Development and Validation of a People-Centred Scale for Evaluating Care Pathway Experiences

Vittoria Sturlese; Gerardo Petruzziello; Stefano Benini; Lucetta Nisticò; Davide Allegri; Anna Pavani; Carlo Descovich; Sergio Cinocca; Federica Lugaresi; Elisa Mazzini; Luca Ghirotto; Domenica Gazineo; Loredana Cerullo

doi:10.5334/ijic.9134

Development and Validation of a People-Centred Scale for Evaluating Care Pathway Experiences

International Journal of Integrated Care

Volume 26 (2026): Issue 2

By: Vittoria Sturlese, Gerardo Petruzziello , Stefano Benini , Lucetta Nisticò, Davide Allegri , Anna Pavani, Carlo Descovich , Sergio Cinocca , Federica Lugaresi, Elisa Mazzini , Luca Ghirotto , Domenica Gazineo and Loredana Cerullo

Open Access

|May 2026

Abstract

Introduction: Care pathways (CPs) are essential for ensuring coordinated, high-quality healthcare, yet patient-reported experiences remain underexplored. In Italy, no validated tool exists to systematically assess persons’ perspectives on CPs. This study aimed to develop and validate a scale to measure patient-reported experiences with CPs.

Methods: A mixed-method approach was used. First, a literature review, a Delphi study involving healthcare professionals, and focus groups with persons and interest-holders informed the generation of items. Next, a pilot test with 218 persons diagnosed with breast cancer refined the scale. Finally, a quantitative study involving 12 CPs across three healthcare organisations assessed the scale’s properties using exploratory and confirmatory factor analyses.

Results: Factor analysis revealed a four-factor structure encompassing person-centrality, responsiveness, integration, and organisation. The scale demonstrated good internal validity, with satisfactory reliability for most factors. Correlations with overall CP evaluation, satisfaction, and self-reported health provided support for external validity. However, the organisational factor showed lower reliability, requiring further refinement.

Discussion: This study provides a robust, multidimensional tool for assessing patients’ reported experiences with CPs. Its findings highlight the importance of person-centred care and integrated service delivery.

Conclusion: The newly developed scale offers a validated measure to enhance CP evaluation, supporting people-centred healthcare practice and policy improvements.

