My group and I have developed a pre-anesthesia health assessment screening questionnaire. We would like to validate if the questionnaire can be administered by patients on their own before their interview with anesthetist. The gold standard method at the clinic involves the nurse anesthetist interviewing the patient using a questionnaire. The literature describes two methods: (1) the anesthesia caregiver interviews the patient but is blinded to the responses provided by the patient; (2) the anesthetist checks the patient's responses during the interview by reading out the question and confirming the answer. The published studies did not explain why the methods described above were used. For a questionnaire validation study, which method would be appropriate? Which would yield the least biased assessment and what advantages and disadvantages would it have? Which would be the most ethical?
Links to articles:
Article Validation of a pre-anaesthetic screening questionnaire
Article Validation of a patient self-administered pre-anaesthetic sc...
Ethics says that Methodology and Method should be clear for an Article to complete without confusion. Questionaire were used for your study so focus on Question and Answers and the details of Answers are sub details which does show Importance but Not mainly significant as the Method is clear. Two types of Assesments could be put on one Table to show the comparison of two results and then pick up the same answers and discuss the significant differences between the two different assesments. Regards
Dear Tarig,
In your case, you have to think about the relative advantages of each method over other. For example, what is the extent of 'intra-subject variability' in caregivers in each method? What approach would be more consistent and less biased? There is no readymade answer to your question. You have to think on various methodological and operational aspects and if you are still not sure, then you can do a pilot testing to compare each method and decide the one which you found superior.
As above,there are advantages and disadvantages to both methods,and whilst the second method may have practical advantages,it would be easier to criticise this for potentially introducing bias from the interaction between interviewer/anaesthetist and patient,during the process of question and confirming the answer.
For instance,if the interviewer adds any vocal or visual cues during the process,it is possible for those to introduce bias.
The first technique may seem less likely to introduce such bias,but also the interviewer needs to be aware of the potential when voicing questions.
We have also used simple self administered questionnaires,and as you will be aware,they too have significant limitations,examples being the way that patients interpret the significance of their co-morbidities,and what previous health issues or procedures they may be willing to admit to.
The whole area is full of potential issues unfortunately.
Good luck with your project.
Thank-you for your very helpful comments Ahsan Ali Siddiqui , Ram Bajpai and Ian Ewart . It is not easy as one has thought and several factors are to be considered.
Thank-you again Ahsan Ali Siddiqui , Ram Bajpai and Ian Ewart for your comments.
The first method (blinding of anesthesia caregiver) has the benefit of achieving more reliable criterion validity estimates. However, the second method (not blinding the anesthesia caregiver) also has the benefit that the anesthesia caregiver would be able to identify the questions to which the patient changed his/her response. The anesthesia caregiver is in a position to ask the patient for the reason of changing the question. It could identify potential ambiguous terms, or medical terms or lack of clarity in questions leading to misinterpretation. Hence, the anesthesia caregiver would be able to detect problems with the construct of the questionnaire that the patient may not report.
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