanding of consultation aspects. | Mixed | Yes | 1 |
Reasons for Treatment Selection Questionnaire (Linden, 2006) [73] | Research Group Psychosomatic Rehabilitation | -To assess reasons why physicians select or do not select a certain treatment. -Non-specific clinical problem. -N/A | -5 dimensions/22 items -theoretical knowledge, experiential knowledge, situational knowledge, anticipations about the further course of treatment, and interactional knowledge | 5 pt categorical response scale | N/A | 0 |
Questionnaire concerning the doctor-patient communication skills (Campbell, 2007) [58] | Royal College of Physicians and Surgeons of Canada | - To develop and psychometrically assess the feasibility, reliability and validity of an assessment tool in which both doctor and patient perceptions of the communication that occurred in a single office visit are captured. - Non-specific clinical problem in general practice and medical specialists practice. - Designed for use in the office settings. | - 2 dimensions/19 items - The final instrument captures both the process aspects of the visit (e.g. patient greeting, listening, and understanding) as well as the content of the visit (e.g. explanations, treatment options, next steps). | 5 pt Likert | Yes | 0 |
Development procedures and psychometrics of the included instruments
Instrument | Origins and development | Conceptual framework | Validity | Reliability |
---|---|---|---|---|
Physician Satisfaction Scale (Shore, 1986) [54, 76, 83] | Delphi method with family physicians to develop first 43-item version on 4 sub-scales. Tested on 49 physicians. The scale was then reduced to 16 items on two sub-scales and tested back on 131 physicians from Family Medicine, General Internal Medicine and Paediatric programs. | Not clear | Content validity: -efforts were put in the development phase of the instrument to ensure validity of the items (consultation with Delphi method). Construct validity: -factor analysis confirms two factors (average loading for patient-related: 0.71 and average loading for contextual: 0.58) -the instrument did not discriminate between different residency programs, geographical location or years of training. | Internal consistency: -Cronbach alpha for global scale: 0.85 (patient-related subscale: 0.89 and contextual subscale: 0.63) |
Physician Mental Workload (Bertram, 1992) [55, 56, 59, 74] | A previous version of the instrument was constructed through discussion with physicians and from a preliminary literature search. It was tested in two different hospital settings and revisions led to a 10-item version also presented on a visual analogue scale. The present instrument is a 6-item adaptation of this previous one. It was tested on 22 residents, who in all saw a total of 92 patients during an afternoon clinic session. It was tested with residents and physicians in practice, internal medicine and very few in paediatric residency | Broad domain of human performance research and measurement approaches employed in the field of human factors research. It encompasses motivational, social, attitudinal, and organizational factors as well as human capability assessment, information processing and decision making and stress effects on performance. | Content validity: -efforts have been made in the development of the first version of the instrument to ensure face validity by consulting physicians, and formal content validity by literature review. The process of selection of the items included in the present version is not described. Construct validity: -correlates with: fatigue: r = 0.42, mean experience, r = -0.65, resident self-rated quality: r = -0.67, third observer's overall quality rating, r = -0.18, personal interaction factor score: r = -.04, technical performance factor score: r = -0.38 -does not correlate with: total number of patients seen, proportion of new patients, patient complexity, personal interaction performance, overall ratings by faculty members and age of the residents. -does not discriminate between female and male residents nor among postgraduate years. Note: In order to not violate the assumption of independence between observations, the unit of analysis chosen was the resident, and an associated average score per resident was used with patient-specific measures. | Internal consistency : -Cronbach alpha: 0.80 (unadjusted for non-independence of observation) -Inter-items correlation: mean: 0.45 (SD.: 0.19) |
