QUOTEchemo: A patient-centred instrument to measure quality of communication preceding chemotherapy treatment through the patient's eyes

Background: Knowing patients' needs is a prerequisite to ensure high quality cancer care. This study describes the development and psychometric properties of a patient-centred instrument to measure needs and actual experiences with communication preceding chemotherapy treatment: QUOTE(chemo). QUOTE-questionnaires (Quality Of care Through the patients' Eyes) are widely used to gain insight into unmet needs, but no validated, standardised questionnaire combining patients' needs and experiences surrounding chemotherapy treatment is available yet. Methods: To evaluate the psychometric proper-ties of the QUOTE(chemo), content validity, internal structure and convergent validity were investigated amongst 345 cancer patients, new to chemotherapy, from 10 different hospitals. Results: Literature study, focus group discussions and a categorisation procedure of 67 relevant topics revealed seven main themes: Treatment-related information, Prognosis information, Rehabilitation information, Coping information, Interpersonal communication, Tailored communication and Affective communication. Confirmatory factor analysis using structural equation modelling indicated that the measurement model provided good fit to the data with factor loadings ranging from .43 to .77. The seven QUOTE(chemo) dimensions captured relevant issues of concern with good internal consistency (alpha .72-.92), satisfactory item-total correlations (.35-.79) and satisfactory convergent validity. Affective communication, Treatment-related information and Rehabilitation information were perceived most important by patients. The instrument also appeared to be able to determine which aspects need improvement to ensure high quality care. The highest need for improvement was found for communicating Prognosis information and Rehabilitation information and for Interpersonal communication. Conclusions: These findings provide preliminary evidence of the reliability and validity of the QUOTE(chemo), for use in cancer care surrounding chemotherapy treatment. Researchers and health care providers can use the instrument to measure patients' needs and experiences with communication to identify aspects that need improvement. (C) 2009 Elsevier Ltd. All rights reserved.