Is there a correlation between the patient-doctor relationship questionnaire and other patient-reported experience measures?

Patient Experience Journal Patient Experience Journal

Volume 7 Issue 1 Article 7

2020

Is there a correlation between the patient-doctor relationship Is there a correlation between the patient-doctor relationship

questionnaire and other patient-reported experience measures? questionnaire and other patient-reported experience measures?

Amanda I. Gonzalez

Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin

Joost T.P. Kortlever

Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin

Léon Rijk

Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin

David Ring

Department of Surgery and Perioperative Care, Dell Medical School – The University of Texas at Austin

Laura E. Brown

Center for Health Communication, Moody College of Communication – The University of Texas at Austin

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Recommended Citation Recommended Citation

Gonzalez A, Kortlever J, Rijk L, Ring D, Brown L, Reichel L. Is there a correlation between the patient-doctor

relationship questionnaire and other patient-reported experience measures?.

Patient Experience Journal

2020; 7(1):44-50. doi: 10.35680/2372-0247.1399.

This Research is brought to you for free and open access by Patient Experience Journal. It has been accepted for

inclusion in Patient Experience Journal by an authorized editor of Patient Experience Journal.

Is there a correlation between the patient-doctor relationship questionnaire and Is there a correlation between the patient-doctor relationship questionnaire and

other patient-reported experience measures? other patient-reported experience measures?

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Authors Authors

Amanda I. Gonzalez, Joost T.P. Kortlever, Léon Rijk, David Ring, Laura E. Brown, and Lee M. Reichel

This research is available in Patient Experience Journal: https://pxjournal.org/journal/vol7/iss1/7

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Volume 7, Issue 1 – 2020, pp. 44-50

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Research

Is there a correlation between the patient-doctor relationship questionnaire

and other patient-reported experience measures?

Amanda I. Gonzalez, Dell Medical School, The University of Texas at Austin, a[email protected]u

Joost T.P. Kortlever, Dell Medical School, The University of Texas at Austin, kortlever.jo[email protected]m

Léon Rijk, Dell Medical School, The University of Texas at Austin, rijk.leon@gmail.com

David Ring, Dell Medical School, The University of Texas at Austin, david.rin[email protected]

Laura E. Brown, Moody College of Communication, The University of Texas at Austin, [email protected]u

Lee M. Reichel, Dell Medical School, The University of Texas at Austin, leereichel@gmail.com

Abstract

Patient reported experience measures (PREMs) can quantify the quality of the patient-clinician relationship, which is

associated with adherence and improved health. However, the scales used to assess PREMs have large ceiling effects,

which limits our ability to learn and improve. This study assessed the correlation of four PREMs: the patient-doctor

relationship questionnaire (PDRQ), a measure of perceived empathy, a measure of satisfaction with the visit, and a

measure of communication effectiveness. We also assessed ceiling effects. We prospectively enrolled 103 new and return

patients in this cross-sectional study. Patients completed a demographic questionnaire, the PDRQ, Jefferson Scale of

Patient Perceptions on Physician Empathy (JSPPPE), four questions assessing communication effectiveness from the

Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS), an 11-point ordinal

measure of satisfaction with the doctor, and four psychological measures. Correlations and ceiling effects were measured.

In bivariate analysis, PDRQ had large correlations with measures of perceived empathy (r=0.58, P<0.001), satisfaction

(r=0.59, P<0.001), and communication effectiveness (r=0.66, P<0.001). No PREMs correlated with psychological

measures. Ceiling effects were common: PDRQ 55%, JSPPPE 35%, communication effectiveness 33%, and satisfaction

76%. These large correlations support prior evidence that these PREMs measure a common underlying construct, and a

single questionnaire may suffice. To better understand factors associated with improved patient experience, we need

measures with limited ceiling effect.

Keywords

Patient doctor-relationship questionnaire, Jefferson scale of patient perceptions on physician empathy, patient reported

experience measures

Introduction

The quality of the relationship between clinician and

patient influences adherence to treatment, outcomes, and

patient satisfaction in general medicine

1-5

and in surgical

care.

6-8

Furthermore, a healthy patient-clinician

relationship also improves clinician resilience

and

satisfaction at work.

