Development and preliminary validation of a patient-report experience measure of acute oncology: The PREMAC study
Richard Wagland, Anna Hurley-Wallace, John Defty, M. Jamal Hossain, Alison RichardsonBackground
Patients with cancer often experience oncological emergencies requiring immediate care, and the quality of acute oncology (AO) care varies between providers. Patient-reported experience measures (PREMs) are a key tool for quality improvement, but none currently exists for AO. This study developed a prototype PREM, the Patient-Reported Experience Measure for Acute OnCology (PREMAC), and conducted preliminary single-site psychometric testing.
Materials and methods
A quality assessment framework guided development across three stages. Stage 1 generated a conceptual framework of accessing AO services from a scoping review and interviews with patients and health professionals. Stage 2 developed a prototype questionnaire, with content validity assessed by a Service User Reference Panel (SURP) and face validity tested through cognitive interviews. Stage 3 tested acceptability, feasibility, structural validity and internal consistency at one tertiary cancer centre in southern England.
Results
Data integration identified ten domains, in the chronological order patients accessing AO experience them: reasons for accessing AO; patient preparedness; accessibility of care; the care environment; competence of care; communication and decision-making; compassionate care; the carer’s role; patient anxiety; and service issues including discharge. The 46-item prototype was completed by 171 respondents. Exploratory factor analysis of 18 four-category ordinal items, using polychoric correlations with minimum residual extraction and oblimin rotation (n = 121 complete cases), supported three provisional domains: information, communication, involvement and perceived care quality (α = 0.935); care environment, dignity, trust and safety (α = 0.711); and discharge information and preparedness (α = 0.704).
Conclusion
PREMAC is the first PREM developed specifically for AO. Preliminary testing indicates the prototype is acceptable and feasible, with early evidence of internal coherence across three provisional domains at a single site. The domain structure and item allocations remain provisional; no total score is recommended. Multisite validation is required before PREMAC could support service comparison or benchmarking.