Incorporating Computer Adaptive Testing

Patient education and shared decision making are of continuously growing importance in modern medicine, including in the preoperative anaesthesia clinic. Additionally, there is a high demand for increasing efficiency in all health care systems worldwide. However, thorough preoperative patient education is essential for obtaining informed consent for any type of anaesthesia. Fortunately, today’s technological advancement makes digital preoperative education and screening feasible, with less direct involvement from the anaesthetist. To inform patients and to screen patients’ knowledge level on anaesthesia effectively and validly in a digital setting, psychometrically validated questionnaires are needed in a wide variety of anaesthesia types, such as general, spinal, epidural, or loco-regional anaesthesia. Multiple initiatives to improve preoperative patient education and subsequent level of knowledge of anaesthesia have been developed, for example by using digital aids(1-4). However, our first questionnaire – the Rotterdam Anaesthesia Knowledge Questionnaire (RAK-Q) with MEC-2020 0468 – was one of the first knowledge questionnaires concerning preoperative anaesthetic practice to be psychometrically validated (not yet published). Since this was the first version of our questionnaire, there were multiple limitations. First, it is probable not all knowledge items were included. Based on our Item Response Theory (IRT) in earlier analysis, multiple items had to be dropped because they did not load on one of the factors, decreasing the number of items. Second, since it is a fixed test, all patients must answer all questions, creating a time-consuming activity. To continue, standard fixed tests almost always provide the best precision for test-takers of medium ability and an increasingly poorer precision for test-takers with more extreme test scores, either high or low(5). The goal of this study is to develop a CAT(6) from our questionnaire. A CAT is a form of computer based testing which adapts to the ability of the test-taker and is therefore also called tailored testing. CAT offers time-saving benefits by shortening the test duration without sacrificing accuracy. When a test-taker responds correctly to an item, the subsequent item presented will be more challenging. Conversely, if the test-taker answers incorrectly, the next item will be easier. This tailored selection of item difficulty, specific to each individual, optimizes the information gathered from both individual items and the overall test performance. Using IRT analysis, multiple levels of item difficulty can be established(7). Since IRT places items and test-takers on the same scale, we can provide tailored tests of various lengths, based on the test-takers abilities(6). Using an increased item bank to develop this CAT will facilitate an improved version of our RAK-Q 1.0, increasing efficiency and decreasing use of resources.

Primary Objective: To develop and validate a knowledge questionnaire as an improved version of our RAK-Q 1.0 (phase 1 and 2). Afterwards we will create a CAT (phase 3). 

Observational prospective noninvasive study without control group

Questionnaire

To the best of our knowledge, no physical or physiological risks are involved for the participant. Patients must fill out our questionnaire once. Since it is a knowledge questionnaire, no physiological discomfort is to be expected of the questions.