The relationship between patient

and clinician is based on trust, knowledge, regard, and

loyalty.

There are numerous instruments designed to

measure patient perceptions of the relationship with the

clinician and most of these instruments measure empathic

components.

Hojat et al.

defines empathy in the

context of patient care as “a predominantly cognitive

(rather than emotional) attribute which involves an

understanding (rather than feeling) of experiences,

concerns, and perspective of the patient, combined with a

capacity to communicate this understanding, and an

intention to help.”

As with other patient-reported

experience measures (PREMs) such as measures of

satisfaction and effective communication, measures of

perceived empathy have large ceiling effects.

Indeed, so

many people mark one of the top two scores that these

ordinal instruments are routinely converted to

dichotomous outcomes.

A measurement with strong

ceiling and floor effects result in what statistician refer to

as censoring: unknown values above the measurement

threshold. Censoring is undesirable in both research as

well as quality and process improvement because

important information is lost that could help determine

important associations that raise opportunities to improve

the patient experience.

There are several questionnaires designed to measure

patient perceptions of clinician empathy.

In a prior study,

we determined that Jefferson Scale of Patient Perceptions

of Physician Empathy (JSPPPE) has less ceiling effect than

the Consultation-and-Relational-Empathy (CARE)

measure.

Patient experience measures are highly correlated, Gonzalez, et al.

45 Patient Experience Journal, Volume 7, Issue 1 – 2020

The aim of this study was to evaluate another patient

experience measure (the patient-doctor relationship

questionnaire; PDRQ) for ceiling effects and correlation

with other patient experience measures and psychological

factors. Our primary hypothesis was that there is no

correlation between the 9-item short form of PDRQ and

JSPPPE. Our secondary hypotheses were that (1) there is

no correlation between the PDRQ-9 and questions

derived from the Clinician and Group Consumer

Assessment of Healthcare Providers and Systems (CG-

CAPHS) questionnaire on physician communication

effectiveness, and (2) between the PDRQ-9 and patient

satisfaction (measured on a 0-10 ordinal scale), (3) there is

no difference in mean frequency of highest possible scores

achieved (ceiling effect) of the PDRQ-9 compared to the

JSPPPE, CG-CAHPS communication effectiveness and

satisfaction, (4) there is no difference in internal

consistency, and completion time of PDRQ-9 compared

to JSPPPE. And finally, we assessed which psychological

factors accounted for variation in PDRQ-9 and JSPPPE.

Methods

Study Design

After institutional review board approval, we prospectively

enrolled 103 patients in a cross-sectional study over a 4-

month period, at one of five participating orthopaedic

specialist offices in a large urban area. We included all new

or return patients aged 18 to 89 years old. Patients were

excluded if they were not fluent in English because some

questionnaires were not available in other languages. After

the visit with the surgeon, a research assistant not involved

in patient care explained the study to the patient and asked

them to participate. Completing the questionnaires

represented consent.

Outcome Measures

Patients were asked to complete six questionnaires, (1) a

demographic survey including the following variables: age,

sex, reason for the visit as indicated by the patient (trauma

vs. non-trauma), (2) PDRQ-9, (3) JSPPPE, (4) four

questions assessing communication effectiveness from the

CG-CAPHS, (5) an overall rating of the doctor on an 11-

point ordinal scale (a measure from the CG-CAPHS), (6)

the 4 question Pain Catastrophizing Scale (PCS-4), (7) a

two question version of the Pain Self-Efficacy

Questionnaire (PSEQ-2), (8) the two-question versions of

the Generalized Anxiety Disorder (GAD-2), and (9)

Patient Health Questionnaire (PHQ-2).

The PDRQ-9 measures the patient’s perception of the

relationship between the clinician and the patient. It is a 9-

item questionnaire, each item is scored from 1 (not at all

appropriate) to 5 (totally appropriate), the total score

ranges from 9 to 45 with higher score indicating a more

favorable patient perception of the patient-doctor

relationship.

The JSPPPE measures patient perception of clinician

empathy. It is a 5-item questionnaire, each item answered

on a 7-point Likert scale between Strongly Disagree (1) to

Strongly Agree (7). The total score ranges from 5 to 35,

with higher scores indicating greater perceived clinician’s

empathy.

