How Closed-ended Survey Questions and Narrative Comments Interact in Characterizing Caregivers’ Overall Assessment of Hospice Care

IntroductionResponses to open-ended questions on experience surveys provide rich information and are useful for quality improvement (QI). We examine the usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey comments for informing hospice QI.MethodsWe administered the CAHPS Hospice Survey to caregivers of patients who died March-August 2021 while receiving care from 56 US hospices. We coded 3811 comments for valence, content and actionability; examined the alignment of comments with experience measures derived from closed-ended questions; and assessed the degree to which comments predicted global rating measures.ResultsComments were provided more often by caregivers with greater involvement in care and of decedents with longer lengths of stay. Most caregivers provided comments (78%); 25% were actionable for QI and 32% mentioned topics beyond those addressed by closed-ended questions. Comments aligned well with the content and valence of caregivers' responses to closed-ended questions assessing similar topics. Comments' valence correctly signaled the direction of caregivers' global ratings, but comments' valence, actionability and content had negligible additional impact on the explained variance in global ratings (1-2%) after accounting for measures assessing specific aspects of care.ConclusionClosed-ended questions on the CAHPS Hospice Survey elicit comprehensive insights on hospice care experiences. While many caregivers elected to provide open-ended feedback, a minority of these comments were actionable for QI, and comments did not provide substantial, unique information. CAHPS Hospice Survey measures are sufficient, without open-ended comments, to guide QI, prioritize actions, benchmark performance and assist caregivers in hospice selection.