Using different perspectives to generate items for a new scale measuring medical outcomes of dysphagia (MOD)

Objective: To compare and contrast clinician, patient, and caregiver perspectives to generate all important and salient items for a new scale to measure medical consequences relevant to adult patients with dysphagia. Study Design and Setting: Six focus groups (three with clinicians, two with patients, and one with caregivers) were conducted with a total of 33 participants. Through the constant comparison method of Grounded Theory, analysis began with open coding and progressed with higher-order categorization to derive perceptions from differing vantage points. Results: Three themes evolved: (1) clinicians, caregivers, and patients each limited the medical consequences of dysphagia to the same impairment domains: pulmonary, nutritional, and psychological; (2) these consequences were given the same priority by clinicians and caregivers, but patients ranked them differently; (3) within each impairment domain, few dimensions were derived by clinicians and many by patients. Patients were more elaborate in their descriptions of psychological consequences. Conclusions: The use of qualitative methodology to generate different perspectives derived different content. Clinicians, caregivers, and patients all agreed on the importance of three domains but differed in their prioritization and specific issues. These findings provide the necessary foundation for development of a comprehensive tool to measure medical consequences among patients with dysphagia. (C) 2009 Elsevier Inc. All rights reserved.