Development of an addiction recovery patient-reported outcome measure: Response to Addiction Recovery (R2AR)
Recovery, a primary goal of addiction treatment, goes beyond abstinence. It encompasses various aspects that differ among individuals, making it challenging to measure. Traditional assessments in addiction care have focused on processes, which provide limited insights into treatment quality and long-term outcomes. In contrast, patient-reported outcomes offer a more comprehensive and nuanced understanding. To address these gaps, this study introduced and tested a patient-reported outcome measure for addiction recovery, called Response to Addiction Recovery (R2AR).
A comprehensive approach, following the Patient-Reported Outcomes Measurement Information System (PROMIS) measure development standard, was adopted. Individuals with personal experience of addiction, treatment providers, and other experts collaborated in refining the measure. Starting with a pool of 356 distinct items, 57 items were examined through surveys and interviews, followed by focus groups and cognitive interviews.
The items demonstrated face validity, showing that they made sense and were relevant. Individuals with personal experience of addiction rated the importance of items higher and with greater diversity than treatment providers. However, both groups agreed that the most crucial item was "There are more important things to me in my life than using substances." The final R2AR instrument comprises 19 items spanning eight domains of recovery, addressing early, active, and long-term recovery phases. Respondents assess each item in terms of its strength and its importance to ongoing recovery.
R2AR empowers individuals with lived experience of addiction to define what is essential for their recovery. It is designed to aid treatment planning within clinical workflows and to monitor recovery progress. Involving individuals with personal experience of addiction and treatment providers in the development process enhances the measure's face validity. The incorporation of individuals with personal experience of addiction in R2AR's development and its use in guiding recovery planning underscores the significance of patient-centeredness in designing clinical tools and involving patients in their care.