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Clinical evaluation questionnaire in advanced cancer: a psychometric study of a novel measure of healthcare provider interactions
  1. Froukje E de Vries1,2,
  2. Kenneth Mah2,
  3. Carmine Malfitano2,3,
  4. Gilla K Shapiro2,3,
  5. Camilla Zimmermann2,4,5,6,7,
  6. Sarah Hales2,4 and
  7. Gary Rodin2,3,4,7
  1. 1Department of Psychiatry, The Netherlands Cancer Institute, Amsterdam, The Netherlands
  2. 2Department of Supportive Care, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
  3. 3Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC), Princess Margaret Cancer Centre (University Health Network) and University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  5. 5Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  6. 6Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  7. 7Princess Margaret Research Institute, Princess Margaret Cancer Centre (University Health Network), Toronto, Ontario, Canada
  1. Correspondence to Dr Kenneth Mah, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; kenneth.mah{at}


Objectives The Clinical Evaluation Questionnaire (CEQ) is a patient-reported experience measure (PREM) that assesses the perceived benefit of therapeutic interactions of patients with advanced cancer with their healthcare providers concerning issues relevant to their illness. It was developed for a randomised controlled trial of Managing Cancer and Living Meaningfully (CALM), a brief supportive-expressive therapy for patients with advanced cancer. The present study evaluates the preliminary psychometric properties of the CEQ.

Method Patients in the CALM and usual care groups completed the CEQ 3 (n=195) and 6 (n=186) months after randomisation. The CEQ’s internal consistency, factor structure and concurrent validity were evaluated, and CEQ scores in the treatment groups were compared.

Results The CEQ demonstrated high internal consistency for both treatment arms (Cronbach’s α=0.94 to 0.95), and a single factor was consistently found in exploratory factor analyses. CEQ scores correlated significantly with satisfaction with the relationship with healthcare providers (r=0.23 to 0.61, p≤0.02) and life completion (r=0.24 to 0.37, p≤0.02) in both groups and with spiritual well-being in the CALM group (meaning: r=0.23 to 0.24, p=0.01 to 0.02; faith: r=0.24 to 0.34, p=0.001 to 0.02). The CALM group showed higher CEQ total scores than usual care at 6 months (CALM: 18.19±6.59; usual care: 14.36±7.67, p<0.001).

Conclusions The CEQ is a reliable and valid PREM of the benefit perceived by patients with advanced cancer from their interactions with healthcare providers. Further study is needed to establish its value as a measure of perceived intervention benefit across different clinical and research settings.

  • psychological care
  • quality of life
  • supportive care
  • cancer

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors CM, CZ, SH and GR contributed to conception and design of the CALM RCT and the development of the CEQ for the trial. FEdV, KM, GKS and GR conceptualised the original manuscript, and FEdV drafted the original manuscript. KM, CM, GKS and GR made substantial contributions to the original manuscript. FEdV and KM completed data analyses, and FEdV, KM, CM, GKS and GR contributed to data interpretation. GKS, CZ and SH provided critical review of the manuscript for intellectual content. All authors approved the final version.

  • Funding The CALM RCT was supported by an operating grant from the Canadian Institutes of Health Research (grant #MOP106473 to GR, SH and Christopher Lo, co-principal investigators) and through programprogramme funding from the Princess Margaret Cancer Centre, University Health Network. The funders of the original trial played no role in the study design, data collection and analysis, data interpretation or writing of this report.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.