Patient-Practitioner Orientation Scale [PPOS-18]

Description

The Patient-Practitioner Orientation Scale (PPOS-18) is a widely used instrument designed to assess attitudes toward the relationship between patients and healthcare professionals. It measures the extent to which an individual endorses a more patient-centered or a more practitioner-centered approach to healthcare.

The scale consists of 18 statements and can be administered to healthcare professionals, students in health-related disciplines, and patients. It examines beliefs about patient participation in decision-making, the distribution of power within the therapeutic relationship, and the importance attributed to the patient’s emotional and personal needs.

Objective

The primary objective of the PPOS-18 is to assess the degree of orientation toward patient-centered care.

The scale can be used to examine the extent to which healthcare professionals support collaboration, shared decision-making, and individualized care.

It can also be used to explore patients’ own expectations and preferences regarding their involvement in healthcare decisions and communication with healthcare professionals.

Structure

The PPOS-18 includes two main subscales:

Sharing: Assesses the extent to which patients are expected to participate actively in decision-making, receive adequate information, and share responsibility and power with healthcare professionals.

Caring: Assesses the importance attributed to the patient’s emotions, expectations, personal circumstances, and overall experience, beyond the strictly biomedical aspects of illness and treatment.

Together, these two dimensions provide a broader assessment of attitudes toward patient-centered healthcare.

Scoring

The 18 items are rated on a six-point Likert scale, typically ranging from:

1 = Strongly agree
to
6 = Strongly disagree

Scoring is performed so that higher scores consistently indicate a stronger patient-centered orientation.

A mean score can be calculated across all 18 items to obtain an overall PPOS score. Separate mean scores can also be calculated for the Sharing and Caring subscales.

Scores range from 1 to 6.

Interpretation

Higher scores indicate stronger endorsement of collaboration, shared decision-making, and individualized care that takes the patient’s values, concerns, and preferences into account.

Lower scores reflect a more traditional or hierarchical orientation in which the healthcare professional is perceived as having the dominant role in decision-making.

The PPOS does not have universally accepted diagnostic cut-off values for classifying respondents as patient-centered or practitioner-centered. For this reason, scores are generally best treated as continuous variables and interpreted comparatively across groups, populations, or time points.

Psychometric Properties

The PPOS has been used extensively among healthcare professionals, medical and health sciences students, and patients. Research has examined its internal consistency, factor structure, and associations with variables such as satisfaction with care, trust in healthcare professionals, communication preferences, and attitudes toward shared decision-making.

Psychometric performance may vary across languages, cultures, and professional groups. Therefore, translated or culturally adapted versions should be evaluated for internal consistency, construct validity, factor structure, and measurement equivalence within the target population.

Applications

The PPOS-18 has been widely applied in medical education, nursing, primary care, healthcare services research, and studies of patient-provider communication.

It can be used to compare professional groups, examine differences between students and experienced practitioners, evaluate educational interventions, and investigate associations between professional attitudes and the quality of clinical communication.

It is also useful in research exploring whether similarities or differences between patients’ and practitioners’ orientations influence satisfaction, trust, communication, and the therapeutic relationship.

Conclusion

The PPOS-18 is a useful instrument for assessing attitudes toward patient-centered healthcare.

Its distinction between Sharing and Caring allows researchers to examine both attitudes toward shared decision-making and the importance attributed to the patient’s personal, emotional, and psychosocial needs.

The scale can therefore contribute to research on healthcare culture, professional education, communication, and the development of more collaborative relationships between patients and healthcare professionals.

References

Krupat, E., Hiam, C. M., Fleming, M. Z., & Freeman, P. (1999). Patient-centeredness and its correlates among first year medical students. International Journal of Psychiatry in Medicine, 29(3), 347–356.

Krupat, E., Rosenkranz, S. L., Yeager, C. M., Barnard, K., Putnam, S. M., & Inui, T. S. (2000). The practice orientations of physicians and patients: The effect of doctor-patient congruence on satisfaction. Patient Education and Counseling, 39(1), 49–59.

Krupat, E., Bell, R. A., Kravitz, R. L., Thom, D., & Azari, R. (2001). When physicians and patients think alike: Patient-centered beliefs and their impact on satisfaction and trust. The Journal of Family Practice, 50(12), 1057–1062.

Mead, N., & Bower, P. (2000). Patient-centredness: A conceptual framework and review of the empirical literature. Social Science & Medicine, 51(7), 1087–1110.