Physician Frustration in Communicating with patients (Levinson, 1993) [72] | A group of experts developed an initial set of 32 items corresponding to common problems encountered by physicians in their encounters with patients. This was pilot-tested on 107 physicians of diverse trainings. A second version of 42 items on 8 sub-scales was distributed to 931 physicians, and was reduced to 39 items, and this version was completed by 1076 physicians. Final version consists of 25 items on 7 sub-scales. | Broad domain pertaining to the quality of the communication and the relationship between patients and their physicians as important pathways to both the medical outcome and satisfaction of both parties. | Content validity: -efforts were put into the development phase of the instrument to ensure validity of the items (x consultation of experts) Construct validity: -factor analysis confirms 7 factors. Mean respective factor loading for all items is 0.68 (SD = 0.10) -the instrument discriminated between younger and older physicians (i.e. younger physicians had higher scores on all subscales meaning they felt more frustrated than the older physicians) and between primary care physicians and specialists on two subscales: too many problems and feeling distressed (i.e. primary care physicians had higher score than specialists). Greater time spent in primary care was associated with higher scores on several subscales. Convergent validity was shown with physicians' general level of satisfaction and the percentage of visits they reported as being frustrating correlating with higher scores on most subscales. | Not provided |
Physician Satisfaction with Primary Care Office Visits (Suchman, 1993) [84, 85] | The development of this instrument was achieved within a larger initiative, "The Collaborative Study of Communication Dynamics". This initiative was organized by the Task Force on Doctor and Patient of the Society of General Internal Medicine that was conducted at 11 sites in North America. Members of this group included well-known experts in the field of patient-doctor interaction and communication. The instrument was tested with 124 physicians (35 residents, 60 general internists and 3 family physicians) who saw a total of 550 patients. | Not clear | Content validity: face validity is considered in that the items of the scale share common ground with previously published measures Construct validity: -factor analysis reveals 4 distinct factors, but since these construct domains were not predicted at first in a theoretical framework, this analysis provides weaker support for the construct validity of the instrument -a number of patient characteristics were significantly associated with the sub-scales. For example, emotional distress of patients was negatively correlated with all satisfaction dimensions except the time dimension. Satisfaction with the patient doctor relationship sub scale was the most important determinant of global satisfaction (R2 = 39%) while the adequacy of data collection process was the second most important determinant (R2 = 4%). Note: Non-independence of observations was taken into account: a bootstrapping technique was used to create 10 replication samples of n = 124 and factor analysis was then performed 10 times. | Internal consistency -Cronbach alpha for the 19 specific items (excluding the general satisfaction question): 0.82 -Cronbach alpha for all 20 items: 0.84 |
Collaboration and Satisfaction about Care Decisions (Baggs, 1994) [49–53, 75] | This instrument is based on a conceptual model for collaboration for conflict resolution. It was developed from an initial 2-item version, the Decision About Transfer, a literature review on the subject and opinion of experts in collaborative practice and of practising professionals in the field. It was pilot tested on a convenience sample of 32 nurses and 26 residents in an intensive care unit. | Thomas (1976) conceptual model of collaboration for conflict resolution and organisational theory by Thompson (1967). | Content validity: -literature review on the subject and opinion of experts in collaborative practice and of practising professionals in the field. Construct validity: -factor analysis confirms a single factor (Eigen value of 4.5, no other higher than 1) that explains 75% of the 6 specific collaboration items variance. Mean factor loading for the six specific collaboration items was 0.87 (SD.: 0.04). -convergence of a combined score of the six specific collaboration items with a combined score of the two satisfaction items: r = 0.66 Criterion validity: -correlation of the six specific collaboration items with the global collaboration question: r = 0.87 Note: Non-independence of observations was taken into account: factor analysis was performed with a sample size of 56 (i.e. all independent data entry points) and confirmed one factor for collaboration | Internal consistency: -Cronbach's alpha: 0.93 -Inter-item correlations: 0.52 – 0.83 |
Medical Communication Competence Scale (Cegala, 1998) [60–63] | Post-interview questionnaires in clinical setting as well as self and other evaluation of communication competence by 15 family practice residents inspired the development of a first version of 56 items. Six physicians scored each item for their importance to communication competence during a medical consultation. Best items constituted the 37 items final version. A corresponding patient instrument was also pilot-tested concomitantly. Hence, these two instruments were pilot-tested with 65 doctors and 52 patients who provided a total of 117 data entries. | Extensive theoretical review supports the development of the scale. | Content validity: efforts were put into the development phase of the instrument to ensure validity of the items (face validity by consultation of potential users) Construct validity: -Factor analysis supports construct validity, but complete loading data is missing. -A cluster analysis using