Review ArticleSystematic Review

Measuring Patients’ Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine

Catherine Hudon, Martin Fortin, Jeannie L. Haggerty, Mireille Lambert and Marie-Eve Poitras
The Annals of Family Medicine March 2011, 9 (2) 155-164; DOI: https://doi.org/10.1370/afm.1226

Article Figures & Data

Figures

Tables

  • Table 1

    Instruments Covered by the 21 Articles Included in the Review

    InstrumentAuthorsCountryYearQuality Scorea
    Patient Perception of Patient-Centeredness (PPPC)Stewart et al9Canada20008 (11)b
    Mallinger et al93United States200513
    Consultation Care Measure (CCM)Little et al11United Kingdom200111
    Little et al94United Kingdom2001b10
    Smith et al95United Kingdom200711
    Patient Reactions Assessment (PRA)Galassi et al96United States19928
    Perceived Involvement in Care Scale (PICS)Lerman et al97United States199512
    Loh et al98United States200711
    Component of Primary Care Instrument (CPCI)Flocke99United States199714
    Flocke et al100United States199811
    Flocke et al101United States199911
    Medical Communication Competence Scale (MCCS)Cegala et al102United States199810
    Primary Care Assessment Survey (PCAS)Safran et al103United States199812
    Safran et al104United States200612
    Duberstein et al105United States20079
    Interpersonal Processes of Care (IPC)Stewart et al106United States199910
    Stewart et al107United States200714
    General Practice Assessment Survey (GPAS)Ramsay et al108United Kingdom200013
    Jayasinghe et al109Australia200812
    Patient Perception of Quality (PPQ)Haddad et al110Canada200012
    Primary Care Assessment Tool-Adult (PCAT–A)Shi et al111United States200112
    Haggerty et al112Canada200811
    Consultation and Relational Empathy (CARE)Mercer et al113United Kingdom200412
    Mercer et al114United Kingdom200512
    Mercer et al115United Kingdom200811
    Instrument on Doctor-Patient Communication Skills (IDPCS)Campbell et al116Canada200712

    • ↵a Maximum score is 15.

    • ↵b Evaluation of an unpublished paper on PPPC (Stewart et al, 2004, available from authors on request), combined with the initial assessment of the study quality of the main article.

  • Table 2

    Characteristics of Instruments Measuring Patient-Centered Care

    InstrumentOriginConceptual BaseDescriptionSubscale (Items)
    Patient Perception of Patient-Centeredness (PPPC)Existing literature and empirical studies on the doctor-patient relationship and the Stewart et al modelStewart et al model14 Items, 4-point Likert scale (completely to not at all)No subscale (14/14, α= .71)
    Consultation Care Measure (CCM)Existing literature and empirical studies on the doctor-patient relationship, the Stewart et al model, and patient interviewsStewart et al model21 Items, 4-point Likert scale (very strongly agree to neutral/disagree)Communication and partnership (11/11, α = .96), personal relationship (3/3, α= .89), health promotion (2/2, α = .87), positive and clear approach to problem (3/3, α= .84) and interest in effect on life (2/2, α= .89)
    Patient Reactions Assessment (PRA)Existing instruments, existing literature and empirical studies on the physician-patient relationship, interviews with patients and caregivers, and clinical experiences of the research teamDimensions of the physician-patient medical relationship15 Items, 7-point Likert scale (very strongly disagree to very strongly agree)Patient information index (2/5, α = .87), patient communication index (1/5, α=.91) and patient affective index (5/5, α=.90)
    Excluded: Patient information index (3/5) and patient communication (4/5)
    Perceived Involvement in Care Scale (PICS)Existing literature and empirical studies on patient participation in medical care, observations of the principal researcher, expert consultationsDimensions of patient participation13 Items, dichotomous scale (yes/no)Doctor facilitation (5/5, α=.60–.73)
    Excluded: Patient information (4/4) and patient decision making (4/4)
    Component of Primary Care Instrument (CPCI)Interim report by the Institute of Medicine (IOM) in 1994 defining primary care and its componentsIOM’s definition of primary care and dimensions of primary care52 Items, 6-point Likert scale (strongly disagree to strongly agree)Accumulated knowledge (7/7, α = .88), interpersonal communication (6/6, α=.75), advocacy (2/9, α=.88), family context(2/3, α = .82) and community context (2/2, α not available)
    Excluded: Comprehensive care (6/6), preference for regular physician (4/4), coordination of care (6/6), family context (1/3), duration of relationship (2/2) and continuity (3/3)
    Medical Communication Competence Scale (MCCS)Existing literature and empirical studies on doctor-patient communicationDimensions of medical communication40 Items (patient’s version), 7-point Likert scale strongly agree to strongly disagree)No subscale (24/40, α = .79 for information giving, α = .76 for information seeking, α = .85 for information verifying, and α =.92 for socioemotional communication)
    Excluded: Patients’ self-competence items (16/40)
    Primary Care Assessment Survey (PCAS)Interim report by the Institute of Medicine (IOM) in 1994 defining primary care and its componentsIOM’s definition of primary care51 Items, 6-point Likert scale (very poor to excellent)Contextual knowledge of patient (5/5, α=.92), communication (6/6, α=.95), interpersonal treatment (4/5, α = .95) and trust (5/8, α=.86)
    Excluded: Organizational access (6/6), financial access (2/2), longitudinal continuity (1/1) and visit-based continuity (2/2), preventive counseling (7/7), integration (6/6), interpersonal treatment (1/5), thoroughness of physical examination (1/1), trust (3/8), screener items (2/2)
    Interpersonal Processes of Care (IPC)Focus group, existing literature and empirical studies on the doctor-patient relationship and the quality of care, Stewart et al model and cognitive interviewsDimensions of interpersonal care processes29 Items, 5-point Likert scale (never to always)Hurried communication (5/5, α = .65), elicited concerns, responded (3/3, α=.80), explained results, medication (4/4, α = .81), patient-centered decision-making (3/3, α = .75) and compassionate, respectful (5/5, α=.71)
    Excluded: Discrimination (4/4) and disrespectful office staff (5/5)
    General Practice Assessment Survey (GPAS)PCASDimensions of primary care30 Items, 6-point Likert scale (very poor to excellent)Communication (2/4, α = .90), interpersonal care (3/3, α=.93), trust (2/4, α=.69) and knowledge of patient (3/3, α=.91)
    Excluded: Accessibility (8/8), technical care (5/5), communication (2/4), trust (2/4) and nursing care (3/3)
    Patient Perception of Quality (PPQ)Existing instruments, existing literature and empirical studies on quality of care, patient interviews and expert consultationsDimensions of quality of care22 Items, 5-point Likert scale (negative to positive)Interpersonal aspects of care (5/5, α = .91) and technical aspects of care (5/12, α=.91)
    Excluded: Technical aspects of care (7/12) and outcomes of care (5/5)
    Priamry Care Assessment Tool– Adult (PCAT–A)Primary Care Assessment Tool–Child, expert consultationsDimensions of primary care74 Items, 4-point Likert scale (definitely not to definitely)Ongoing care (12/20, α=.92)
    Excluded: First-contact accessibility (4/4), first contact utilization (3/3), ongoing care (8/20) coordination of services (8/8), comprehensiveness services available (21/21), comprehensive service received (13/13) and community orientation (5/5)
    Colsultation and Relational Empathy (CARE)Existing literature and empirical studies on empathy and in-depth qualitative work on patient’s views on holistic careDimensions of empathy10 Items, 5-point Likert scale (poor to excellent)No subscale (10/10, α=.92)
    Instrument on Doctor-Patient Communication Skills (IDPCS)Existing instruments (PPPC and Core Competency of Interpersonal and Communication Skills), revised conceptual framework adapted from the Calgary–Cambridge guide and expert consultationsThe Stewart et al model and communication theories19 items, 5-point Likert scale (strongly disagree to strongly agree)No subscale (19/19, α=.69)
  • Table 3

