Abstract
Clinician compassion is a vital element of health care quality. Currently, there appears to be no validated and feasible method for health care organizations to measure patient assessment of clinician compassion on a large scale. To develop and validate a tool for measuring patient assessment of clinician compassion that can be used in conjunction with the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey. This prospective cohort study took place from June 1 to August 30, 2018, at a US academic health care system among a pilot cohort consisting of 3325 adult patients and a validation cohort consisting of 3483 adult patients, both of whom had an outpatient clinic visit and completed the CG-CAHPS survey. After a comprehensive literature review, 12 candidate survey items were developed. Face and construct validity were performed. Candidate items were disseminated to patients in conjunction with the CG-CAHPS survey in a series of 2 studies: (1) exploratory factor analysis in one cohort to determine the factor structure and the most parsimonious set of items; and (2) validity testing in a second cohort using confirmatory factor analysis. Reliability was tested using Cronbach α. Convergent validity was tested with patient assessment of clinician communication and overall satisfaction questions from CG-CAHPS survey. Overall, 6493 patient responses were analyzed. The mean (SD) age was 60 (15) years, 4239 patients (65.3%) were women, and 5079 (78.2%) were white. Exploratory factor analyses identified a 5-item compassion measure to be the most parsimonious. Confirmatory factor analyses found good fit. The compassion measure demonstrated good internal consistency (α = 0.94) and convergent validity (clinician communication: ρ = 0.44; overall satisfaction: ρ = 0.52) but reflected a patient experience domain (compassionate care) distinct from what is currently captured in the CG-CAHPS survey. A simple 5-item tool to measure patient assessment of clinician compassion was developed and validated for use in conjunction with CG-CAHPS survey.
Highlights
Compassion is the emotional response to another’s pain and suffering involving an authentic desire to help.[1,2,3] In health care, compassion is a fundamental component of the therapeutic relationship, and patients and physicians consider compassion to be a vital element of high-quality care.[4]
Focus on compassionate care is of potential importance to the financial sustainability of health care organizations, given that a lack of compassion is associated with increased resource utilization and health care spending.[14,15,16,17]
Given that our goal was to develop a concise measurement tool that can be added to the CG-CAHPS survey for wide dissemination across all practice areas of a health care organization, we identified the candidate items with the strongest factor loadings on a single construct
Summary
Compassion is the emotional response to another’s pain and suffering involving an authentic desire to help.[1,2,3] In health care, compassion is a fundamental component of the therapeutic relationship, and patients and physicians consider compassion to be a vital element of high-quality care.[4] is compassion desired by patients, but compassion is associated with better clinical outcomes. Across numerous conditions.[5] For example, greater patient perception of clinician compassion has been associated with reduced migraine headache disability,[6] enhanced immune response, shorter duration and lower severity of cold symptoms,[7] reduced depression and better quality of life,[8,9,10] better patient-reported outcome measures among trauma patients,[11] and better patient adherence to prescribed therapy.[12] A randomized clinical trial among oncology patients[13] found a compassion intervention to significantly reduce patient anxiety. Focus on compassionate care is of potential importance to the financial sustainability of health care organizations, given that a lack of compassion is associated with increased resource utilization and health care spending.[14,15,16,17]
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