Can Naive Viewers Put Themselves in the Patients' Shoes? Reliability and Validity of the Analogue Patient Methodology

Background: Analogue patients (APs) are untrained viewers given the task of viewing and rating their impressions of a medical interaction while taking on the patient role. This methodology is often used to assess patient perceptions when using real patient (RP) populations is unethical or impractical. Objectives: This study examines the reliability and validity of the AP methodology and its optimal implementation. Research Design: Forty-six videotaped interactions of RP-physician interactions, where RP satisfaction scores existed, were viewed by 216 APs, who rated satisfaction. Interrater reliability for AP satisfaction scores was evaluated. AP and RP satisfaction scores were compared with each other and correlated with the physician's observer-coded patient-centeredness. Measures: RP satisfaction was measured with a 15-item scale after the whole interaction. Physicians' patient-centered behavior was coded with the Four Habits Coding Scheme. AP satisfaction was measured after viewing the entire interaction with a single satisfaction question, a 4-item satisfaction scale including that single item, and the original 15-item satisfaction scale used by the RPs. Results: AP satisfaction ratings were reliable (alpha=0.70 for 4 APs). AP satisfaction was a significant predictor of RP satisfaction (r = 0.29, P = 0.05), especially when the analysis was limited to the RPs who reported being less than perfectly satisfied (r = 0.65, P = 0.002). AP satisfaction was a better predictor than RP satisfaction of providers' patient-centered behaviors in the interaction. Conclusions: The AP methodology is a valid and reliable approach to gathering patient perception data about provider-patient interactions. Results suggest practical advice for researchers using the AP methodology.