    Patient-Centered Care Measurement Instruments Included in the Review

    Number of Items Assessing Conceptual Framework Dimension
    InstrumentDisease and Illness ExperienceWhole PersonCommon GroundPatient-Doctor Relationship
    Patient Perception of Patient-Centeredness4190
    Consultation Care Measure6291
    Patient Reactions Assessment0026
    Perceived Involvement in Care Scale2030
    Component of Primary Care Instrument5536
    Medical Communication Competence Scale00186
    Primary Care Assessment Survey41412
    Interpersonal Processes of Care4088
    General Practice Assessment Survey2125
    Patient Perception of Quality0145
    Primary Care Assessment Tool–Adult4422
    Consultation and Relational Empathy2125
    Instrument on Doctor-Patient Communication Skills20103

Additional Files

  • Supplemental Appendixes

    Supplemental Appendix 1. Electronic Literature Search of the MEDLINE, Embase, and Cochrane Databases; Supplemental Appendix 2. Quality Assessment of the Studies Included in the Review, Based on the Modified Version of Standards for Reporting of Diagnostic Accuracy; Supplemental Appendix 3. Subscales and Items of Instruments Measuring Patient-Centered Care; Supplemental Appendix 4. Psychometric Properties of Included Instruments (Except PPPC and CCM Already Described in the Text)

    Files in this Data Supplement:

  • The Article in Brief

    Measuring Patients' Perceptions of Patient-Centered Care: A Systematic Review of Tools for Family Medicine

    Catherine Hudon , and colleagues

    Background Patient-centered care is widely acknowledged as a core value in family medicine. This systematic review examines existing research to identify and compare instruments, subscales, or items assessing patient perceptions of patient-centered care in family medicine.

    What This Study Found Thirteen instruments measuring patients� perceptions of patient-centered care are available. Two of the instruments are dedicated to patient-centered care but are visit-based, limiting their applicability for the study of care processes over time, such as chronic illness management. The 11 remaining instruments provide only partial coverage of patient-centered care.

    Implications

    • As valid measures of perceptions of patient-centered care are applied within the patient-centered medical home organizing framework, researchers will be better able to determine how systems-level dimensions, such as accessibility and coordination of care, fit and whether they should be considered in a model of patient-centered care.
    • Future research, including qualitative interviews with primary care patients, could help refine this conceptual model to better understand which dimensions are really patient centered, are most meaningful for patients, and may have an impact on long-term outcomes.
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