Lukas Gramm

Patient communication competence: Development of a German questionnaire and correlates of competent patient behavior

OBJECTIVE The aim of our study was to design and psychometrically test a patient questionnaire to capture patient communication competence in the context of patient-provider interaction (CoCo questionnaire). We also aimed to determine patient characteristics associated with competent patient behavior. METHODS To assure content validity, we initially conducted 17 focus groups (n=97) made up of patients and providers. In the main study n=1.264 patients with chronic back pain, chronic-ischemic heart disease or breast cancer who underwent inpatient rehabilitation were surveyed at the end of rehabilitation. RESULTS The CoCo questionnaire contains four scales (patient adherence in communication, critical and participative communication, communication about personal circumstances, active disease-related communication) and 28 items addressing competent patient behavior. We provide evidence of unidimensionality, local independence, reliability, a Rasch-Model fit, the absence of differential item functioning, and signs of construct validity. The most important correlates of communication competence are health literacy and communication self-efficacy. CONCLUSION The CoCo questionnaire has good psychometric properties in German. Future research should examine CoCos responsiveness and analyze criterion validity by means of observation data. PRACTICE IMPLICATIONS The CoCo questionnaire can be recommended for use in evaluating patient communication training programs.

Taking into account patients’ communication preferences: Instrument development and results in chronic back pain patients

OBJECTIVE The objective is to develop an instrument that measures the extent of matching between patient communication preferences and physician communication behavior and takes various essential aspects of patient-provider communication into consideration. Furthermore we give a description of communication preferences and matching for chronic back pain patients. METHODS Using an existing questionnaire for assessing patient communication preferences (named KOPRA), a questionnaire on the communication behavior of physicians (KOVA questionnaire) was developed with identical contents. Combining KOPRA and KOVA items results in preference-matching items. N=703 patients were surveyed. RESULTS After item selection all scales of the KOVA questionnaire are unidimensional, reliable, and satisfy the requirements of an item response theory model. The preference-matching scales are also unidimensional and reliable (Cronbachs alpha .87-.91). In addition, there is evidence of the validity of both instruments. Matching between communication preferences and behavior is relatively high overall, but there are some areas with clear discrepancies. CONCLUSION AND PRACTICE IMPLICATIONS The preference-matching scales allow areas to be identified in which physicians are not very successful in addressing the communication preferences of patients. With back pain patients, physicians should take particular consideration of the very great need for open communication and information about further treatment.

Predictors of communication preferences in patients with chronic low back pain

Background The objective of this exploratory study was to identify patient-related predictors of communication preferences in patients with chronic low back pain for various dimensions of patient-physician communication (patient participation and orientation, effective and open communication, emotionally supportive communication, communication about personal circumstances). Methods Eleven rehabilitation centers from various parts of Germany participated in collection of data between 2009 and 2011. A total of 701 patients with chronic low back pain were surveyed at the start of rehabilitation. The patient questionnaire captured communication preferences, pain impact, pain intensity, and psychologic variables (fear avoidance beliefs, illness coherence, control beliefs, communication self-efficacy, and personality characteristics). The rehabilitation physicians filled out a documentation sheet containing information on diagnosis, inability to work, duration of the illness, and comorbidity at the beginning and end of rehabilitation. Hierarchical regression analyses were performed. Results On average, effective, open, and patient-centered communication was very important for patients with back pain, emotionally supportive communication was important, and communication about personal circumstances was somewhat important. The variance in communication preferences explained by the predictors studied here was 8%–19%. Older patients showed a lower preference for patient-centered and open communication, but a higher preference for communication about personal circumstances. Patients with psychologic risk factors (eg, fear avoidance beliefs), extroverted patients, and patients with high self-efficacy in patient-physician interaction generally had higher expectations of the physician’s communicative behavior. Conclusion Providers should take into consideration the fact that patients with back pain have a strong need for effective, open, and patient-centered communication. A flexible approach to communication needs appears to be especially important for communication about emotional and personal circumstances, because the patients differ most clearly in this respect. Personal characteristics provided only initial clues to possible preferences; for more precision, an individual assessment (by means of questionnaires or discussion) is needed.

Psychometric Properties of a German Translation of the PROMIS® Depression Item Bank

The patient-reported outcome measurement information system (PROMIS®) initiative has developed and evaluated a set of publicly available, efficient, and flexible measures of patient-reported outcomes in different health domains, including mental health. The objective of this study was to translate the PROMIS Depression item bank into German and evaluate the psychometric properties of the translated items. Items were translated using forward and backward translation and cognitive interviews. Distribution characteristics, unidimensionality, Rasch model fit, reliability, construct validity, and internal responsiveness were investigated in a sample of 234 patients in in-patient psychosomatic rehabilitation centers in Germany. The translated items showed good psychometric properties, the distribution characteristics were satisfactory, and the sufficient unidimensionality was obtained by fitting a bifactor model. The construct validity was demonstrated, and it was reliable and was shown to detect clinically significant changes. The translated items can be recommended for the assessment of depression. Future studies should examine the generalizability of the results.

Development and Psychometric Evaluation of a German Version of the PROMIS® Item Banks for Satisfaction With Participation

The Patient Reported Outcomes Measurement Information System (PROMIS) initiative aims to provide reliable and precise item banks measuring patient-reported outcomes in different health domains. The aim of the present work was to provide a German translation of the PROMIS item banks for satisfaction with participation and to psychometrically test these German versions. Cognitive interviews followed a forward–backward translation. Distribution characteristics, unidimensionality, Rasch model fit, reliability, construct validity, and internal responsiveness were tested in 262 patients with chronic low back pain undergoing rehabilitation. Results for the final 13- and 10-item German static scales (Satisfaction with Participation in Social Roles–German version [PSR-G] and Satisfaction for Participation in Discretionary Social Activities–German version [PSA-G]) regarding unidimensionality were satisfactory. The scales are reliable and show good Rasch model fit and distribution characteristics. Both scales are sensitive to small to moderate clinical changes, and we observed initial proof of construct validity. These German versions of the Satisfaction with Participation scales can be recommended to assess participation in a clinical context. The scales’ applicability in other contexts should be examined.

Psychometric properties of the German version of the MacNew heart disease health-related quality of life questionnaire

BackgroundThere is a lack of German-language, disease-specific health related quality of life instruments applicable in cardiac rehabilitation. The purpose of this project was to investigate the psychometric properties of the German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire (MacNew) in patients undergoing cardiac rehabilitation.MethodsThe MacNew was filled out by 5692 inpatients. We analysed acceptance (number of missing values), ceiling and floor effects, reliability (Cronbach’s α), factor structure (confirmatory factor analysis), construct validity (correlation with a generic health-related quality of life instrument), and sensitivity to change.ResultsTwo items had more than 7% missing data. We observed neither floor nor ceiling effects. Cronbach’s α of the scales ranged from 0.78 (physical scale) to 0.95 (global scale). Confirmatory factor analysis failed to reproduce the proposed factor structure (CFI = 0.882; TLI = 0.871; RMSEA = 0.074). We therefore drafted our own model (CFI = 0.932; TLI = 0.921; RMSEA = 0.064), and observed a correlation pattern largely conforming to the hypotheses with a generic health-related quality of life instrument. The effect sizes we noted between the start and end of rehabilitation fell between 0.66 and 0.74; at the 6-month follow-up they ranged from 0.69 to 0.92.ConclusionsThe German version of the MacNew Heart Disease Health-related Quality of Life Questionnaire is a suitable instrument with which to measure the impairment experienced by individuals with heart disease during inpatient cardiologic rehabilitation. The social and the global scale must be interpreted cautiously.