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Jones R, O'Loughlin R, Xiong X, Bahrampour M, Devlin N, Hiscock H, Chen G, Mulhern B, Dalziel K. Comparative Psychometric Performance of Common Generic Paediatric Health-Related Quality of Life Instrument Descriptive Systems: Results from the Australian Paediatric Multi-Instrument Comparison Study. PHARMACOECONOMICS 2024; 42:39-55. [PMID: 37955799 PMCID: PMC11169028 DOI: 10.1007/s40273-023-01330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The aim of this study was to compare the psychometric performance of common generic paediatric health-related quality-of-life instrument descriptive systems (PedsQL generic core 4.0, EQ-5D-Y-3L, EQ-5D-Y-5L, Child Health Utility 9D [CHU9D], Assessment of Quality of Life 6D [AQoL-6D], and Health Utilities Index Mark 3 [HUI3]) by child age, report type, and health status. METHODS Data for children aged 5-18 years were from the Australian Paediatric Multi-Instrument Comparison study. Ceiling effects, test-retest reliability, known-group validity, convergent and divergent validity, and responsiveness were assessed in the total sample and by child age (5-12 years vs 13-18 years), report type (self- vs proxy report), and health status. Instruments were scored using an exploratory level sum score (LSS) approach. RESULTS Survey data were available for 5945 children, with follow-up data available for 2346 children. The EQ-5D-Y-3L demonstrated ceiling effects. The PedsQL, EQ-5D-Y-3L, EQ-5D-Y-5L, and CHU9D demonstrated acceptable test-retest reliability. All instruments demonstrated known-group, convergent, and divergent validity. The EQ-5D-Y-3L, EQ-5D-Y-5L, and CHU9D demonstrated responsiveness to improvements in health and the PedsQL, EQ-5D-Y-3L, EQ-5D-Y-5L, and CHU9D to worsening health. The AQoL-6D and HUI3 had inconclusive test-retest reliability and responsiveness evidence due to small sample size. Importantly, ceiling effects, test-retest reliability and responsiveness varied by subgroup. CONCLUSION Results reflect instrument performance using LSSs, which may differ to utility scores. In the total sample, the EQ-5D-Y-5L and CHU9D descriptive systems demonstrated evidence of good performance (i.e., meeting prespecified criteria) across all psychometric attributes tested. Performance varied by child age and report type, indicating room for considerations by population and study.
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Affiliation(s)
- Renee Jones
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia.
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Rachel O'Loughlin
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Xiuqin Xiong
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Mina Bahrampour
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Campbell F, Whear R, Rogers M, Sutton A, Barlow J, Booth A, Tattersall A, Wolstenholme L, Thompson‐Coon J. PROTOCOL: What is the effect of intergenerational activities on the wellbeing and mental health of children and young people? CAMPBELL SYSTEMATIC REVIEWS 2023; 19:e1347. [PMID: 37475878 PMCID: PMC10354504 DOI: 10.1002/cl2.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
This is the protocol for a Campbell systematic review. The objectives are as follows: this systematic review will examine the impact of intergenerational interventions on the wellbeing and mental health in children and young people and will identify areas for future research as well as key messages for service commissioners.