13,15,19

The CG-CAHPS records patients’ experience with the

clinicians and staff.

20-22

Five scores can be reported, four

composite measures (timeliness of care, how well

providers communicate with patients, providers’ use of

information to coordinate patient care and interaction with

office staff) and one overall rating of the clinician. For the

purpose of this study the overall rating of the clinician and

the composite measure of communication effectiveness

were used. The measure of clinician communication

includes four items (provider explained things in a way

that was easy to understand, provider listened carefully to

patient, provider showed respect for what patient had to

say, provider spent enough time with patient), which are

answered on a 4-point scale (1=never, 2=sometimes,

3=usually, 4=always). This composite score can be

reported by top box (the percentage of responses in the

most positive response categories) or average scoring

(mean across all the responses). The overall rating of the

doctor uses a scale from 0 to 10, with 0 being the worst

doctor possible and 10 being the best doctor possible. We

inadvertently used a scale numbered from 0 to 100.

The PCS-4 consists of 4 questions measuring maladaptive

thoughts in response to nociception

on a 4-item scale

(0=not at all to 4=all the time). The scale contains two

items on magnification, one item on rumination, and one

item on helplessness. Higher scores indicate more worst-

case thinking, a potentially unhelpful cognitive coping

strategy.

The PSEQ-2 measures adaptive cognitive coping strategies

in response to nociception. Specifically, the understanding

that one can engage in normal activities and achieves one’s

goals. Total scores range from 0 (not at all confident) to 12

(completely confident), with 12 representing more

adaptive thoughts.

The GAD-2 is a 2-item questionnaire that measures

symptoms of anxiety in the last two weeks. The total score

ranges from 0 (not at all) to 6 (nearly every day), with

higher score indicating greater symptoms of anxiety.

The PHQ-2 is a 2-item questionnaire that measures

symptoms of depression. The items are scaled from 0 (not

at all) to 3 (nearly every day). The total score ranges from 0

to 6 with higher scores indicating more symptoms of

depression.

Patient experience measures are highly correlated, Gonzalez, et al.

Patient Experience Journal, Volume 7, Issue 1 – 2020 46

Patient Characteristics

After excluding one patient that started but did not

complete the survey, 102 patients remained for final

analysis. Median age of the cohort was 55 (interquartile

range IQR 40-65) and 56% were women. Two-thirds of

people had non-traumatic problems (66%) (Table 1).

Statistical Analysis

Continuous variables were reported as median with IQR

and discrete variables as proportions. In order to assess

the associations between PDRQ-9 and JSPPPE with the

independent variables, we used Spearman rho correlation

coefficients for continuous variables and the Mann-

Whitney Test for dichotomous variables. To calculate the

floor and ceiling effect of the PDRQ-9 and JSPPE we

assessed the frequency of the lowest and highest 5% of

scores respectively, as well as the percentage of minimum

and maximum scores. Differences in categorical variables

were calculated using the Fisher’s exact test. Because of no

floor effect for the JSPPPE score, no difference was

calculated. Correlation between PDRQ-9 and JSPPPE

completion time was assessed with the Spearman rho

correlation coefficient. To measure how closely the set of

items within the PDRQ-9 and JSPPPE questionnaire are

related, we calculated the internal consistency of each

instrument using Cronbach . The higher the  value, the

more the items share covariance and probably measure the

same underlying concept. We planned to move all

psychological measures to multivariable analysis and

construct two multivariable linear regression models to

identify variables independently associated with (1)

PDRQ-9 and (2) JSPPPE. To assess the proportion of

variance in the dependent variable explained by the

(individual) independent variables, we planned to calculate

semi partial R-squared (R

) and adjusted R

values. P

<0.05 was considered statistically significant.

A priori power analysis indicated that a sample of 98

subjects would provide 80% statistical power with alpha

set at 0.05 to find a hypothesized correlation of 0.67 with a

target correlation of 0.80. In order to account for 5%

incomplete responses, we aimed to enroll 5% more.

Results

PDRQ-9 had large correlations with JSPPPE (r=0.58,

P<0.001; Table 2), satisfaction (r=0.59, P<0.001), and

communication effectiveness (r=0.66, P<0.001; Table 2).

