Measuring empathic, person-centred communication in primary care nurses:validity and reliability of the Consultation and Relational Empathy (CARE) Measure

Background Empathic patient-centred care is central to high quality health encounters. The Consultation and Relational Empathy (CARE) Measure is a patient-rated experience measure of the interpersonal quality of healthcare encounters. The measure has been extensively validated and is widely used by doctors in primary care but has not been validated in nursing. This study assessed the validity and reliability of the CARE Measure in routine nurse consultations in primary care. Methods Seventeen nurses from nine general medical practices located in three Scottish Health Boards participated in the study. Consecutive patients (aged 16 years or older) were asked to self-complete a questionnaire containing the CARE Measure immediately after their clinical encounter with the nurse. Statistical analysis included Spearman’s correlation and principal component analysis (construct validity), Cronbach’s alpha (internal consistency), and Generalisability theory (inter-rater reliability). Results A total of 774 patients (327 male and 447 female) completed the questionnaire. Almost three out of four patients (73 %) felt that the CARE Measure items were very important to their current consultation. The number of ‘not applicable’ responses and missing values were low overall (5.7 and 1.6 % respectively). The mean CARE Measure score in the consultations was 45.9 and 48 % achieved the maximum possible score of 50. CARE Measure scores correlated in predicted ways with overall satisfaction and patient enablement in support of convergent and divergent validity. Factor analysis found that the CARE Measure items loaded highly onto a single factor. The measure showed high internal consistency (Cronbach’s alpha coefficient = 0.97) and acceptable inter-rater reliability (G = 0.6 with 60 patients ratings per nurse). The scores were not affected by patients’ age, gender, self-perceived overall health, living arrangements, employment status or language spoken at home. Conclusions The CARE Measure has high face and construct validity, and internal reliability in nurse consultations in primary care. Its ability to discriminate between nurses is sufficient for educational and quality improvement purposes

Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening

Screening is a well-established tool to advance earlier cancer diagnosis. We used Davison’s concept of ‘candidacy’ to explore how individuals draw on collectively constructed images of ‘typical’ colorectal cancer (CRC) sufferers, or ‘candidates’, in order to evaluate their own risk and to ascertain the impact of candidacy on screening participation in CRC. We interviewed 61 individuals who were invited to participate in the Scottish Bowel Screening Programme. Of these, 37 were screeners (17 men and 20 women) and 24 non-screeners (13 men and 11 women). To analyse these data we used a coding frame that drew on: symptoms, risk factors, and retrospective and prospective candidacy. Few participants could identify a definite bowel cancer candidate and notions of candidacy were largely predicated on luck in the sense that anyone could be a candidate for CRC and there was little evidence to support a linear relationship between feelings of risk and screening decisions. Often participants described screening as part of a wider portfolio of being healthy and referred to feeling obliged to look after themselves. Our study suggests that rather than candidates for bowel cancer, screeners viewed themselves as candidates for screening by which screening decisions pointed towards the acceptance and normalisation of the rhetoric of personal responsibility for health. These findings have related theoretical and practical implications; the moral structure that underpins the new public health can be witnessed practically in the narratives by which those who see themselves as candidates for screening embrace wider positive health practices.</p

Assessing the Consultation and Relational Empathy (CARE) Measure in sexual health nurses' consultations