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Affiliation(s)
- Fiona Campbell
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUnited KingdomUK
| | - Rebecca Whear
- NIHR CLAHRC South West Peninsula (PenCLAHRC)University of Exeter Medical SchoolExeterUK
| | - Morwenna Rogers
- NIHR ARC South West Peninsula (PenARC)University of Exeter Medical School, University of ExeterExeterUK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited KingdomUK
| | - Jane Barlow
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Andrew Booth
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited KingdomUK
| | - Andrew Tattersall
- School of Health and Related Research (ScHARR)University of SheffieldSheffieldUnited KingdomUK
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Tan RLY, Soh SZY, Chen LA, Herdman M, Luo N. Psychometric Properties of Generic Preference-Weighted Measures for Children and Adolescents: A Systematic Review. PHARMACOECONOMICS 2023; 41:155-174. [PMID: 36404365 DOI: 10.1007/s40273-022-01205-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Preference-weighted measures (PWMs)-also referred to as preference-based measures in the literature-of health status/health-related quality of life plays an essential role in estimating quality-adjusted life-years (QALY) for use in economic evaluations of healthcare products and interventions. However, as PWMs are first and foremost intended to accurately reflect respondent health status, they should ideally demonstrate good psychometric properties for the population in question. This study aimed to systematically review published evidence on the measurement properties of commonly used PWMs for children and adolescents. METHODS Three electronic databases (PubMed, Medline, and PsycINFO) were searched for articles assessing the psychometric properties (content validity, construct validity-including convergent validity and known-group validity, test-retest reliability, and responsiveness) of the PWMs of interest (AQoL-6D, CHU9D, HUI2, HUI3, and EQ-5D-Y). The COsensus-based Standards for the selection of health Measurement INstruments methodology (COSMIN) guidelines were used to assess (a) the methodological quality of the studies included and (b) the psychometric performance of the instruments covered. Data were analysed overall as well as by population (country and disease group) and perspective (self-report or proxy-report). The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42021277296). RESULTS In total, 53 articles were included in this systematic review. Health Utilities Index (HUI) was tested only in patient populations, CHU9D was most frequently tested in general population samples, while EQ-5D-Y was tested in both populations. Overall, there was high-quality evidence supporting sufficient construct validity for all instruments except AQoL-6D. Evidence supporting test-retest and responsiveness was scarce. There was high-quality evidence supporting sufficient responsiveness of HUI2 and HUI3, and inconsistent test-retest reliability of CHU9D and EQ-5D-Y. Evidence for content validity was minimal and therefore not extracted and synthesized for any PWMs. CONCLUSION This review provides updated evidence on the measurement properties of existing generic PWMs for children and adolescents. High-quality evidence for all relevant psychometric properties and across a range of populations was not available for any of the instruments included, indicating that further work is needed in this direction. This study has identified some of the most noticeable evidence gaps for each of the individual measures. Users can use this information to guide their decision on the choice of PWM to administer.
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Affiliation(s)
- Rachel Lee-Yin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Sonia Zhi Yi Soh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Le Ann Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Michael Herdman
- Office of Health Economics, 105 Victoria Street, London, SW1E 6QT, UK
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
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Tomlinson D, Dupuis LL, Johnston DL, Kuczynski S, Patel S, Schechter T, Vettese E, Mairs M, Tomlinson GA, Sung L. Reliability and validity of proxy-SSPedi and mini-SSPedi in pediatric patients 2-7 years receiving cancer treatments. BMC Cancer 2022; 22:730. [PMID: 35787263 PMCID: PMC9254487 DOI: 10.1186/s12885-022-09814-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/22/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom Screening in Pediatrics Tool (SSPedi) was developed for symptom screening by children 8-18 years. Objectives were to evaluate the reliability and validity of proxy-SSPedi and self-report mini-SSPedi for younger children. Methods This multi-center study enrolled guardians of children 2-7 years receiving cancer treatments (proxy-SSPedi) and their children 4-7 years (mini-SSPedi). The two populations were: (1) More symptomatic group where children were receiving active cancer treatment and were in hospital or clinic for four consecutive days; and (2) Less symptomatic group where children were receiving maintenance therapy for acute lymphoblastic leukemia or had completed cancer therapy. Proxy-SSPedi or mini-SSPedi were completed with measures of mucositis, nausea, pain, quality of life and overall symptoms. Respondents in the more symptomatic group repeated proxy-SSPedi/mini-SSPedi and a global symptom change scale 3 days later. Results There were 402 guardians and 326 children included in the analysis. Test re-test reliability of proxy-SSPedi showed intraclass correlation coefficient (ICC) 0.83 (95% confidence interval (CI) 0.72-0.90). Mean difference in proxy-SSPedi between more and less symptomatic groups was 9.7 (95% CI 8.3-11.1). Proxy-SSPedi was responsive to change and hypothesized relationships between measures were observed. With a priori threshold ≥0.6, inter-rater ICC among all dyads and those 6-7 years were 0.54 (95% CI 0.45-0.62) and 0.62 (95% CI 0.50-0.71) respectively. Among participating children, other hypothesized reliability and validity thresholds were generally met. Conclusions Proxy-SSPedi is reliable, valid and responsive in children 2-7 years old receiving cancer treatments. Mini-SSPedi can be used for children 6-7 years of age. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09814-8.