Table 1. Patient and clinical characteristics

Variables

N=102

Age in years, median (IQR)

55 (40-65)

Women, n (%)

57 (56)

Diagnosis, n (%)

Trauma

35 (34)

Non-trauma

67 (66)

PCS-4, median (IQR)

5.0 (2.0-10)

PSEQ-2, median (IQR)

8.5 (6.0-12)

GAD-2, median (IQR)

1.0 (0.0-3.0)

PHQ-2, median (IQR)

1.0 (0.0-2.0)

CG-CAHPS communication, median (IQR)

4.0 (4.0-4.0)

Satisfaction, median (IQR)

94 (83-100)

PDRQ, median (IQR)

45 (37-45)

JSPPPE, median (IQR)

32 (25-35)

PCS=Pain Catastrophizing Scale; PSEQ=Pain Self-Efficacy Questionnaire; GAD=Generalized Anxiety Disorder;

PHQ=Patient Health Questionnaire; CG-CAHPS=Clinical and Group Consumer Assessment of Healthcare

Providers and Systems; PDRQ=Patient-Doctor Relationship Questionnaire; JSPPPE= Jefferson Scale of Patient

Perceptions of Physician Empathy

Patient experience measures are highly correlated, Gonzalez, et al.

47 Patient Experience Journal, Volume 7, Issue 1 – 2020

PDRQ-9 had more maximum scores (55% vs. 35%; P

<0.001) and more scores in the top 5% (59% vs. 40%;

P<0.001) than JSPPPE. Both measures took an average of

50 seconds to complete. Both PDRQ-9 and JSPPPE had

substantial internal reliability: Cronbach’s  of 0.97 and

0.94 respectively (Table 3). The PDRQ-9 also had more

ceiling effect than satisfaction (33%; P<0.001) and less

than communication effectiveness (76%).

No psychological factors were associated with PDRQ-9 or

JSPPPE in bivariate analysis, so we omitted the planned

multivariable analysis.

Discussion

Most patient-reported experience measures (PREMs) have

notable ceiling effects. This lost information (censoring)

makes it difficult to learn about factors associated with a

better patient experience so that we can improve. This

study assessed the PDRQ-9 and compared it to other

experience measures including the JSPPPE, the

communication effectiveness questions from the CG-

CAHPS questionnaires and an 11-point ordinal measure of

satisfaction.

This study has some limitations. First, only English-

speaking patients were included; this might limit the

generalizability of the results. Second, mutual knowledge,

trust, loyalty and regard, on which the relationship is

based,

might have been affected by the inclusion of

return patients. Finally, all the surgeons were men, so these

results may apply best to male surgeons in an orthopaedic

specialty care setting. A systematic review found no

difference in empathy assessed on the CARE measure

between primary care physicians, specialists and

complementary and alternative medicine providers.

However, women clinicians were more empathic than men

and allied health professionals scored higher than

physicians.

The large correlation between PDRQ-9 and JSPPPE

suggests that these measures may quantify a common

underling construct. The two measures of perceived

clinician empathy that we have evaluated are largely

correlated and ask similar questions. Both the JSPPPE and

the PDRQ-9 ask if the patient feels understood: “my

physician understands me” (PDRQ-9), “the physician

understands my emotions, feelings and concerns”

Table 2. Bivariate analyses of factors associated with PDRQ and JSPPPE

PDRQ

P value

JSPPPE

P value

Age,

0.09

0.360

0.02

0.812

Gender

Man

0.271

0.449

Women

Diagnosis

Trauma

0.165

0.050

Non-trauma

PCS-4,

-0.05

0.622

-0.17

0.098

PSEQ-2,

0.07

0.460

0.04

0.661

GAD-2,

0.02

0.861

0.00

0.999

PHQ-2,

-0.05

0.605

-0.06

0.525

CG-CAHPS communication,

0.66

<0.001

0.54

<0.001

Satisfaction,

0.59

<0.001

0.59

<0.001

JSPPPE,

0.58

<0.001

Spearman’s rho correlation for continuous variables indicated by r. PDRQ=Patient-Doctor Relationship Questionnaire;

JSPPPE=Jefferson Scale of Patient Perceptions of Physician Empathy; PCS=Pain Catastrophizing Scale; PSEQ=Pain Self-

Efficacy Questionnaire; GAD=Generalized Anxiety Disorder; PHQ=Patient Health Questionnaire; CG-CAHPS=Clinical

and Group Consumer Assessment of Healthcare Providers and Systems.