Background: Increasingly healthcare policies emphasise the importance of person-centred, empathic care. Consequently, healthcare professionals are expected to demonstrate the ‘human’ aspects of care in training and in practice. The Consultation and Relational Empathy (CARE) Measure is a patient-rated measure of the interpersonal skills of healthcare practitioners. It has been widely validated for use by healthcare professionals in both primary and secondary care. This paper reports on the validity and reliability of the CARE Measure with sexual health nurses. Methods: Patient questionnaires were collected for 943 consultations with 20 sexual health nurses. Participating patients self-completed the questionnaire immediately after the encounter with the nurse. The questionnaire included the ten item CARE Measure, the Patient Enablement Index, and overall satisfaction instruments. Construct validity was assessed through Spearman’s correlation and principal component analysis. Internal consistence was assessed through Cronbach’s alpha and the inter-rater reliability through Generalisability Theory. Data were collected in 2013 in Scotland. Results: Female patients completed 68% of the questionnaires. The mean patient age was 28.8 years (standard deviation 9.8 years). Two of the 20 participating nurses withdrew from the study. Most patients (71.7%) regarded the CARE Measure items as very important to their consultation and the number of ‘not applicable’ and missing responses’ were low (2.6% and 0.1% respectively). The participating nurses had high CARE Measure scores; out of a maximum possible score of 50, the overall mean CARE measure score was 47.8 (standard deviation 4.4). The scores were moderately correlated with patient enablement (rho = 0.232, p = 0.001) and overall satisfaction (rho = 0.377, p = 0.001. Cronbach’s alpha showed the measure’s high internal consistency (Cronbach’s alpha coefficient = 0.95), but the inter-rater reliability could not be calculated due to the high achieved CARE Measure scores that varied little between nurses. Conclusions: Within this clinical context the CARE Measure has high perceived relevance and face validity. The findings support construct validity and some evidence of reliability. The high CARE Measure scores may have been due to sample bias. A future study which ensures a representative sample of patients on a larger group of nurses is required to determine whether the measure can discriminate between nurses

Outcome related to impact on daily living: preliminary validation of the ORIDL instrument

<p>Abstract</p> <p>Background</p> <p>The challenge of finding practical, patient-rated outcome measures is a key issue in the evaluation of health care systems and interventions. The ORIDL (Outcome in Relation to Impact on Daily Living) instrument (formerly referred to as the Glasgow Homoeopathic Hospital Outcomes Scale or GHHOS) has been developed to measure patient's views of the outcome of their care by asking about change, and relating this to impact on daily life. The aim of the present paper is to describe the background and potential uses of the ORIDL, and to report on its preliminary validation in a series of three studies in secondary and primary care.</p> <p>Methods</p> <p>In the first study, 105 patients attending the Glasgow Homoeopathic Hospital (GHH) were followed-up at 12 months and changes in health status were measured by the EuroQol (EQOL) and the ORIDL. In the second study, 187 new patients at the GHH were followed-up at 3, 12, and 33 months, using the ORIDL, the Short Form 12 (SF-12), and the Measure Yourself Medical Outcome Profile (MYMOP). In study three, 323 patients in primary care were followed for 1 month post-consultation using the ORIDL and MYMOP. In all 3 studies the Patient Enablement Instrument (PEI) was also used as an outcome measure.</p> <p>Results</p> <p>Study 1 showed substantial improvements in main complaint and well-being over 12 months using the ORIDL, with two-thirds of patients reporting improvements in daily living. These improvements were not significantly correlated with changes in serial measures of the EQOL between baseline and 12 months, but were correlated with the EQOL transitions measure. Study 2 showed step-wise improvements in ORIDL scores between 3 and 33 months, which were only weakly associated with similar changes in SF-12 scores. However, MYMOP change scores correlated well with ORIDL scores at all time points. Study 3 showed similar high correlations between ORIDL scores and MYMOP scores. In all 3 studies, ORIDL scores were also significantly correlated with PEI-outcome scores.</p> <p>Conclusion</p> <p>There is significant agreement between patient outcomes assessed by the ORIDL and the EQOL transition scale, the MYMOP, and the PEI-outcome instrument, suggesting that the ORIDL may be a valid and sensitive tool for measuring change in relation to impact on life.</p

Predicting and comparing patient satisfaction in four different modes of health care across a nation

