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Initial Validation of a Patient-Reported Measure of Compassion: Determining the Content Validity and Clinical Sensibility among Patients Living with a Life-Limiting and Incurable Illness



Although compassionate care is considered a cornerstone of quality palliative care, there is a paucity of valid and reliable measures to study, assess, and evaluate how patients experience compassion/compassionate care in their care.


The aim was to develop a patient-reported compassion measure for use in research and clinical practice with established content-related validity evidence for the items, question stems, and response scale.


Content validation for an initial 109 items was conducted through a two-round modified Delphi technique, followed by cognitive interviews with patients. A panel of international Subject Matter Experts (SMEs) and a Patient Advisory Group (PAG) assessed the items for their relevancy to their associated domain of compassion, yielding an Item-level Content Validity Index (I-CVI), which was used to determine content modifications. The SMEs and the PAG also provided narrative feedback on the clarity, flow, and wording of the instructions, questions, and response scale, with items being modified accordingly. Cognitive interviews were conducted with 16 patients to further assess the clarity, comprehensibility, and readability of each item within the revised item pool.


The first round of the Delphi review produced an overall CVI of 72% among SMEs and 80% among the PAG for the 109 items. Delphi panelists then reviewed a revised measure containing 84 items, generating an overall CVI of 84% for SMEs and 86% for the PAG. Sixty-eight items underwent further testing via cognitive interviews with patients, resulting in an additional 14 items being removed.


Having established this initial validity evidence, further testing to assess internal consistency, test–retest reliability, factor structure, and relationships to other variables is required to produce the first valid, reliable, and clinically informed patient-reported measure of compassion.

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Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


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The authors would like to acknowledge the following individuals for their support in this study: the Subject Matter Experts, Dr. Mary Vachon, Dr. Nathan Consedine, Dr. Philip Larkin, Dr. Betty Ferrell, Dr. Stephen Post, Dr. Stephen Smith, Dr. Latha Chandran, and Dr. Antonio Fernando, and Mark Hall, Research Associate, Faculty of Nursing, University of Calgary, for providing support with the data analysis.


This study was funded through a Canadian Institutes of Health Research Project Scheme Grant (#364041).

Author information




All authors (1) made substantial contributions to the conception and design of the study, acquisition of data, and analysis and interpretation of data; (2) were involved in drafting the manuscript or revising it critically for important intellectual content; (3) gave final approval of the version to be published and have participated sufficiently in the work to take public responsibility for appropriate portions of the content; and (4) agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Shane Sinclair.

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Conflict of Interest

The authors (SS, PJ, TFH, LR, SEM, LC, LES, and CL) declare that they have no competing interests.

Ethics Approval and Consent to Participate

This study was approved by the University of Calgary Conjoint Health Research Ethics Board (REB #17-0754).

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Sinclair, S., Jaggi, P., Hack, T.F. et al. Initial Validation of a Patient-Reported Measure of Compassion: Determining the Content Validity and Clinical Sensibility among Patients Living with a Life-Limiting and Incurable Illness. Patient 13, 327–337 (2020).

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