Background
Patients’ preferences
Information and education
Access to care
Emotional support
Family and friends
Continuity and transition
Physical comfort
Coordination of care
Improved outcomes
Development of instruments to assess the eight dimensions of PCC
Methods
Setting and participants
Data collection
Survey instruments
Development of items to assess PCC
Job satisfaction
Background characteristics
Analysis
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The overall test of goodness-of-fit assesses the discrepancy between the model implied and the sample covariance matrix via a normal-theory weighted least squares test. A plausible model has low, preferably non-significant χ2 values. Chi-square is, however, known to be overly sensitive when the sample size is large (more than 200 respondents) [44], resulting in difficulties to obtain the desired non-significant level [45].
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The Standardized Root Means square Residual (SRMR), which is a scale-invariant index for global fit ranging between 0 and 1. SRMR values below 0.08 indicate a good fit.
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The Root Mean Square Error of Approximation (RMSEA), which is preferably ≤0.06.
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The Comparative Fit Index (CFI), which compares the independent model (i.e., observed variables are unrelated) to the estimated model. CFI values are preferably larger than 0.95.
Results
Sample characteristics of professionals
Percentage | ||
---|---|---|
Gender | - Female | 86.8% |
Working past | - More than 5 years | 87.5% |
Working hours per week | - More than 22 h per week | 70.3% |
Occupation | - General support worker | 33.3% |
- Personal support worker | 26.8% | |
- Personal support worker day-care | 17.4% | |
- Paramedical | 2.6% | |
- Behavioral specialist | 2.1% | |
- Assistant support worker | 1.7% | |
- Assistant support worker day-care | 1.5% | |
- Others | 6.5% |
Datascreening
Item | Valid n | Missing | Mean | sd | |
---|---|---|---|---|---|
Patients’ preferences
| |||||
1.
|
Healthcare professionals treat clients with dignity and respect
| 463 | 1(0.2%) | 4.31 | .66 |
2.
|
Healthcare is focused on improving the quality of life of clients
| 463 | 1(0.2%) | 3.91 | .83 |
3.
|
Healthcare professionals take client’s preferences into account
| 463 | 1(0.2%) | 3.91 | .71 |
4. | Healthcare professionals involve clients in decisions regarding their care | 460 | 4(0.9%) | 3.21 | 1.02 |
5. | Clients are supported to set and achieve their own treatment goals | 456 | 8(1.7%) | 3.18 | 1.12 |
Physical comfort
| |||||
6.
|
Healthcare professionals pay attention to pain management
| 453 | 11(2.4%) | 3.50 | 1.14 |
7.
|
Healthcare professionals take client’s preferences for support with their daily living needs into account
| 462 | 2(0.4%) | 3.90 | .86 |
8. | Clients’ areas are clean and comfortable | 441 | 23(5.0%) | 3.19 | .91 |
9.
|
Clients have privacy
| 460 | 4(0.9%) | 3.29 | 1.02 |
Coordination of care
| |||||
10.
|
Healthcare professionals are well-informed; clients need to tell their story only once
| 453 | 11(2.4%) | 3.31 | .84 |
11.
|
Care is well-coordinated between professionals
| 464 | 0 (0.0%) | 3.50 | .82 |
12. | Clients know who is coordinating their care | 451 | 13(2.8%) | 3.65 | 1.17 |
13. | Clients have a first point of contact who knows everything about their condition and treatment | 459 | 5(1.1%) | 3.94 | 1.04 |
14.
|
Healthcare professionals work as a team in care delivery to clients
| 462 | 2(0.4%) | 4.10 | .87 |
Emotional support
| |||||
15.
|
Healthcare professionals pay attention to client’s anxiety about their situation
| 421 | 43(9.3%) | 3.99 | .88 |
16.
|
Healthcare professionals involve relatives in the emotional support of the client
| 456 | 8(1.7%) | 3.61 | .96 |
17.
