Please analyze the following article, “The use of cognitive interviewing methodology in the design and testing of a screening tool for supportive and palliative care needs” by Nisar Ahmed, Janine C. Bestall, Sheila A. Payne, Bill Noble, and Sam H. Ahmedzai. This study, published in Support Care Cancer in 2009, details the application of cognitive interviewing to develop the Sheffield Profile for Assessment and Referral to Care (SPARC), a new screening measure aimed at identifying the specialist supportive and palliative care needs of patients with advanced illness.
The authors embarked on this work because while psychometrically sound measure development is complex, existing palliative care measures often lacked systematic testing with patients and professionals, and did not comprehensively cover all relevant domains (e.g., physical, psychological, social, spiritual, information, family support). The goal was to create a brief measure suitable for a vulnerable patient population.
The methodology involved an initial draft screening measure developed from a systematic literature review, interviews with patients, carers, and health and social care professionals. This draft, containing 65 questions across various sub-headings like communication, physical symptoms, and emotional issues, was then subjected to cognitive interviews. Six health and social care professionals and one consumer (a former cancer patient) participated in these interviews. The researchers employed both the ‘thinking aloud technique’ (concurrent approach), where participants verbalized their thoughts while or after answering each question, and a ‘debriefing’ or retrospective approach to gather overall feedback on the measure completion experience. An 11-question cognitive interview schedule was developed to guide discussions on clarity, relevance, tense, and appropriateness of response categories for each item.
Key findings from this process revealed the technique’s effectiveness in identifying jargon, confusing questions, and issues with phrasing and format. Participants often found the initial measure too long, repetitive, formal, and confusing, with many questions not worded naturally. For instance, “Have you been able to speak to someone about your illness?” was refined to “Have you been able to talk to someone—either a professional or your family and friends—about your illness, care or treatment?” to clarify the term “someone”. Similarly, medical jargon like “fatigued/tired” and “nausea” were simplified to “tired” and “sick,” respectively.
The interviews also highlighted sensitive questions related to finances, sexual intimacy, death and dying, and religious beliefs, prompting discussions on how to introduce these topics ethically and provide adequate support. While these sensitive questions were retained for their importance in holistic needs assessment, the feedback informed subsequent considerations for their administration. The original simple yes/no response format was deemed inappropriate for many questions, as participants preferred options for grading severity, leading to a re-evaluation of response formats. Based on the cognitive interviews, the measure was reduced from 65 to 60 questions and one question about weight change was added. This process eventually led to the development of SPARC-45.
The authors concluded that despite some limitations—such as the subjective and artificial nature of the technique, its time-consuming aspect, and the potential for a non-representative sample—the data demonstrated the usefulness of cognitive interviewing as a crucial first step in the development and refinement of SPARC. This study strongly advocates for the wider and routine use of this technique in supportive and palliative care research to proactively identify potential problems before field testing. Further research is recommended to evaluate the comparative usefulness of cognitive interviews in pre-test versus field environments.
APA Reference:
Ahmed, N., Bestall, J. C., Payne, S. A., Noble, B., & Ahmedzai, S. H. (2009). The use of cognitive interviewing methodology in the design and testing of a screening tool for supportive and palliative care needs. Supportive Care in Cancer, 17(6), 665–673. https://doi.org/10.1007/s00520-008-0521-2