References

Pearson SD, Goulart-Fisher D, Lee TH. Critical Pathways as a Strategy for Improving Care: Problems and Potential. Ann Intern Med. 1995;123:941–948. DOI: 10.7326/0003-4819-123-12-199512150-00008
Open DOI Search in Google Scholar Back to article
Every NR, Hochman J, Becker R, et al. Critical Pathways. Circulation. 2000;101:461–465. DOI: 10.1161/01.CIR.101.4.461
Open DOI Search in Google Scholar Back to article
Panella M, Marchisio S, Di Stanislao F. Reducing clinical variations with clinical pathways: do pathways work? Int J Qual Health Care. 2003;15:509–521. DOI: 10.1093/intqhc/mzg057
Open DOI Search in Google Scholar Back to article
E-P-A Definition of care pathway. Eur Pathw Assoc n.d. https://e-p-a.org/care-pathways/ (accessed October 30, 2024).
Search in Google Scholar Back to article
Seys D, Coeckelberghs E, Sermeus W, et al. Overview on the target population and methods used in care pathway projects: A narrative review. Int J Clin Pract. 2021;75:e14565. DOI: 10.1111/ijcp.14565
Open DOI Search in Google Scholar Back to article
Vanhaecht K, Panella M, van Zelm R, et al. An overview on the history and concept of care pathways as complex interventions. Int J Care Pathw. 2010;14:117–123. DOI: 10.1258/jicp.2010.010019
Open DOI Search in Google Scholar Back to article
Smith E, Ross FM. Service user involvement and integrated care pathways. Int J Health Care Qual Assur. 2007;20:195–214. DOI: 10.1108/09526860710743345
Open DOI Search in Google Scholar Back to article
Wind A, van der Linden C, Hartman E, et al. Patient involvement in clinical pathway development, implementation and evaluation – A scoping review of international literature. Patient Educ Couns. 2022;105:1441–1448. DOI: 10.1016/j.pec.2021.10.007
Open DOI Search in Google Scholar Back to article
Pulvirenti M, McMillan J, Lawn S. Empowerment, patient centred care and self-management. Health Expect. 2014;17:303–310. DOI: 10.1111/j.1369-7625.2011.00757.x
Open DOI Search in Google Scholar Back to article
Barry MJ, Edgman-Levitan S. Shared Decision Making — The Pinnacle of Patient-Centered Care. N Engl J Med. n.d.;366:780–781. DOI: 10.1056/NEJMp1109283
Open DOI Search in Google Scholar Back to article
Stepanian N, Larsen MH, Mendelsohn JB, et al. Empowerment interventions designed for persons living with chronic disease – a systematic review and meta-analysis of the components and efficacy of format on patient-reported outcomes. BMC Health Serv Res. 2023;23:911. DOI: 10.1186/s12913-023-09895-6
Open DOI Search in Google Scholar Back to article
Wang H, Jia J, Fan Y, et al. Impact of inpatient self-efficacy and trust in physicians on inpatient satisfaction with medical services: the mediating role of patient participation in medical decision-making. Front Psychol. 2024;15. DOI: 10.3389/fpsyg.2024.1364319
Open DOI Search in Google Scholar Back to article
World Health Organization. WHO global strategy on people-centred and integrated health services: interim report. Geneva: World Health Organization; 2015.
Search in Google Scholar Back to article
Sepucha KR, Levin CA, Uzogara EE, et al. Developing instruments to measure the quality of decisions: Early results for a set of symptom-driven decisions. 4th Int Conf Shar Decis Mak. 2008;73:504–510. DOI: 10.1016/j.pec.2008.07.009
Open DOI Search in Google Scholar Back to article
Gill PS. Patient engagement: an investigation at a primary care clinic. Int J Gen Med. 2013;6:85–98. DOI: 10.2147/IJGM.S42226
Open DOI Search in Google Scholar Back to article
Bru-Luna LM, Martí-Vilar M, Merino-Soto C, et al. Person-centered care assessment tool with a focus on quality healthcare: a systematic review of psychometric properties. BMC Psychol. 2024;12:217. DOI: 10.1186/s40359-024-01716-7
Open DOI Search in Google Scholar Back to article
Bombard Y, Baker GR, Orlando E, et al. Engaging patients to improve quality of care: a systematic review. Implement Sci. 2018;13:98. DOI: 10.1186/s13012-018-0784-z
Open DOI Search in Google Scholar Back to article
World Health Organization. Framework on integrated, people-centred health services; 2016.
Search in Google Scholar Back to article
Olsen CF, Bergland A, Bye A, et al. Crossing knowledge boundaries: health care providers’ perceptions and experiences of what is important to achieve more person-centered patient pathways for older people. BMC Health Serv Res. 2021;21:310. DOI: 10.1186/s12913-021-06312-8
Open DOI Search in Google Scholar Back to article