|
Healthcare professionals pay attention to client’s anxiety over the impact of their illness on their loved ones (if applicable)
| 375 | 89(19.2%) | 3.30 | 1.16 |
Access to care
| |||||
18.
|
The building is accessible to all clients
| 458 | 6(1.3%) | 4.03 | 1.00 |
19.
|
Clear directions are provided to and inside the building
| 447 | 17(3.7) | 3.16 | 1.25 |
20.
|
It is easy to schedule an appointment
| 461 | 3(0.6%) | 3.28 | 1.01 |
21. | Waiting times for an appointment are acceptable | 457 | 7(1.5%) | 3.25 | .95 |
22. | Language is not a barrier for access to care | 453 | 11(2.4%) | 2.93 | 1.28 |
Continuity and transition
| |||||
23.
|
When a client is transferred to another ward, relevant patient information is transferred as well
| 459 | 5(1.1%) | 3.33 | 1.04 |
24.
|
Clients who are transferred are well-informed about where they are going, what care they will receive and who will be their contact person
| 440 | 24(5.2%) | 3.55 | 1.00 |
25.
|
Clients get skilled advice about care and support at home after discharge
| 432 | 32(6.9%) | 3.46 | 1.03 |
Information and education
| |||||
26. | Clients are well-informed about all aspects of their care | 435 | 29(6.3%) | 3.21 | .98 |
27.
|
Clients can access their care records
| 406 | 58(12.5%) | 2.87 | 1.47 |
28.
|
Clients are in charge of their own care
| 444 | 20(4.3%) | 2.93 | 1.10 |
29.
|
Healthcare professionals support clients to be in charge of their care
| 451 | 13(2.8%) | 3.41 | 1.02 |
30. | There is open communication between clients and healthcare professionals | 449 | 15(3.2%) | 3.83 | .94 |
31. | Healthcare professionals have good communication skills | 464 | 0 (0.0%) | 3.72 | .77 |
Family and friends
| |||||
32. | Accommodation for relatives is provided | 413 | 51(11.0%) | 1.43 | .81 |
33.
|
Healthcare professionals involve relatives in decisions regarding the patient’s care
| 462 | 2(0.4%) | 4.11 | .91 |
34.
|
Healthcare professionals pay attention to loved ones in their role as carer for the client
| 461 | 3(0.6%) | 3.91 | .89 |
35.
|
Healthcare professionals pay attention to the needs of family and friends of the client
| 455 | 9(1.9%) | 3.66 | .92 |
Confirmatory factor analysis with 35 items
Multiple imputed data using EM algorithm (n = 464) | Χ2
| RMSEA | CFI | SRMR |
---|---|---|---|---|
Model 1: 35 items | 3465.828 (P = 0.0) | 0.0719 | 0.957 | 0.0715 |
Model 2: final short version 24 items | 933.335 (P = 0.0) | 0.0474 | 0.986 | 0.0487 |
Confirmatory factor analysis with 24 items
Item | λ | Estimates (standard error) |
---|---|---|
Patients’ preferences
| ||
1. Healthcare professionals treat clients with dignity and respect | 0.771 | 0.771 (0.047) |
2. Healthcare is focused on improving the quality of life of clients | 0.689 | 0.689 (0.042) |
3. Healthcare professionals take client’s preferences into account | 0.762 | 0.762 (0.041) |
Physical comfort
| ||
4. Healthcare professionals pay attention to pain management | 0.476 | 0.476 (0.045) |
5. Healthcare professionals take client’s preferences for support with their daily living needs into account | 0.699 | 0.699 (0.041) |
6. Clients have privacy | 0.537 | 0.537 (0.040) |
Coordination of care
| ||
7. Healthcare professionals are well-informed; clients need to tell their story only once | 0.738 | 0.738 (0.046) |
8. Care is well-coordinated between professionals | 0.787 | 0.787 (0.036) |
