Background The illness experiences of people with kidney disease are not systematically ascertained as part of clinical care. We conducted the first real-world psychometric evaluation of the consideRATE questions among patients with kidney disease and assessed healthcare experiences in a rural hospital setting.

Methods We conducted a cross-sectional survey with a sample of patients with kidney disease and their care partners. Our survey consisted of demographic questions, consideRATE (8-items) to measure healthcare experience, and CANHELP-Lite (21-items) as a reference for consideRATE psychometric assessment. We scored consideRATE as continuous (range: 1-4) and top-box (score=4). We conducted internal reliability (Cronbach’s alpha) and validity (convergent and discriminant using Pearson’s correlation) tests. We compared mean consideRATE scores between paired subgroups using t-tests. We examined the relationship between rurality and healthcare experience using a multivariable linear regression model and rural-urban commuting area codes.

Results We recruited 163 participants, including 52 who lived in rural areas. The mean consideRATE score was 3.65 (SD=0.42), and the top-box score was 35% (n=59). Internal consistency for consideRATE was 0.86. We demonstrated convergent validity (continuous: r=0.5, p<0.001 and top-box: r=0.3, p<0.001) and discriminant validity (continuous: r=0.1, p>0.05 and top-box: r=0.1, p>0.05). Subgroup analyses revealed no significant differences in overall consideRATE scores by rurality status, state of residence, travel time, and gender. After adjustment for demographics, lower continuous mean consideRATE scores were significantly associated with longer travel time to the clinic (p<0.01), religious affiliation (p<0.05), and age over 55 years (p<0.01). We found no significant association between total consideRATE score and rurality.

Conclusion We found validity in the first real-world psychometric assessment of consideRATE among people with kidney disease and found associations between healthcare experience and various demographic variables.

Catherine H. Saunders and Glyn Elwyn, and report copyright but no relevant financial interest in the consideRATE questions, the measure of serious illness care experience assessed in this study. Glyn Elwyn has edited and published books that provide occasional royalties: Shared Decision Making (Oxford University Press) and Groups (Radcliffe Press). Glyn Elwyn's academic interests are focused on shared decision-making and coproduction. In addition to consideRATE, he owns copyright in measures of shared decision making (collaboRATE) and care integration (integRATE), a measure of goal setting (coopeRATE), a measure of clinician willingness to do shared decision making (incorpoRATE), an observer measure of shared decision making (Observer OPTION-5 and Observer OPTION-12). He is the Founder and Director of &think LLC which owns the registered trademark for Option GridsTM patient decision aids. He is an adviser to EBSCO Publishing. All other authors report no conflicts of interest.

This study was supported by internal funds from the Dartmouth Hitchcock Medical Center Department of Medicine.

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Dartmouth Health Institutional Review Board (IRB) approved this study in May 2023 [IRB ID: 02000560].

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All data produced in the present study are available upon reasonable request to the authors