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Measuring the HRQOL of children in clinical practice may also meet with some resistance by clinicians who feel that the completion of these measures represents too great a burden for children and their parents, particularly children with serious illnesses.
Routine use of standardized HRQOL instruments in pediatric clinical practice may be impeded by physician attitudinal barriers or concern that completion of these measures represents too great a burden.
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Results were derived from a small sample and it is possible that more reminders may have increased completion of the measures at the second time point.
All other interactions between the participant and the interviewer were kept to a minimum so as not to interfere with the participant's completion of the measures.
It is possible that completion of the measure in-hospital may lead to increased social desirability bias compared to mail-out survey measures.
Finally, cognitive interviews with patients following completion of the measure provided evidence that participants interpreted the items, instructions, and response options as intended, and that the items comprehensively evaluated patient experiences of nighttime symptoms of COPD.
A modified version of the CSRI [ 37] was administered to assess parents' and children's contacts with health, social care and education professionals in the six months prior to completion of the measure.
In other words, to verify this validity it is necessary to ask the respondent, during completion of the measure, whether the items and scales look reasonable at "face value".
Additionally, the increase in provision of administration time for outcome measures may have been influential for the completion of these service-user completed measures which involve extra burden in terms of posting-out and collecting questionnaires.
Both versions were similar in length, with regards to number of pages, estimated completion time and coverage of these measures.
Therefore, when implementing the routine completion of satisfaction measures, encouraging honest feedback by asking patients to complete measures outside the clinic environment and by highlighting the confidentiality of their responses may be beneficial.
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