Cognitive interviews guide design of a new CAM patient expectations questionnaire

Abstract

BackgroundNo consistent relationship exists between pre-treatment expectations and therapeutic benefit from various complementary and alternative medicine (CAM) therapies in clinical trials. However, many different expectancy measures have been used in those studies, with no validated questionnaires clearly focused on CAM and pain. We undertook cognitive interviews as part of a process to develop and validate such a questionnaire.MethodsWe reviewed questions about expectations of benefits of acupuncture, chiropractic, massage, or yoga for pain. Components of the questions – verbs, nouns, response options, terms and phrases describing back pain – were identified. Using seven different cognitive interview scripts, we conducted 39 interviews to evaluate how individuals with chronic low back pain understood these individual components in the context of expectancy questions for a therapy they had not yet received. Chosen items were those with the greatest agreement and least confusion among participants, and were closest to the meanings intended by the investigators.ResultsThe questionnaire drafted for psychometric evaluation had 18 items covering various domains of expectancy. “Back pain” was the most consistently interpreted descriptor for this condition. The most understandable response options were 0-10 scales, a structure used throughout the questionnaire, with 0 always indicating no change, and 10 anchored with an absolute descriptor such as “complete relief”. The use of words to describe midpoints was found to be confusing. The word “expect” held different and shifting meanings for participants. Thus paired items comparing “hope” and “realistically expect” were chosen to evaluate 5 different aspects of treatment expectations (back pain; back dysfunction and global effects; impact of back pain on specific areas of life; sleep, mood, and energy; coping). “Impact of back pain” on various areas of life was found to be a consistently meaningful concept, and more global than “interference”.ConclusionsCognitive interviews identified wordings with considerable agreement among both participants and investigators. Some items widely used in clinical studies had different meanings to participants than investigators, or were confusing to participants. The final 18-item questionnaire is undergoing psychometric evaluation with goals of streamlining as well as identifying best items for use when questionnaire length is constrained.

Development of the generic, multidimensional Treatment Expectation Questionnaire (TEX-Q) through systematic literature review, expert surveys and qualitative interviews

“…The relevance of this differentiation was pointed out in the integrative model of expectations 18 and is further supported by recent empirical evidence. 40 Based on Kirsch’s 22 theoretical considerations regarding the probabilistic nature of non-volitional expectations, and on Sherman et al ’s 41 indepth analysis of patients’ understanding of treatment expectations, our phrasing aimed to capture best both aspects of magnitude and probability. To prevent ambiguity, each of these aspects could have been assessed in a separate item (eg, ‘How likely do you think your symptoms will improve?’ and ‘How much improvement do you expect?’), but we refrained from it for the sake of our scale’s brevity and applicability.…”

New perspectives on patient expectations of treatment outcomes: results from qualitative interviews with patients seeking complementary and alternative medicine treatments for chronic low back pain

“…Initial coding of interview data contributed to the design of questionnaire items for further testing in cognitive interviews [ 25 ]; the resulting draft questionnaire is currently undergoing psychometric analysis. Here, we report on our in-depth analysis of qualitative interviews with patients to better understand how patients conceptualize and articulate expectations and hopes for the outcomes of CAM treatments for which they have limited or no prior experience.…”

Stakeholder expectations from the integration of chiropractic care into a rehabilitation setting: a qualitative study

“…Stakeholders often did not differentiate between their expectations and their hopes for the anticipated chiropractic program. Expectations are thought to reflect likely outcomes whereas hopes represent optimal outcomes [ 9 , 36 , 41 , 42 ]. This distinction may not be clear to stakeholders or newly integrating chiropractic providers in similar settings.…”