This study aims to inform strategic policy makers and managers about the value of general population surveys by determining and comparing dimensions of satisfaction in four different health services in Scotland: general practice, domiciliary care, outpatients and inpatients (including day cases). The research design involved secondary data analysis of a national telephone survey conducted to inform the development of a national health plan. The database was created using a stratified quota sample of 3052 people of 16 years and above resident in Scotland in 2000. The main outcome measures investigated were overall measures of patient satisfaction with each type of service. Principal components analysis was used to determine the dimensions. Interest was in the extent to which patients, many of whom were the same (having used more than one service), evaluated different services in similar ways, as well as those factors specific to each service. Using logistic regression, the results demonstrate that interpersonal care and information, and desired improvements in service were universal and key explanatory dimensions in all services, followed by a combination of access, physical facilities, time and quality of food, depending on relevance to the service. These factors, particularly interpersonal care and information, distinguished well the highly satisfied from the others, with age providing further discrimination between non-hospital patients, while gender added to discrimination between inpatients. In conclusion, despite the limitations of telephone interviews, it is feasible to ask about several services at the same time and for the answers to reflect common underlying dimensions of evaluation found in more exhaustive research within each service. These factors offer a set of summary measures by which services can be easily evaluated at a strategic level and point to where efforts to increase patient satisfaction can be maximised.Patient satisfaction General practice Domiciliary care Outpatients Inpatients Population surveys Scotland UK

Embracing Empathy: A Universal Approach to Person-Centred, Empathic Healthcare Encounters

This highly practical, user-friendly guide is based on a broad definition of relational empathy in the clinical context. With a clear focus on understanding the patient’s situation, perspective and feelings, and communicating and acting on that understanding in beneficial way, the book establishes the flexible, person-centred CARE Approach. Connecting, Assessing, Responding and Empowering are the four interacting components of the CARE Approach, a flexible framework which has been specifically developed to help practitioners reflect on, practice, maintain and improve their communication skills and to use these skills effectively in helping empower and enable the patient. It is not rigid or prescriptive, rather it provides a broad set of guiding principles depending on the situation and circumstance. It is highly recommended for all healthcare practitioners wanting to improve their patient interactions, and is ideal for individuals, groups or organisations. Easy-to-read and comprehend, it features suggested exercises throughout, and audio and video clips of simulated patient-practitioner encounters to illustrate certain points, and facilitate learning and reflection

Improvements in daily living reported by the ORIDL over 33 months at GHH (Study 2)

<p><b>Copyright information:</b></p><p>Taken from "Outcome related to impact on daily living: preliminary validation of the ORIDL instrument"</p><p>http://www.biomedcentral.com/1472-6963/7/139</p><p>BMC Health Services Research 2007;7():139-139.</p><p>Published online 2 Sep 2007</p><p>PMCID:PMC2014756.</p><p></p

Patient-centredness and the outcome of consultations with depressed patients in areas of high and low socioeconomic deprivation

&lt;b&gt;Background&lt;/b&gt; Most patients with depression are managed in general practice. In deprived areas, depression is more common and poorer outcomes have been reported.&lt;p&gt;&lt;/p&gt;&lt;b&gt;Aim&lt;/b&gt; To compare general practice consultations and early outcomes for patients with depression living in areas of high or low socioeconomic deprivation.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Design and setting&lt;/b&gt; Secondary data analysis of a prospective observational study involving 25 GPs and 356 consultations in deprived areas, and 20 GPs and 303 consultations in more affluent areas, with follow-up at 1 month.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Method&lt;/b&gt; Validated measures were used to (a) objectively assess the patient centredness of consultations, and (b) record patient perceptions of GP empathy.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Results&lt;/b&gt; PHQ-9 scores &gt;10 (suggestive of caseness for moderate to severe depression) were significantly more common in deprived than in affluent areas (30.1% versus 18.5%, P&lt;0.001). Patients with depression in deprived areas had more multimorbidity (65.4% versus 48.2%, P&lt;0.05). Perceived GP empathy and observer-rated patient-centred communication were significantly lower in consultations in deprived areas. Outcomes at 1 month were significantly worse (persistent caseness 71.4% deprived, 43.2% affluent, P = 0.01). After multilevel multiregression modelling, observer-rated patient centredness in the consultation was predictive of improvement in PHQ-9 score in both affluent and deprived areas.&lt;p&gt;&lt;/p&gt; &lt;b&gt;Conclusion&lt;/b&gt; In deprived areas, patients with depression are more common and early outcomes are poorer compared with affluent areas. Patient-centred consulting appears to improve early outcome but may be difficult to achieve in deprived areas because of the inverse care law and the burden of multimorbidity