Patient experience measures are highly correlated, Gonzalez, et al.

Patient Experience Journal, Volume 7, Issue 1 – 2020 48

(JSPPPE), as well as “the physician is an understanding

doctor” (JSPPPE). The JSPPPE is favored for it’s more

limited ceiling effects, but a measure with even less ceiling

effect is necessary for us learn from the large group of

patients that rate us highly, but likely see opportunities for

improvement.

The large correlation between PDRQ-9 and other PREMs

(satisfaction and communication effectiveness) suggests

that all three types of PREMs quantify a common

underlying construct. The domains of both PREMs are

contained in the PDRQ-9, namely the notion of time

spent with the clinician “my physician has enough time for

me” (PDRQ-9) and “provider spent enough time with

patient” (CH-CAHPS), communication, understanding,

and satisfaction. This may explain the consistent

observation of large correlations between perceived

empathy, clinician-patient relationship with

communication effectiveness and satisfaction.

5-7,29

Both the PDRQ-9 and the JSPPPE have unacceptably

high ceiling effects. The internal consistency of the

PDRQ-9 and the notable ceiling effect we observed are

similar to what was reported in previous research in

Dutch,

German,

and Spanish

populations. The

PRDQ-9 was initially developed in the Dutch primary care

setting and showed good psychometrics characteristics

including factorial structure, reliability and validity.

We observed no association between psychological

measures and the PDRQ-9 and JSPPPE, which is

inconsistent with prior research. In a cross-sectional study

including 703 adults with coronary artery disease, Schenker

et al.

reported a large association between clinician-

patient communication effectiveness as assessed by the

patient and symptoms of depression measured on the

PHQ-9 after adjustment for medical comorbidities, disease

severity and patient demographics (odds ratio 1.5; 95% CI

1.2 to 1.8). Swenson et al.,

including 231 patients with

diabetes mellitus type II, severe depression symptoms

were independently associated with suboptimal

communication in the multivariable model. However, in

both studies communication was coded as a dichotomous

outcome, which can lead to statistical limitations.

Further

research assessing the patient-clinician relationship is

needed to assess the influence of the mental health.

Besides psychological measures, social factors should also

be considered. Qualitative research reported that patients

from lower socio-economic status (SES) perceived that

their SES affected their health care experiences.

In a

secondary analysis of 112 videotaped consultations by

eight general practitioners, CARE was used to measure

perceived empathy, and the Measure of Patient-Centered

Communication was used by two researchers to rate

communication effectiveness based on transcripts. Among

patients with lower SES status, greater empathy was

related to understanding the whole person, in higher SES

areas empathy was related to response to emotional

Table 3. Floor and ceiling effect PDRQ vs other PREMs, completion time, and internal consistency PDRQ vs

JSPPPE

PDRQ

JSPPPE

PDRQ vs

JSPPPE

CG-CAPHS

communi-

cation

PDRQ vs

CG-CAPHS

communica-

tion

Satis-

faction

PDRQ

satisfaction

P value

Ceiling effect (top score), n (%)

56 (55)

35 (35)

<0.001

77 (76)

<0.001

34 (33)

<0.001

Ceiling effect (top 5%), n (%)

60 (59)

41 (40)

<0.001

77 (76)

<0.001

50 (49)

<0.001

Floor effect (lowest score) , n (%)

1 (1.0)

0 (0.0)

Floor effect (lowest 5%), n (%)

2 (2.0)

0 (0.0)

Completion time PDRQ vs JSPPPE

(seconds), median (IQR)

50 (39-

73)

48 (33-65)

0.136

Cronbach alpha

0.97

0.94

PDRQ=Patient-Doctor Relationship Questionnaire; JSPPPE=Jefferson Scale of Patient Perceptions of Physician Empathy;

CG-CAHPS=Clinical and Group Consumer Assessment of Healthcare Providers and Systems

Patient experience measures are highly correlated, Gonzalez, et al.