Ceccarelli G, Foglia E, Ferrario L, et al. Care pathways production and review checklist: results from an HTA evaluation. Recenti Prog Med. 2022;113:177–188. DOI: 10.1701/3761.37483
Open DOI Search in Google Scholar Back to article
Gartner J-B, Abasse KS, Bergeron F, et al. Definition and conceptualization of the patient-centered care pathway, a proposed integrative framework for consensus: a Concept analysis and systematic review. BMC Health Serv Res. 2022;22:558. DOI: 10.1186/s12913-022-07960-0
Open DOI Search in Google Scholar Back to article
Cherif E, Martin-Verdier E, Rochette C. Investigating the healthcare pathway through patients’ experience and profiles: implications for breast cancer healthcare providers. BMC Health Serv Res. 2020;20:735. DOI: 10.1186/s12913-020-05569-9
Open DOI Search in Google Scholar Back to article
Ocloo J, Goodrich J, Tanaka H, et al. The importance of power, context and agency in improving patient experience through a patient and family centred care approach. Health Res Policy Syst. 2020;18:10. DOI: 10.1186/s12961-019-0487-1
Open DOI Search in Google Scholar Back to article
van der Vlegel-Brouwer W, van Kemenade E, Stein KV, et al. Research in Integrated Care: The Need for More Emergent, People-Centred Approaches. Int J Integr Care. 2020;20:5. DOI: 10.5334/ijic.5627
Open DOI Search in Google Scholar Back to article
De Luc K. Care pathways: an evaluation of their effectiveness. J Adv Nurs. 2000;32:485–496. DOI: 10.1046/j.1365-2648.2000.01500.x
Open DOI Search in Google Scholar Back to article
Rucci P, Foglino S, Bravi F, et al. Validation of the OPportunity for Treatment In ONcology (OPTION) questionnaire measuring continuity of care. Eur J Cancer Care (Engl). 2018;27:e12765. DOI: 10.1111/ecc.12765
Open DOI Search in Google Scholar Back to article
Zakkar M. Patient experience: determinants and manifestations. Int J Health Gov. 2019;24:143–154. DOI: 10.1108/IJHG-09-2018-0046
Open DOI Search in Google Scholar Back to article
Foglino S, Bravi F, Carretta E, et al. The relationship between integrated care and cancer patient experience: A scoping review of the evidence. Health Policy. 2016;120:55–63. DOI: 10.1016/j.healthpol.2015.12.004
Open DOI Search in Google Scholar Back to article
Bravi F, Ruscio ED, Frassoldati A, et al. Patient and Health Care Professional Perspectives: A Case Study of the Lung Cancer Integrated Care Pathway. Int J Integr Care. 2018;18:7. DOI: 10.5334/ijic.3972
Open DOI Search in Google Scholar Back to article
Wodskou PM, Høst D, Godtfredsen NS, et al. A qualitative study of integrated care from the perspectives of patients with chronic obstructive pulmonary disease and their relatives. BMC Health Serv Res. 2014;14:471. DOI: 10.1186/1472-6963-14-471
Open DOI Search in Google Scholar Back to article
Vanhaecht K, De Witte K, Depreitere R, et al. Development and validation of a care process self-evaluation tool. Health Serv Manage Res. 2007;20:189–202. DOI: 10.1258/095148407781395964
Open DOI Search in Google Scholar Back to article
Kozlowska O, Tallett A, Bond S, et al. Developing and exploring the validity of a patient reported experience measure for adult inpatient diabetes care. Diabet Med. 2024;41:e15266. DOI: 10.1111/dme.15266
Open DOI Search in Google Scholar Back to article
Jamieson Gilmore K, Corazza I, Coletta L, et al. The uses of Patient Reported Experience Measures in health systems: A systematic narrative review. Health Policy. 2023;128:1–10. DOI: 10.1016/j.healthpol.2022.07.008
Open DOI Search in Google Scholar Back to article
O’Neill D, Noortman R, Burghoorn, AW, et al. The Patient Experience Driver Toolkit: Centering Patients in the Design of New Care Pathways. Int J Human–Computer Interact. 2025:1–19. DOI: 10.1080/10447318.2025.2490400
Open DOI Search in Google Scholar Back to article
Picker Institute Europe. A person centred health service. Our vision for the NHS; 2024.
Search in Google Scholar Back to article
Boulkedid R, Abdoul H, Loustau M, et al. Using and reporting the Delphi method for selecting healthcare quality indicators: a systematic review. PloS One. 2011;6:e20476. DOI: 10.1371/journal.pone.0020476
Open DOI Search in Google Scholar Back to article
Dalkey NC. The Delphi Method: An Experimental Study of Group Opinion. Santa Monica, CA: The Rand Corporation; 1969. DOI: 10.1016/S0016-3287(69)80025-X
Open DOI Search in Google Scholar Back to article
Grimm KJ, Widaman KF. Construct validity. APA Handb. Res. Methods Psychol. Vol 1 Found. Plan. Meas. Psychom., Washington, DC, US: American Psychological Association; 2012, p. 621–642. DOI: 10.1037/13619-033