9. Healthcare professionals work as a team in care delivery to clients | 0.647 | 0.647 (0.043) |
Emotional support
| ||
10. Healthcare professionals pay attention to client’s anxiety about their situation | 0.764 | 0.764 (0.038) |
11. Healthcare professionals involve relatives in the emotional support of the client | 0.863 | 0.863 (0.029) |
12. Healthcare professionals pay attention to client’s anxiety over the impact of their illness on their loved ones (if applicable) | 0.789 | 0.789 (0.031) |
Access to care
| ||
13. The building is accessible to all clients | 0.649 | 0.649 (0.053) |
14. Clear directions are provided to and inside the building | 0.555 | 0.555 (0.045) |
15. It is easy to schedule an appointment | 0.645 | 0.645 (0.041) |
Continuity and transition
| ||
16. When a client is transferred to another ward, relevant patient information is transferred as well | 0.617 | 0.617 (0.045) |
17. Clients who are transferred are well-informed about where they are going, what care they will receive and who will be their contact person | 0.857 | 0.857 (0.026) |
18. Clients get skilled advice about care and support at home after discharge | 0.838 | 0.838 (0.031) |
Information and education
| ||
19. Clients can access their care records | 0.598 | 0.598 (0.050) |
20. Clients are in charge of their own care | 0.859 | 0.859 (0.042) |
21. Healthcare professionals support clients to be in charge of their care | 0.842 | 0.842 (0.045) |
Family and friends
| ||
22. Healthcare professionals involve relatives in decisions regarding the patient’s care | 0.845 | 0.845 (0.042) |
23. Healthcare professionals pay attention to loved ones in their role as carer for the client | 0.901 | 0.901 (0.026) |
24. Healthcare professionals pay attention to the needs of family and friends of the client | 0.810 | 0.810 (0.043) |
Internal consistency and inter-correlations
24-item short version | Cronbach’s alpha | Scale mean (sd) | Correlations range | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Patients’ preferences | 1, 2, 3 | .71 | 4.05 (.58) | .31–.55 | ||||||||
2. Physical comfort | 6, 7, 9 | .52 | 3.57 (.72) | .40–.56 | .55*** | |||||||
3. Coordination of care | 10, 11, 14 | .69 | 3.64 (.66) | .32–.55 | .55*** | .54*** | ||||||
4. Emotional support | 15, 16, 17 | .77 | 3.63 (.76) | .34–.56 | .45*** | .56*** | .43*** | |||||
5. Access to care | 18, 19, 20 | .59 | 3.49 (.76) | .28–.45 | .40*** | .41*** | .45*** | .34*** | ||||
6. Continuity and transition | 23, 24, 25 | .77 | 3.44 (.82) | .44–.36 | .44*** | .40*** | .44*** | .42*** | .44*** | |||
7. Information and education | 27, 28, 29 | .74 | 3.07 (.94) | .31–.41 | .31*** | .41*** | .32*** | .41*** | .31*** | .41*** | ||
8. Family and friends | 33, 34, 35 | .85 | 3.89 (.79) | .28–.54 | .49*** | .46*** | .41*** | .54*** | .28*** | .36*** | .33*** | |
9. Overall PCC | All of the above | .93a
| 3.60 (.53) | .65–.76 | .72*** | .76*** | .71*** | .74*** | .65*** | .70*** | .66*** | .69*** |
Construct validity
Job satisfaction | |
---|---|
Patients’ preferences | .34*** |
Physical comfort | .30*** |
Coordination of care | .29*** |
Emotional support | .20*** |
Access to care | .31*** |
Continuity and transition | .32*** |
Information and education | .18*** |
Family and friends | .19*** |
Overall PCC | .38*** |
Overall PCC | |
---|---|
Personnel satisfaction | .37*** |
Workload | .20*** |
Professional support | .40*** |
Salary | .24*** |
Prospects and training | .24*** |