See the CARE Measure: Link to the measure
The CARE Measure is a person-centred process measure that measures the amount of empathy that a patient feels they have received during a consultation. It is based on a broad definition of empathy and has been rigorously developed and tested by Prof. Stewart Mercer and colleagues in terms of its theoretical underpinning and its validity and reliability. It has been validated for use by GPs, secondary care doctors, and most AHPs. It is free to use. Patients complete the measure after the consultation in their own time, so clinic time should not affected by this measure’s use. It should take patients no longer than 10 minutes to complete. At present there have been no studies which specifically investigate the suitability of the CARE Measure for use with children, individuals with communication difficulties or learning disabilities which impede comprehension. In 2010-2011 a large scale assessment of the validity, reliability, and feasibility of the CARE Measure in AHP practice was carried out by the Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling. The study found that the CARE Measure was not feasible for use by all AHP groups and settings, specifically in inpatient settings and by AHPs who only see a small number of patients or patients not suitable for the measure due to the lower numbers of patients seen, time constraints, and other practice-based issues. In order to improve the feasibility of the CARE Measure and expand it for use with other patient and staff groups, various versions of the CARE Measure, including a version using ‘talking mats’, a screening measure version, and the CARE Approach are under development and will be added to the Framework at a later date.
How to collect the data
You should hand a CARE Measure to your patient at the end of the consultation and ask them to complete it before leaving. It is best if you are not present while they complete this, as they may feel pressured to fill it in very positively, so we recommend the following solutions:
If you work in an outpatient department it is best if you ask the patient to fill this out in the reception (where available) and have a designated and clearly labelled box for them to put the CARE Measure into when they have finished.
If you are a domiciliary clinician it is best if you provide the patient with a pre-paid addressed envelope to return the CARE Measure in. They then complete it after you have left and the form is posted back.
It can also be helpful if you label the CARE Measures in some way to allow you to identify any that may go walkabout, or if other staff members are also collecting measures in the same drop-box. This can be something as simple as writing your initials in the top corner or assigning yourself and the rest of the staff individual numbers that they can identify their own measures with.
How much data do you need to collect?
Ideally you should collect data from 50 consecutive patients to get the most representative picture of how you ar perceived by your patients. Do not self-select the patients or you will not receive a true picture of your practice. You may need to hand out more than 50 CARE Measures to receive 50 back.
What to do with your raw data – scoring the measure
A website is currently under construction which will automatically calculate CARE Measure scores and provide up to date feedback based on normative values. A link to the website will be added to this page once it is live. Traditional scoring instructions are outlined below.
Scoring the CARE Measure – Once you have collected you 50 questionnaires from consecutive patients you should take time to score them. Patients score each of the ten items of the CARE Measure as follows:
- Poor – 1
- Fair – 2
- Good – 3
- Very good – 4
- Excellent – 5
If you have more than two blank or 'does not apply' responses on a single CARE Measure then this one should be removed from your overall data-set. This is for reliability reasons. For CARE Measures where you have one or two blank or 'does not apply' responses, you should work out the mean average of the other scored questions and use this average as the score for your blank or 'does not apply' responses. This can take a little time to get used to, but based on various analyses (see the links in the later sections), this provides a more representative overall score.
All ten of the CARE Measure items should then be added together following the scoring guidance above. You will have a maximum of 50 and a minimum score of 10. Once you have summed each measure you should then work out your mean average score. To do this add up all of your total scores for each CARE Measure and divide this number by the number of total questionnaires that you have collected. This will give you your mean average.
Interpreting your findings
A list of normative values has been provided by the CARE Measure’s creator, Prof. Stewart Mercer here.
These are values that act as guidance to let you know roughly where you sit in the scheme of things, like ‘cut-off scores.’ As part of the CARE study run by Dr. Edward Duncan and Dr. Jennifer Murray at the NMAHP Research Unit, University of Stirling, normative values relating to AHPs in outpatient, inpatient and domiciliary practice have been identified. These are slightly different to those derived from GP practices (in the link above) and we suggest that NMAHPs should use the values in the table below:
Thus if you had a mean score of 47 then your score would fall betweem 75th and 90th percentile, i.e,. in the top 25% of scores. If you had a mean score of 48, this would place you in the top 10% of scores.
What might also be helpful is to consider your score in light of the average scores that were collected on the same AHP data as above, in the table below:
Reporting your findings
See also Stage 5: Reporting Outcomes
To make the reporting of information easier for you we suggest that you use the following template to report your CARE Measure findings. This is not the whole story, however, just a small part of it. You should still continue on to Stages 5 and 6 to best report your findings and to move onto the next stages (e.g., acting on your findings).
“The Consultation and Relational Empathy (CARE) measure was used to assess person centred care. The CARE Measure is a person centred process measure that is cited in the NHSScotland Quality Strategy and measures the amount of empathy that a patient feels that they have received during their consultation. I scored _*put your score here*_. This falls in the _*check the table and put in your percentile here*_ percentile, meaning that my score falls into the top/bottom _*check the table and put in this information here*_% of scores. My score is above/below the mean average.
Mercer, S.W., McConnachie, A., Maxwell, M., Heaney, D.H., & Watt, G.C.M. (2005). Relevance and performance of the Consultation and Relational Empathy (CARE) Measure in general practice. Family Practice, 22(3), 328-334.
Mercer, S.W., Watt, G.C.M., Maxwell, M., & Heaney, D.H.. (2004). The development and preliminary validation of the Consultation and Relational Empathy (CARE) Measure: an empathy-based consultation process measure. Family Practice, 21(6), 699-705.
Mercer, S.W., & Reynolds, W.J. (2002). Empathy and quality of care. BJGP,52(Suppplement), S9-S12.
Copyright/intellectual property rights
The CARE Measure can be used free of charge. The measure may not be used on a commercial basis without the consent of the author and the Chief Scientist Office of the Scottish Executive Health Department, on behalf of the Scottish Ministers. If you would like more information, please contact:
Dr. Stewart Mercer
General Practice and Primary Care
Division of Community-based Sciences
University of Glasgow
1 Horselethill Road
Glasgow G12 9LX
You have reached the end of the guidance for this measure. Move onto Stage 5: Reporting Outcomes.
Or go back to Stage 3: Considering Options to review other measures.