Tailoring and Evaluating Treatment with the Patient-Specific Needs Evaluation: A Patient-Centered Approach.

Abstract

No patient-reported instrument assesses patient-specific information needs, treatment goals, and personal meaningful gain (PMG), a novel construct evaluating individualized, clinically relevant improvement. This study reports the development of the Patient-Specific Needs Evaluation (PSN) and examines its discriminative validity (ie, its ability to distinguish satisfied from dissatisfied patients) and test-retest reliability in patients with hand or wrist conditions. A mixed-methods approach was used to develop and validate the PSN, following Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines, including pilot testing, a survey (pilot, n = 223; final PSN, n = 275), cognitive debriefing ( n = 16), expert input, and validation. Discriminative validity was assessed by comparing the satisfaction level of patients who did and did not achieve their PMG ( n = 1985) and test-retest reliability using absolute agreement, the Cohen kappa, and intraclass correlation coefficients ( n = 102). The authors used a sample of 2860 patients to describe responses to the final PSN. The PSN has only 5 questions (completion time, ±3 minutes) and is freely accessible online. The items and response options were considered understandable by 90% to 92% of the end-users and complete by 84% to 89%. The PSN had excellent discriminative validity (Cramer V, 0.48; P < 0.001) and moderate to high test-retest reliability (kappa, 0.46 to 0.68; intraclass correlation coefficients, 0.53 to 0.73). The PSN is a freely available, patient-centered decision support tool that helps clinicians tailor their consultations to patients' individual needs and goals. It contains the PMG, a novel construct evaluating individualized, clinically relevant treatment outcomes. The PSN may function as a conversation starter, facilitate expectation management, and aid shared decision-making. The PSN is implementation-ready and can be readily adapted to other patient populations.