Person-centered care (PCC) is increasingly recognized as crucial for individuals with chronic illnesses and functional limitations. Effective PCC assessment tools are essential to ensure quality care delivery. This review examines the validity evidence of the Person-Centered Care Assessment Tool (P-CAT), a widely used instrument for measuring PCC, using the Standards for Educational and Psychological Testing as a framework.
The P-CAT, a 13-item ordinal scale, assesses PCC across three dimensions: person-centered care, organizational support, and environmental accessibility. Developed in Australia for long-term care settings for individuals with dementia, the P-CAT has since been adapted for diverse healthcare environments, including oncology and psychiatric units. Its brevity, simplicity, and potential for cross-cultural applicability have contributed to its widespread adoption.
Validity Evidence Based on the “Standards”
The “Standards” framework provides a comprehensive approach to evaluating validity evidence based on five sources: test content, response processes, internal structure, relations to other variables, and consequences of testing. Applying this framework to the P-CAT reveals the following:
Test Content
The P-CAT items reflect essential elements of PCC described in the literature, including individualized care planning, goal-oriented care, interprofessional collaboration, and ongoing communication. Expert review, literature reviews, and stakeholder input informed the initial item development, supporting the content validity of the P-CAT.
Response Processes
While the original P-CAT development study did not explicitly investigate response processes, subsequent adaptations in various languages suggest that the items are generally understood and interpreted consistently across different cultural contexts. However, more rigorous qualitative research exploring how respondents interpret and answer the P-CAT items is needed.
Internal Structure
The original P-CAT validation study identified a three-factor structure, aligning with the instrument’s three dimensions. However, subsequent validation studies have not consistently replicated this three-factor structure. Some studies have reported using the total P-CAT score, disregarding its multidimensionality. Further research employing robust factor analytic techniques is crucial to clarify the internal structure of the P-CAT. A reliability generalization study indicated a mean alpha value of 0.81 across 25 samples, suggesting good internal consistency.
Relations to Other Variables
Limited research has examined the relationship between P-CAT scores and other relevant variables. Studies exploring the association between P-CAT scores and patient outcomes, staff satisfaction, and quality of care indicators would strengthen the validity evidence for the instrument.
Consequences of Testing
The consequences of using the P-CAT have not been systematically evaluated. Research investigating the impact of P-CAT implementation on healthcare practices, resource allocation, and patient experiences would provide valuable insights into the consequences of testing.
Conclusion
The P-CAT is a promising tool for assessing PCC, but further research is needed to strengthen its validity evidence. Specifically, future studies should prioritize rigorous investigation of response processes, clarification of the internal structure across different populations and settings, and examination of the relationship between P-CAT scores and other relevant variables. A comprehensive understanding of the consequences of P-CAT use is also essential. This systematic review, guided by the “Standards” framework, highlights areas where further research is needed to ensure the appropriate interpretation and application of the P-CAT in promoting and evaluating person-centered care. This enhanced understanding of the P-CAT’s validity will contribute to its effective use in improving healthcare quality and patient experiences.
