User-Centered Design of the consideRATE Questions, a Measure of People's Experiences When They Are Seriously Ill

Abstract

Context: No brief patient-reported experience measure focuses on the most significant concerns of seriously ill individuals.

Objectives: The objective of the study was to develop the consideRATE questions.

Methods: This user-centered design study had three phases. We reviewed the literature and consulted stakeholders, including caregivers, clinicians, and researchers, to identify the elements of care most important to patients (Phase 1). We refined items based on cognitive interviews with patients, families, and clinicians (Phase 2). We piloted the measure with patients and families (Phase 3).

Results: Phase 1 resulted in seven questions addressing the following elements: 1) care team attention to patients' physical symptoms, 2) emotional symptoms, 3) environment of care, 4) respect for patients' priorities, 5) communication about future plans, 6) communication about financial and similar affairs, and 7) communication about illness trajectory. Phase 2 participants included eight patients, eight family members, and seven clinicians. We added an open-text comment option. We did not identify any other issues that were important enough to participants to include. Response choices ranged from one (very bad) to four (very good), with a not applicable option (does not apply). Phase 3 involved 15 patients and 16 family members and demonstrated the acceptability of the consideRATE questions. Most reported that the questions were not distressing, disruptive, or confusing. Completion time averaged 2.4 minutes (range 1-5).

Conclusion: Our brief patient-reported serious illness experience measure is based on what matters most to patients, families, and clinicians. It was acceptable to patients and families in a regional sample. It has promise for use in clinical settings.

Keywords: Serious illness; measurement; palliative care; patient-reported experience measure; patient-reported outcome measure.

Fig. 1.

Iterative the consideRATE questions development.

Fig. 2.

Most important elements of serious illness care comprising the consideRATE suite constructs. Note: Based on the systematic review by Virdun et al. Numbers correspond to ranked elements of serious illness experience, according to patient priorities. Adequate environment for care and minimizing burden tied for fifth most important elements of care.

Fig. 3.

Changes in the consideRATE question instructions and items. Note: See Appendix IV for complete measure items.