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Affiliation(s)
- Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada.,Department of Pharmacy, The Hospital for Sick Children555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, M5S 3M2, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), 99 Citation Drive, Toronto, Ontario, M2K 1S9, Canada
| | - Serina Patel
- Division of Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario, N6A 5W9, Canada
| | - Tal Schechter
- Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Emily Vettese
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - Mark Mairs
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, Ontario, M5G 0A4, Canada. .,Division of Haematology/Oncology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Development of a functional and psychosocial evaluation toolkit using mixed methodology in a community-based physical activity program for childhood cancer survivors. Support Care Cancer 2022; 30:8101-8110. [PMID: 35776188 DOI: 10.1007/s00520-022-07219-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE The evidence demonstrating the benefits of exercise and PA in patients and survivors of childhood cancer has been translated into a handful of community-based programs, such as the Pediatric cancer patients and survivors Engaging in Exercise for Recovery Program (PEER). To support the translation of research to practice, the next step in knowledge translation is to evaluate program effectiveness. An evaluation must consider the goals of the PEER program, feedback from key stakeholders, and logistics of this program. Thus, the purpose of this study was to develop an evaluation toolkit with an algorithm for the implementation of the PEER program. METHODS Semi-structured interviews were conducted with three different groups (stakeholders in pediatric oncology, PEER parents, and PEER participants). The interviews were transcribed and coded by two independent reviewers. RESULTS Key themes extracted from the interviews were split into physical and psychosocial themes. The most reported psychosocial themes were quality of life (QOL), fatigue/energy levels, fun, and cs; and physical themes included motor skills, physical literacy, and physical activity levels. Tools were compiled into the evaluation based on key themes identified as well as logistics of PEER. An algorithm was developed to tailor the evaluation to participants based on age and mobility. CONCLUSION To date, this is the first evaluation toolkit and algorithm developed for a specific community-based PA program, the PEER program. The next step in knowledge translation will be to implement the evaluation to assess feasibility and share the evaluation for adoption within other developing programs.
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Whang KA, Le TK, Khanna R, Williams KA, Roh YS, Sutaria N, Choi J, Gabriel S, Chavda R, Semenov Y, Kwatra SG. Health-related quality of life and economic burden of prurigo nodularis. J Am Acad Dermatol 2021; 86:573-580. [PMID: 34058278 DOI: 10.1016/j.jaad.2021.05.036] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/26/2021] [Accepted: 05/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prurigo nodularis (PN) is an understudied, pruritic inflammatory skin disease. Little is known about the effect of PN on quality of life and its associated economic burden. OBJECTIVE To quantify the impact of PN on quality of life and its economic implications. METHODS A cohort study of PN patients (n = 36) was conducted using the Health Utilities Index Mark 3 questionnaire. Control data from US adults (n = 4187) were obtained from the 2002-2003 Joint Canada/United States Survey of Health. Quality-adjusted life year loss and economic costs were estimated by comparing the Health Utilities Index Mark 3 scores of the PN patients with those of the controls. RESULTS The PN patients had lower overall health performance compared to the controls, (mean ± SE, 0.52 ± 0.06 vs 0.86 ± 0.003, respectively, P < .001). In multivariable regression, PN was found to be associated with worse health performance (coefficient -0.34, 95% CI [-0.46 to -0.23]), most prominent in the pain subdomain (coefficient -0.24, 95% CI [-0.35 to -0.13]). This correlated to an average of 6.5 lifetime quality-adjusted life years lost per patient, translating to an individual lifetime economic burden of $323,292 and a societal burden of $38.8 billion. CONCLUSION These results demonstrate that PN is associated with significant quality-of-life impairment, similar to the level of other chronic systemic conditions. PN is also associated with a substantial individual economic burden, emphasizing the necessity of research on effective treatment options.