Euclidean distances among standardized item response was performed for each file. As hypothesized by the author, the results of both cluster analysis covered 4 clusters: information giving, information seeking, information verifying and socio emotional communication. -a series of research questions in which within-sample comparisons (i.e. comparisons made within the physician data file and the patient data file) and between-sample comparisons (i.e. comparisons made between the physician and the patient data files) were shown to be consistent with the literature on doctor-patient communication. For example, doctors rated their socioemotional competence higher than their competence in information exchange than in any of the other information subscales paralleling poor competence in information exchange observed in previous researches. | Internal consistency for the doctor's scale (Cronbach alpha's) - information giving: 0.86 - information seeking: 0.75 - information verifying: 0.78 - socio emotional communication: 0.90 |
Provider Decision Process Assessment Instrument (Dolan, 1999) [57, 64–67, 69–71] | Based on the construct of decisional conflict, this instrument is an adaptation of O'Connor's 16-item Patient Decisional Conflict Scale. Data were obtained on two sites from 14 residents, 7 physicians and one fellow in General Internal Medicine. | Ottawa Decision Support Framework. | Content validity: face validity assessed by asking participants for direct feedback. Construct validity: moderately confirmed by negative correlation with two satisfaction items: satisfaction with the decision (Spearman's r = -0.58) and assessment of the quality of the decision (Spearman's r = -0.52). | Internal consistency: -Cronbach alpha: 0.878 Note: In order to not violate the assumption of independence between observations, a bootstrapping approach was used. (i.e. 30 random samples consisting of one patient from each of seven physicians) Cronbach alpha was 0.90, 95%CI= 0.87 – 0.92. |
Patient-Physician Discordance Scale (Sewitch, 2003) [77–82]. | On the basis of a literature review, two domains were identified: patient's health status and the office visit. Two experts, a clinical psychologist and a gastroenterologist, were provided with a list of items recorded from the literature review and asked to select the top 10 items thought to be relevant to making treatment decision. A consensus was reached after a brief discussion. | Broad domain of patient-physician discordance. | Content validity: Based on the literature review and two experts. For construct and criterion validity, data are provided only for the combination of the physician's and patient's questionnaires | Data are provided only for the combination of the physician's and patient's questionnaires. |
Mutual Understanding Scale (Harmsen, 2005) [68] | This instrument was developed based on Kleinman's theory, a method of phasing or structuring of consultations by the physician (S.O.A.P. method) and a consensus method of decision-making called the Nominal Group Technique or expert-panel meeting | Kleinman's theory about the influence of culturally determined views on health beliefs and the necessity for physician and patient to demonstrate these views by exchanging explanatory models during the consultation. | Content validity: By using questions about different consultation aspects, known as GP standard of structuring the consultation, the complete consultation was covered. For construct and criterion validity, data are provided only for the combination of the physician's and patient's questionnaires | Data are provided only for the combination of the physician's and patient's questionnaires. |
Reasons for Treatment Selection Questionnaire (Linden, 2006) [73] | N/A | Action theory | N/A | N/A |
Questionnaire concerning the doctor-patient communication skills [58] | This pair of instruments was developed based on the Patient Centered Care method [98] and theories in the field of communication. Its authors drew on existing instruments and the communication skills expertise of 2 members of the steering group to create the pair of instruments. The initial instruments were administered to 4 specialists and 3 family doctors in Ontario, Canada, who, along with their patients, provided feedback. The final pair of instruments was tested with 16 family doctors and 22 specialists from 3 Canadian provinces. These doctors recruited a total of 1881 patients. | Patient Centered Care method [98] and theories in the field of communication. | Content validity: based on existing instruments and the communication skills expertise of 2 members of the steering group to create the pair of instruments. Construct validity: -Factor analysis was performed by using the whole set of 38 items (19 items in the doctor's questionnaire plus 19 items in the patient's questionnaire) to ascertain whether the patient and doctor items were 2 separate factors. Then by examining the data for patient and doctor separately, the authors ascertained if the process and content items accounted for separate factors. The items on all 3 datasets (i.e. 19 items from the patient data alone, 19 items from the doctor data alone, and the combined dataset of 38 items) were separately intercorrelated using Pearson product) moment correlations. | Internal consistency: -Cronbach alpha for the doctor and patient questionnaires: 0.70 and 0.69, respectively. Number of patients per doctor required for a reliable assessment of the doctor's overall communication skills: - The G analysis provided a G = 0.98 and 0.40 (standard errors of 0.003 and 0.02) for doctors and patients, respectively. |