49 Patient Experience Journal, Volume 7, Issue 1 – 2020

queues, and in both groups empathy was associated with

establishing common ground.

Various PREMs ask similar questions and have large

correlations suggesting they all measure the same

underlying construct and have unacceptably high ceiling

effects. This underlying construct or connectedness could

be described as the measurement of the components of

the relationship (knowledge, trust, loyalty, and regard) and

their interaction within the patient-clinician interaction,

which is being developed any time when patient and

clinician interact. Research is merited to determine

whether a single, perhaps very brief measure of patient

experience developed to limit ceiling effects can inform

efforts to understand the factors associated with perceived

empathy, communication effectiveness, and satisfaction

with care so that we can develop care strategies that

improve the patient experience.

References

1. Van der Feltz-Cornelis CM, Van Oppen P, Van

Marwijk HW, De Beurs E, Van Dyck R. A patient-

doctor relationship questionnaire (PDRQ-9) in

primary care: development and psychometric

evaluation. Gen Hosp Psychiatry. 2004;26(2):115-120.

2. Price S, Mercer SW, MacPherson H. Practitioner

empathy, patient enablement and health outcomes: a

prospective study of acupuncture patients. Patient Educ

Couns. 2006;63(1-2):239-245.

3. Hojat M, Louis DZ, Markham FW, Wender R,

Rabinowitz C, Gonnella JS. Physicians' empathy and

clinical outcomes for diabetic patients. Acad Med.

2011;86(3):359-364.

4. Rakel D, Barrett B, Zhang Z, et al. Perception of

empathy in the therapeutic encounter: effects on the

common cold. Patient Educ Couns. 2011;85(3):390-397.

5. Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E,

Rossen PB, von der Maase H. Association of

perceived physician communication style with patient

satisfaction, distress, cancer-related self-efficacy, and

perceived control over the disease. Br J Cancer.

2003;88(5):658-665.

6. Weng HC, Steed JF, Yu SW, et al. The effect of

surgeon empathy and emotional intelligence on

patient satisfaction. Adv Health Sci Educ Theory Pract.

2011;16(5):591-600.

7. Menendez ME, Chen NC, Mudgal CS, Jupiter JB,

Ring D. Physician Empathy as a Driver of Hand

Surgery Patient Satisfaction. J Hand Surg Am.

2015;40(9):1860-1865 e1862.

8. Steinhausen S, Ommen O, Thum S, et al. Physician

empathy and subjective evaluation of medical

treatment outcome in trauma surgery patients. Patient

Educ Couns. 2014;95(1):53-60.

9. Zwack J, Schweitzer J. If every fifth physician is

affected by burnout, what about the other four?

Resilience strategies of experienced physicians. Acad

Med. 2013;88(3):382-389.

10. Ramirez AJ, Graham J, Richards MA, Cull A, Gregory

WM. Mental health of hospital consultants: the effects

of stress and satisfaction at work. Lancet.

1996;347(9003):724-728.

11. Chipidza FE, Wallwork RS, Stern TA. Impact of the

Doctor-Patient Relationship. Prim Care Companion

CNS Disord. 2015;17(5).

12. Eveleigh RM, Muskens E, van Ravesteijn H, van Dijk

I, van Rijswijk E, Lucassen P. An overview of 19

instruments assessing the doctor-patient relationship:

different models or concepts are used. J Clin Epidemiol.

2012;65(1):10-15.

13. Hojat M, DeSantis J, Gonnella JS. Patient Perceptions

of Clinician's Empathy: Measurement and

Psychometrics. J Patient Exp. 2017;4(2):78-83.

14. Mercer SW, McConnachie A, Maxwell M, Heaney D,

Watt GC. Relevance and practical use of the

Consultation and Relational Empathy (CARE)

Measure in general practice. Fam Pract.

2005;22(3):328-334.

15. Kane GC, Gotto JL, Mangione S, West S, Hojat M.

Jefferson Scale of Patient's Perceptions of Physician

Empathy: preliminary psychometric data. Croat Med J.

2007;48(1):81-86.

16. Schenker Y, Stewart A, Na B, Whooley MA.

Depressive symptoms and perceived doctor-patient

communication in the Heart and Soul study. J Gen

Intern Med. 2009;24(5):550-556.

