Measuring patient centeredness with German language Patient-Reported Experience Measures (PREM) - a systematic review and qualitative analysis according to COSMIN

Background: Patient centeredness is an integral part of the quality of care. Patient-reported experience measures (PREMs) are assumed to be an appropriate tool to assess patient-centredness. An evaluation of German-speaking PREMs is lacking. Objective: To perform a systematic review and qualitative analysis of psychometric measurement qualities of German-speaking PREMs. Methods: A systematic literature search was performed in Medline, PsycInfo, CINHAL, Embase, Cochrane database (last search 9th November 2021) for studies describing generic, surgery- or cancer care-specific PREMs. Subsequently, questionnaires that were not in German or for which no German translation exists were excluded. Furthermore, questionnaires, that are for healthcare professionals rather than patients as well as disease-specific questionnaires were excluded. Baseline data for all studies was extracted by two independent reviewers. Psychometric measurement qualities of the questionnaires were assessed according to the COSMIN guidelines. Results: In total, 3457 abstracts were screened, of which 3345 were excluded. The remaining 112 articles contained 51 PREMs, of which 12 were either developed in or translated into German: 8 generic (NORPEQ, PPE-15, PEACS, HCAHPS, QPPS, DUQUE, PEQ-G, Schoenfelder et al.), 4 cancer-specific (EORTC IN-PATSAT32, PSCC-G, Danish National Cancer Questionnaire, SCCC) and no surgery-specific PREM. None of the PREMs covered all 16 domains patient-centeredness. Overall rating of structural validity was adequate only for PEACS and HCAHPS. High ratings for internal consistency were given for NORPEQ, Schoenfelder et al., PSCC-G and the SCCC. Cross-cultural validity for translated questionnaires was adequate only for the PSCC-G, while reliability was adequately assessed only for the EORTC IN-PATSAT32. Due to a lack of measurement gold standard and minimal important change, criterion validity and measurement invariance could not be assessed. Most PREMs showed the expected outcomes for hypotheses testing for construct validity. Conclusion: None of the PREMs has been fully evaluated in German. Based on current evidence, the EORTC IN-PATSAT32 and PSCC-G can be recommended for cancer patients, while HCAHPS, NORPEQ, PPE-15 and PEACS might be used as generic PREMs. Compared to other languages PREM development in German is rudimentary and no comprehensive PREM system is currently available.