Open DOI Search in Google Scholar Back to article
Carradori T, Bravi F, Butera DS, et al. Continuity of care in oncology. Quantitative analysis of data from patients treated in two different settings in Emilia—lRomagna. Recenti Prog Med. 2017;108:288–293. DOI: 10.1701/2715.27716
Open DOI Search in Google Scholar Back to article
Mazzini E, Cerullo L, Mazzi G, et al. The Experience of Accreditation of the Reggio Emilia Research Hospital with the OECI Model. Tumori J. 2015;101:S42–S46. DOI: 10.5301/tj.5000466
Open DOI Search in Google Scholar Back to article
Servizio Prevenzione collettiva e Sanità pubblica. Il Protocollo Diagnostico-Terapeutico e Assistenziale per il carcinoma mammario della Regione Emilia-Romagna. Regione Emilia-Romagna; 2018.
Search in Google Scholar Back to article
Regione Emilia-Romagna. Guida per i valutatori alla verifica dei Percorsi Diagnostico Terapeutici Assistenziali (PDTA) nell’ambito delle visite di accreditamento; 2013.
Search in Google Scholar Back to article
Gale NK, Heath G, Cameron E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol. 2013;13:117. DOI: 10.1186/1471-2288-13-117
Open DOI Search in Google Scholar Back to article
Braun V, Clarke V. Thematic Analysis. A Practical Guide. London: SAGE Publications; 2021.
Search in Google Scholar Back to article
Boateng GO, Neilands TB, Frongillo EA, et al. Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front Public Health. 2018;6. DOI: 10.3389/fpubh.2018.00149
Open DOI Search in Google Scholar Back to article
Hair JF, Black WC, Babin BJ, et al. Multivariate data analysis. Eighth edition. Andover, Hampshire, United Kingdom: Cengage; 2019.
Search in Google Scholar Back to article
MacKenzie SB, Podsakoff PM, Podsakoff NP. Construct Measurement and Validation Procedures in MIS and Behavioral Research: Integrating New and Existing Techniques. MIS Q. 2011;35:293–334. DOI: 10.2307/23044045
Open DOI Search in Google Scholar Back to article
Mirzaei A, Carter SR, Patanwala AE, et al. Missing data in surveys: Key concepts, approaches, and applications. Res Soc Adm Pharm. 2022;18:2308–2316. DOI: 10.1016/j.sapharm.2021.03.009
Open DOI Search in Google Scholar Back to article
Worthington RL, Whittaker TA. Scale Development Research: A Content Analysis and Recommendations for Best Practices. Couns Psychol. 2006;34:806–838. DOI: 10.1177/0011000006288127
Open DOI Search in Google Scholar Back to article
Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model. 1999;6:1–55. DOI: 10.1080/10705519909540118
Open DOI Search in Google Scholar Back to article
George D, Mallery P. SPSS for Windows step by step: a simple guide and reference 11.0 update. 4th ed. Boston: Allyn and Bacon; 2003.
Search in Google Scholar Back to article
Batalden M, Batalden P, Margolis P, et al. Coproduction of healthcare service. BMJ Qual Amp Saf. 2016;25:509. DOI: 10.1136/bmjqs-2015-004315
Open DOI Search in Google Scholar Back to article
Hsu C-C, Sandford BA. Minimizing Non-Response in The Delphi Process: How to Respond to Non-Response. Pract Assess Res Eval. 2007;12:1–6.
Search in Google Scholar Back to article
Bravo P, Edwards A, Barr PJ, et al. Conceptualising patient empowerment: a mixed methods study. BMC Health Serv Res. 2015;15:252. DOI: 10.1186/s12913-015-0907-z
Open DOI Search in Google Scholar Back to article
Barlow J, Wright C, Sheasby J, et al. Self-management approaches for people with chronic conditions: a review. Patient Educ Couns. 2002;48:177–187. DOI: 10.1016/S0738-3991(02)00032-0
Open DOI Search in Google Scholar Back to article
Ferrand YB, Siemens J, Weathers D, et al. Patient Satisfaction With Healthcare Services A Critical Review. Qual Manag J. 2016;23:6–22. DOI: 10.1080/10686967.2016.11918486
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.5334/ijic.9134 | Journal eISSN: 1568-4156

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Language: English

Page range: 13 - 13

Submitted on: Feb 1, 2025

Accepted on: May 7, 2026

Published on: May 22, 2026

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

patient-centred evaluation,

healthcare quality assessment,

oncology pathways,

mixed-methods validation,

integrated care

© 2026 Vittoria Sturlese, Gerardo Petruzziello, Stefano Benini, Lucetta Nisticò, Davide Allegri, Anna Pavani, Carlo Descovich, Sergio Cinocca, Federica Lugaresi, Elisa Mazzini, Luca Ghirotto, Domenica Gazineo, Loredana Cerullo, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 26 (2026): Issue 2