title: Using method triangulation to validate a new instrument (CPWQ-com) assessing cancer patients' satisfaction with communication.
abstract: OBJECTIVE
  Patients' perceptions of care including the communication with health care staff is recognized as an important aspect of the quality of cancer care. Using mixed methods, we developed and validated a short instrument assessing this communication.
  
  
  METHODS
  Based on focus group interviews with 77 informants, an 8-item instrument was developed. This short instrument aimed at assessing overall aspects of the communication between cancer patients and health care staff. The items were validated first through cognitive interviews with patient-observer agreement with 52 cancer patients who completed the questions and then participated in tape-recorded open-ended interviews. Observer ratings of the interviews were compared with the patients' written responses collected before interviews and kappa values were calculated. The comprehensibility of each item was subsequently elaborated in traditional cognitive interviews with 17 cancer patients. Finally, psychometric analyses took place with data from 1490 cancer patients.
  
  
  RESULTS
  The weighted kappas concerning patient-observer agreement ranged 0.31-0.88. Disagreements mainly consisted of the observer choosing the response category indicating the highest level of satisfaction whereas the patients had chosen the second highest level. Cognitive interviews showed that the questions were generally interpreted as intended. One item was excluded due to low validity. A sum scale of the remaining seven items had high reliability (Cronbach's alpha 0.89).
  
  
  CONCLUSIONS
  Seven items performed well. They proved to be valid measures of satisfaction with communication with the health care staff and constitute a sum scale with high reliability. The cognitive interviews provided valuable insight into the patients' perception of communication.
authors.affiliation: The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark. lone.ross@dadlnet.dk
authors.forename: Lone
authors.initials: L
authors.lastname: Ross
authors.forename: Louise Hyldborg
authors.initials: LH
authors.lastname: Lundstrøm
authors.forename: Morten Aagaard
authors.initials: MA
authors.lastname: Petersen
authors.forename: Anna Thit
authors.initials: AT
authors.lastname: Johnsen
authors.forename: Torquil
authors.initials: T
authors.lastname: Watt
authors.forename: Mogens
authors.initials: M
authors.lastname: Groenvold
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D017060:Patient Satisfaction; D011369:Professional-Patient Relations; D011594:Psychometrics / Q000295:instrumentation*; D011795:Surveys and Questionnaires; D055815:Young Adult