Does the personal questionnaire provide a more sensitive measure of cardiac surgery related-anxiety than a standard pencil-and-paper checklist?

A staging approach to measuring patient-centred subjective outcomes

INTRODUCTION

In assessing clinical change, measurement is often based on psychometric scales. However, change is best revealed within the constellation of problems salient to the patient, rather than in alterations in the abstract constructs, psychometrically measured. These patients' problems often serially unfold in qualitative stages, even before the full-blown disorder emerges. These qualitative stages constitute the natural history extending from early to late, fluctuating from mild to severe, and progressing from full-blown disorder to recovery.

METHOD

We reviewed the literature on clinimetrics and patient-centred subjective measures, and related these findings to the use of the discretized-analogue scaling method.

RESULTS

There is increasing recognition of clinimetric approaches that structure the pre-clinical and clinical material into a scale that reflects the symptoms, consequences and complications in a manner understandable to the patient, and enabling the quantification of severity or change. This monograph provides criteria and methods for developing these building blocks that enable the assessment of severity, stage or change. We show examples of their use in quantitative clinical outcome measurement.

CONCLUSION

We encourage further studies in the ideology and procedures for measuring clinical change in terms of personally subjective experiences.

Factors related to fear in patients undergoing cataract surgery: a qualitative study focusing on factors associated with fear and reassurance among patients who need to undergo cataract surgery

The aim was to identify factors that are related to fear among patients who need to undergo cataract surgery. The data were collected by focus group interviews (n=27). The doctor-patient relationship, patient education, the wait, hospital organization, social support, sensations, previous experience, outcome of surgery, and coping strategies were identified as the main factors that contribute to feelings of fear related to cataract surgery. Five stages of fear were identified: at home after diagnosis, during preparation for surgery at the hospital, the day of surgery, the post-operative visits, and the period after these follow-up visits at home. A model regarding the factors related to fear in patients awaiting cataract surgery was developed, which emphasizes the importance of a good doctor-patient relationship, and the need for patient education that is tailored to the individual patients.

The List of Individual Symptoms for Therapy Evaluation (LISTE)--an efficient method for individualized outcome assessment

An newly developed method for individualized assessment of therapy outcome, the "List of Individual Symptoms for Therapy Evaluation" (LISTE), is presented together with first empirical results on its testmetric properties and experience with this assessment instrument is reported. The LISTE method is an approach for objective 2-point assessment of therapy outcome which aims to use the advantages of individualized assessment methods while avoiding the known disadvantages to a considerable extent. So far, the results and experience with this method are very encouraging. The results of a first empirical evaluation indicate that the method supplies clinically relevant and objective data relating to treatment outcome, and that the method has acceptable testmetric characteristics in terms of sufficient reliability and validity values. Furthermore, the LISTE method is convenient for interviewing the therapist, parents and patients, it is neither expensive nor time consuming, and is compatible with clinical routine. The method requires little training and involves little additional effort. It can be used for face-to-face interviews or telephone interviews, and can also be applied as a paper-and-pencil test. Issues of application and the need for further studies are discussed.