17. Glaser KM, Markham FW, Adler HM, McManus PR,

Hojat M. Relationships between scores on the

Jefferson Scale of physician empathy, patient

perceptions of physician empathy, and humanistic

approaches to patient care: a validity study. Med Sci

Monit. 2007;13(7):CR291-294.

18. Keulen M, Teunis T, Kortlever J, Vagner G, Ring D,

Reichel L. Measurement of Perceived Physician

Empathy in Orthopaedic Patients. . In Press: J Patient

Experience.

19. Hemmerdinger JM, Stoddart SD, Lilford RJ. A

systematic review of tests of empathy in medicine.

BMC Med Educ. 2007;7:24.

20. Foundation RWJ. How to Report Results of the

CAHPS Clinician & Group Survey. .

wwwforces4qualityorg.

21. Crofton C, Lubalin JS, Darby C. Consumer

Assessment of Health Plans Study (CAHPS).

Foreword. Med Care. 1999;37(3 Suppl):MS1-9.

22. Dyer N, Sorra JS, Smith SA, Cleary PD, Hays RD.

Psychometric properties of the Consumer Assessment

of Healthcare Providers and Systems (CAHPS(R))

Clinician and Group Adult Visit Survey. Med Care.

2012;50 Suppl:S28-34.

23. Sullivan M, Bishop S, Pivik J. The Pain

Catastrophizing Scale: Development and V alidation.

Psychological Assessment.7(4):524-532.

Patient experience measures are highly correlated, Gonzalez, et al.

Patient Experience Journal, Volume 7, Issue 1 – 2020 50

24. Bot AG, Becker SJ, van Dijk CN, Ring D, Vranceanu

AM. Abbreviated psychologic questionnaires are valid

in patients with hand conditions. Clin Orthop Relat Res.

2013;471(12):4037-4044.

25. Bot AGJ, Nota S, Ring D. The creation of an

abbreviated version of the PSEQ: the PSEQ-2.

Psychosomatics. 2014;55(4):381-385.

26. Kroenke K, Spitzer RL, Williams JB, Monahan PO,

Lowe B. Anxiety disorders in primary care:

prevalence, impairment, comorbidity, and detection.

Ann Intern Med. 2007;146(5):317-325.

27. Kroenke K, Spitzer RL, Williams JB, Lowe B. An

ultra-brief screening scale for anxiety and depression:

the PHQ-4. Psychosomatics. 2009;50(6):613-621.

28. Howick J, Steinkopf L, Ulyte A, Roberts N, Meissner

K. How empathic is your healthcare practitioner? A

systematic review and meta-analysis of patient

surveys. BMC Med Educ. 2017;17(1):136.

29. Zenger M, Schaefert R, van der Feltz-Cornelis C,

Brahler E, Hauser W. Validation of the Patient-

Doctor-Relationship Questionnaire (PDRQ-9) in a

representative cross-sectional German population

survey. PLoS One. 2014;9(3):e91964.

30. Mingote Adan J, Moreno Jimenez B, Rodriguez

Carvajal R, Galvez Herrer M, Ruiz Lopez P.

Psychometric validation of the Spanish version of the

Patient-Doctor Relationship Questionnaire (PDRQ).

Actas Esp Psiquiatr. 2009;37(2):94-100.

31. Swenson SL, Rose M, Vittinghoff E, Stewart A,

Schillinger D. The influence of depressive symptoms

on clinician-patient communication among patients

with type 2 diabetes. Med Care. 2008;46(3):257-265.

32. Altman DG, Royston P. The cost of dichotomising

continuous variables. BMJ. 2006;332(7549):1080.

33. Arpey NC, Gaglioti AH, Rosenbaum ME. How

Socioeconomic Status Affects Patient Perceptions of

Health Care: A Qualitative Study. J Prim Care

Community Health. 2017;8(3):169-175.

34. Lundy J, Bikker A, Higgins M, et al. General

practitioners’ patient-centredness and responses to

patients’ emotional cues and concerns: relationships

with perceived empathy in areas of high and low

socioeconomic deprivation. Journal of Compassionate

Health Care. 2015.