Quality of the studies that reported on the included instruments
Section and Topic | Item | [83] | [56] | [72] | [84] | [50] | [61] | [65] | [81] | [68] | [73]* | [58] |
---|---|---|---|---|---|---|---|---|---|---|---|---|
TITLE/ABSTRACT
| Identify the article as a study concerning a measuring instrument. | + | + | + | + | + | + | + | + | + | 0 | + |
INTRODUC-TON
| State the research questions or study aims, like developing or validating a measuring instrument. | + | + | + | + | + | + | + | + | + | 0 | + |
METHODS
| ||||||||||||
Participants
| Describe the study population: The inclusion and exclusion criteria, setting and locations where the data were collected. | + | + | + | + | + | + | + | + | + | 0 | + |
Describe the method of recruitment of the participants. | 0 | 0 | 0 | + | 0 | 0 | 0 | + | + | 0 | + | |
Describe participant sampling: Was the study population a consecutive series of participants defined by the selection criteria in items 3 and 4? If not, specify how participants were further selected. | 0 | 0 | 0 | 0 | 0 | + | 0 | + | + | 0 | + | |
Describe data collection: Was data collection planned before the use of the measuring instrument? | 0 | 0 | 0 | + | 0 | + | 0 | + | 0 | 0 | + | |
Test methods
| Describe the reference standard criterion validity and its rationale. | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + | 0 | + | 0 |
Describe technical specifications of material and methods involved including how and when measurements were taken, and/or cite references for measuring instrument. | + | + | + | + | + | + | + | + | + | 0 | + | |
Describe definition of and rationale for the units, cut-offs and/or categories of the results of the instrument and the reference standard. | + | + | + | + | + | + | + | + | + | 0 | 0 | |
Describe the number, training and expertise of the persons executing and reading the measuring instrument and the reference standard. | 0 | 0 | 0 | + | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Describe other tests or relevant information for the readers concerning the measuring instrument (subjective). | + | + | + | + | + | + | + | + | + | + | + | |
Statistical methods
| Describe methods for calculating or comparing measures of reliability, validity, and the statistical methods used to quantify uncertainty (e.g. 95% confidence intervals) | + | + | 0 | + | + | 0 | + | + | + | 0 | + |
Describe methods for calculating test reproducibility, if done. | 0 | 0 | 0 | 0 | 0 | 0 | + | 0 | 0 | 0 | + | |
Describe a method that takes into account non-independence of data (if applicable) | 0 | + | 0 | + | + | 0 | + | 0 | 0 | 0 | 0 | |
RESULTS
| ||||||||||||
Participants
| Report when study was done, including beginning and ending dates of recruitment. | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + | + | 0 | 0 |
Report demographic characteristics of the study population (e.g. age, sex, employment, recruitment centers). | + | + | + | + | + | + | 0 | + | + | 0 | + | |
Report the number of participants satisfying the criteria for inclusion (a flow diagram is strongly recommended). | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + | + | 0 | + | |
Test results
| Report time interval from the measuring instrument to the reference standard, and any measures administered in between. | 0 | 0 | 0 | 0 | 0 | 0 | 0 | + | 0 | 0 | 0 |
Report distribution of severity of the situation being assessed (define criteria) in those with the target condition; other diagnoses in participants without the target condition | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Report a cross tabulation of the results of the measuring instrument (including indeterminate and missing results) by the results of the reference standard; for continuous results, the distribution of the test results by the results of the reference standard | + | 0 | + | + | + | + | + | + | + | 0 | 0 | |
Report any adverse events from performing the measuring instrument or the reference standard | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Estimates
| Report estimates of accuracy and measures of statistical uncertainty (e.g. 95% confidence intervals). | + | + | + | + | 0 | + | + | + | + | 0 | 0 |
Report how indeterminate results, missing responses and outliers of the measuring instrument were handled. | 0 | 0 | 0 | 0 | 0 | + | + | 0 | 0 | 0 | 0 | |
Report estimates of variability of accuracy between groups of participants, if done. | 0 | 0 | + | + | 0 | 0 | + | 0 | 0 | 0 | + | |
Report estimates of test reproducibility, if done. | 0 | 0 | 0 | 0 | 0 | 0 | + | 0 | 0 | 0 | + | |
DISCUSSION
| Discuss the clinical applicability of the study findings. | + | + | + | + | + | + | + | + | + | 0 | + |
11/26 | 11/26 | 11/26 | 16/26 | 11/26 | 13/26 | 15/26 | 18/26 | 15/26 | 2/26* | 14/26 |