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. 2025 Sep;28(9):1417-1425.
doi: 10.1016/j.jval.2025.05.006. Epub 2025 Jun 4.

Quality of Care for Patients With Advanced Illness Scale: Development, Preference Elicitation, and Evaluation of Measurement Properties

Mihir Gandhi  1 , Felicia Jia Ler Ang  2 , Shirlyn Hui Shan Neo  3 , Juan Marcos Gonzalez  4 , Yin Bun Cheung  5 , Eric Andrew Finkelstein  2 ; QCPAI Study Group
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Free article

Quality of Care for Patients With Advanced Illness Scale: Development, Preference Elicitation, and Evaluation of Measurement Properties

Mihir Gandhi et al. Value Health. 2025 Sep.
Free article

Abstract

Objectives: To develop the Quality of Care for Patients with Advanced Illness (QCPAI) scale, derive preference-weighted scoring, and evaluate measurement properties for comprehensively assessing advanced care quality from the patient's perspective.

Methods: A 15-item QCPAI scale, including self-administered and caregiver proxy versions, was developed through a 5-step process (scoping review, item development, translation, cognitive debriefing, and reconciliation) in English and Chinese. A study was conducted among 200 advanced cancer patients and their caregivers, with baseline and 1-week follow-up surveys. A preference-weighted scoring system was derived using best-worst scaling among patients. Measurement properties evaluated included criterion validity, known-group validity, test-retest reliability, equivalence of self-administered and proxy responses, and equivalence between language versions.

Results: Respondents ranked medical treatment, symptom control, and cost as the most important aspects of care. Criterion validity was supported by a strong correlation (ρ > 0.5) between the QCPAI score and satisfaction with overall care. Known-group validity based on patients with varying levels of quality of life demonstrated significantly different mean QCPAI scores. Test-retest reliability was confirmed with an intraclass correlation coefficient exceeding 0.75. Equivalence was demonstrated between English and Chinese versions and between patient self-reports and caregiver proxy responses (standardized effect size ≤ 0.2).

Conclusions: The QCPAI scale exhibits robust validity and reliability in measuring the quality of advanced illness care. Healthcare organizations and policy makers are encouraged to adopt the QCPAI scale as a standard tool for systematically evaluating and enhancing care quality.

Keywords: advanced illness; cancer; end-of-life care; experience measure; palliative care; quality of care.

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Conflict of interest statement

Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section. Dr Ozdemir is an editor for Value in Health and had no role in the peer-review process of this article.

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