Development of the CAHPS Cancer Care Survey

The CAHPS^® Cancer Care Survey was developed and tested in two phases by the American Institutes for Research (AIR) and the Mayo Clinic with the support of multiple funders:

• The first phase of the project took place between October 2009 and March 2013. It was sponsored by AHRQ’s CAHPS program and the Outcomes Research Branch of the National Cancer Institute (NCI). In addition, the California Health Care Foundation (CHCF) funded market demand research in California and provided supplemental funding to support the initial field test. The survey developers also contributed supplemental funds to the first field test.
• The second phase took place between January 2014 and February 2016. CHCF funded a second field test of a revised survey.

Stakeholder input. AIR and Mayo Clinic began by developing a conceptual framework for understanding patient-centered cancer care based on input from multiple qualitative methods, including:

• An environmental scan
• Stakeholder interviews
• Review and input from a Technical Expert Panel (TEP)
• Focus groups with patients and caregivers.

Development and testing of the initial version. Based on the input from stakeholders, the survey development team crafted multiple survey questions, using the standard CAHPS question format, to address different dimensions of cancer care. They then evaluated the content validity and comprehensibility of the questions by cognitively testing a draft of the survey among patients who had received cancer treatment. That process resulted in version 1.0 of the instrument: a 73-item survey that included 41 questions designed to measure patient experiences in eight domains of cancer care, including access, communication, shared decision making, patient self-management, and patient safety. This survey was put through an iterative testing process that included an initial round of field testing with six hospital-based cancer centers located in the West Coast, Midwest, South, Northeast, and Southeast United States and psychometric analyses of data from this first field test.

Development of the final version. Based on the results of the first field test and additional input from stakeholders, the survey developers made several revisions to the survey, in part to make it more consistent with the CAHPS Clinician & Group Survey. They also conducted testing of the proposed measures with patients who had received cancer treatment. This version of the survey was translated into Spanish and field-tested with four community-based oncology practices in California. Based on analyses of the field test results and input from the CAHPS Consortium, the survey was finalized and approved by AHRQ for the CAHPS trademark in 2016.