CAT for Healthcare Professionals
How was the CAT developed?
Many patients with COPD are currently sub-optimally managed, and it’s thought that this is due in part to the tendency of patients to understate the severity of their condition to those responsible for treating them2. This makes it difficult for treatment to be assigned appropriately.
There is a need for a tool that will (i) help patients gain a better understanding of how their condition impacts on their life, (ii) help them to express this to their healthcare professional, supporting a more effective consultation and facilitating better management, and (iii) provide a reliable measurement of the impact of COPD on a patient’s life. The CAT was developed to meet this need.
The items to be included in the CAT were developed in such a way that ensured they measure the aspects of COPD that are most important to patients and healthcare professionals in an accurate, reliable and simple manner.
The development of the CAT was a three stage process
Concept Development1
First, a strategic review of the literature was conducted to (i) confirm the need for a CAT-like tool; and (ii) provide the conceptual framework for developing such a tool.
The review focused on placebo-controlled studies and current guidelines for the management of COPD. It found that, in COPD, two labelled health states exist – ‘stable’ vs. exacerbation. However, treatment guidelines provided no definition of the limits of variability for COPD symptoms or manifestations of this condition that should trigger a change in management.
The CAT was developed based on the concept that for each COPD patient there is an ‘optimal state’, which affords them the highest quality of life possible – this will differ for each patient, according to severity of their disease. An international panel of experts in pulmonary and primary care agreed that this concept was useful – i.e. that achievement of the best possible health, given the patient’s underlying severity of disease, was an appropriate and realistic management aim.
The literature review also found that there was no short, simple measure of overall disease severity that is/could be used routinely in clinical practice. The need for such a tool was confirmed by the expert advisory panel.
Item Genereation2
In the UK and US, approximately 60 patients with COPD of varying severities were recruited and interviewed in order to gain an understanding of how patients with COPD experience their condition, and the language they use to describe this experience. The number of patients interviewed was not predetermined at the start of the study. Instead, patients were recruited until no further useful information could be derived from the interviews.
Interviews with healthcare professionals were also conducted in order to explore which components of COPD have the greatest influence on management decisions, and the ways in which healthcare professionals determine whether a patient is optimally or sub-optimally managed. This, together with input from the literature review and expert advisory panel, ensured that only those findings from the patient interviews that are considered clinically relevant were used in the development of the CAT.
These interviews identified a number of key themes/concepts that were meaningful and important to both patients and physicians. From these, a draft set of 21 items was developed, covering a range of health domains.
These were included in the item reduction and validation studies.
Item reduction & validation3
Stage 3 was conducted to ensure that those items included in the CAT contribute to the measurement of the impact of COPD on a patient’s life in a reliable manner, and to ensure the CAT will be valid for patients with different disease severities and in different parts of the world. This was done based on data from three observational prospective studies conducted in Europe and the USA, with a combined enrolment of 1,503 patients. From the draft set of 21 items generated in Stage 2, 8 were eventually selected for inclusion in the CAT.
In these studies, the measurement properties of the CAT were judged to be excellent – across both stable and exacerbating patient groups – and a strong correlation was demonstrated between CAT scores and SGRQ scores. It was also shown that the CAT provides a reliable measure of the impact of COPD, independent of language – which should ensure that the test is relevant to an international COPD population and applicable for global use.
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References
- Jones et al. Primary Care Respiratory Journal 2009; 18(3): 208-215.
- Rennard et al. European Respiratory Journal 2002; 20: 799-805.
- Jones et al. European Respiratory Journal 2009; 34: 648-654.
Page Last Updated: April 25, 2012
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If you are a healthcare professional, this guide will show you how to use the CAT in the best way.
