P50 - Systematic review of psychometric properties of PREMs

Public interest in healthcare is increasingly focusing on the perspectives of patients. This emphasis serves various purposes, such as enhancing a patient-centered approach and evaluating healthcare performance. The assessment of these perspectives relies on diverse tools, including Patient Reported Outcome Measures (PROMs), satisfaction evaluations, and Patient Reported Experience Measures (PREMs). PROMs, specifically, are valuable for quantifying the outcomes. They are considered as a reflexive tool. Satisfaction assessments gauge the subjective satisfaction of patients' experiences. PREMs are multidimensional and objective in evaluating patients' experience. We consider it as a formative tool and it must be validated as such. Observations reveal that many PREMs are validated as reflexive tools or often utilized as satisfaction questionnaires. Objectives Our primary objective was to investigate the methods used to validate the psychometric properties of these PREMs. Our main outcome measure focused on the validation methods employed for each PREM. Second outcomes were: response types, guidelines used, French validation and their application in research. For PREMs predating 2018, we used the appendix of a systematic review summarizing all PREMs until 2018. Then, we searched in PubMed "PREM" published from 2018 to March 2023. We analyzed 127 articles. 83 of the identified PREMs underwent factorial analysis, especially Factor Analysis (EFA), and a majority also or solely employed Cronbach's alpha. 13 PREMs only used consensus methods for validation, especially with Delphi consensus method. Some evaluated external validity using Spearman, Pearson correlation, or ANOVA. 114 articles did not adhere to any specific guidelines, while nine followed the COSMIN guidelines, sometimes because of the lack of guidelines for formative tools. A large number employed subjective scales, often for measuring satisfaction. As for research utilization, half of the identified PREMs were cited in research as primary or secondary outcomes. In summary, the majority of PREMs are developed as reflexive tools and used to assess satisfaction rather than experience. Clearly defining the validation method for a measurement tool can be difficult. We assert that PREMs should be developed more as formative tools. We believe that the experience results from the sum of criteria evaluated by the items, and not from the measurement of a latent variable that would be the "past experience." Unfortunately, there is no clear consensus for the psychometric validation of formative tool. Also, we believe it could be interesting to offer a comprehensive evaluation with a grid of items that must be present to provide an optimal experience. This type of grid is used for the evaluation of health students and is considered as comprehensive and reproducible. We were pleasantly surprised to find that half of them have been used at least once in research. Overall, many PREMs are validated within the context of a paradigm shift in the healthcare field, placing the patient and his experience at the forefront of concerns. PREMs enable an objective and multidimensional evaluation of the patient experience, providing a distinct approach from PROMs and satisfaction. However, we note that they are often used to measure satisfaction and validated reflexively, limiting the advantages and the different approach they bring compared to PROMs and satisfaction.