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

This article examines the value of narrative comments from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey, which collects feedback from informal caregivers of hospice patients, for informing hospice quality improvement (QI). Analyzing 3,811 comments from caregivers of decedents who received care in 56 U.S. hospices, the study found that while most caregivers provided comments and about one-quarter were actionable for QI, these open-ended responses largely aligned with closed-ended survey measures and added minimal unique information beyond them. Comments correctly reflected caregivers' overall ratings of hospice care but explained little additional variance in global ratings after accounting for closed-ended responses. The findings suggest that the CAHPS Hospice Survey's closed-ended questions sufficiently capture caregiver experiences to guide QI, benchmarking, and hospice selection, though narrative comments may still offer detailed context and specific ideas for improvement initiatives.