Patient and public involvement in the design, administration and evaluation of patient feedback tools, an example in psychiatry: a systematic review and critical interpretative synthesis

Background Patient feedback is considered integral to healthcare design, delivery and reform. However, while there is a strong policy commitment to evidencing patient and public involvement (PPI) in the design of patient feedback tools, it remains unclear whether this happens in practice. Methods A systematic review using thematic analysis and critical interpretative synthesis of peer-reviewed and grey literature published between 2007 and 2017 exploring the presence of PPI in the design, administration and evaluation of patient feedback tools for practising psychiatrists. The research process was carried out in collaboration with a volunteer mental health patient research partner. Results Fourteen articles (10 peer-reviewed, four grey literature) discussing the development of nine patient feedback tools were included. Six of the nine tools reviewed were designed from a professional perspective only. Tool content and its categorization primarily remained at the professional's discretion. Patient participation rates, presence of missing data and psychometric validation were used to determine validity and patient acceptability. In most instances, patients remained passive recipients with limited opportunity to actively influence change at any stage. No article reviewed reported PPI in all aspects of tool design, administration or evaluation. Conclusions The majority of patient feedback tools are designed, administered and evaluated from the professional perspective only. Existing tools appear to assume that: professional and patient agendas are synonymous; psychometric validation is indicative of patient acceptability; and psychiatric patients do not have the capacity or desire to be involved. Future patient feedback tools should be co-produced from the outset to ensure they are valued by all those involved. A reconsideration of the purpose of patient feedback, and what constitutes valid patient feedback, is also required.