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Affiliation(s)
- Katherine A Whang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Thomas K Le
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Youkyung Sophie Roh
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nishadh Sutaria
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Justin Choi
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sylvie Gabriel
- Galderma Prescription Global Business Unit, Rue d'Entre-deux-Villes, La Tour-de-Peilz, Switzerland
| | - Rajeev Chavda
- Galderma Prescription Global Business Unit, Rue d'Entre-deux-Villes, La Tour-de-Peilz, Switzerland
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Rowen D, Keetharuth AD, Poku E, Wong R, Pennington B, Wailoo A. A Review of the Psychometric Performance of Selected Child and Adolescent Preference-Based Measures Used to Produce Utilities for Child and Adolescent Health. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:443-460. [PMID: 33641779 DOI: 10.1016/j.jval.2020.09.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/08/2020] [Accepted: 09/25/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This review examined the psychometric performance of 4 generic child- and adolescent-specific preference-based measures that can be used to produce utilities for child and adolescent health. METHODS A systematic search was undertaken to identify studies reporting the psychometric performance of the Child Health Utility (CHU9D), EQ-5D-Y (3L or 5L), and Health Utilities Index Mark 2 (HUI2) or Mark 3 (HUI3) in children and/or adolescents. Data were extracted to assess known-group validity, convergent validity, responsiveness, reliability, acceptability, and feasibility. Data were extracted separately for the dimensions and utility index where this was reported. RESULTS The review included 76 studies (CHU9D n = 12, EQ-5D-Y-3L n = 20, HUI2 n = 26,HUI3 n = 43), which varied considerably across conditions and sample size. EQ-5D-Y-3L had the largest amount of evidence of good psychometric performance in proportion to the number of studies examining performance. The majority of the evidence related to EQ-5D-Y-3L was based on dimensions. CHU9D was assessed in fewer studies, but the majority of studies found evidence of good psychometric performance. Evidence for HUI2 and HUI3 was more mixed, but the studies were more limited in sample size and statistical power, which was likely to have affected performance. CONCLUSIONS The heterogeneity of published studies means that the evidence is based on studies across a range of countries, populations and conditions, using different study designs, different languages, different value sets and different statistical techniques. Evidence for CHU9D in particular is based on a limited number of studies. The findings raise concerns about the comparability of self-report and proxy-report responses to generate utility values for children and adolescents.
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Affiliation(s)
- Donna Rowen
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Anju D Keetharuth
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Edith Poku
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Ruth Wong
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Becky Pennington
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Allan Wailoo
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
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Adaptation and evaluation of a child-friendly patient reported outcome measure for use in Australia. Collegian 2021. [DOI: 10.1016/j.colegn.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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A systematic review of the psychosocial impact of fibroids before and after treatment. Am J Obstet Gynecol 2020; 223:674-708.e8. [PMID: 32474012 DOI: 10.1016/j.ajog.2020.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 04/15/2020] [Accepted: 05/20/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Despite the high prevalence of uterine fibroids, the psychosocial impact of fibroids has not been evaluated across different quality of life indicators and compared with other chronic conditions. Here, we rigorously analyzed available evidence pertaining to the psychosocial burden of uterine fibroids in premenopausal women and compared validated quality of life and symptom scores before and after treatment. DATA SOURCES We searched PubMed, PsycINFO, ClinicalTrials.gov, Embase, and Cochrane Library for publications from January 1990 to January 2020. STUDY ELIGIBILITY CRITERIA We considered English-language publications that evaluated the association between uterine fibroids diagnosed by imaging studies in premenopausal women and quality of life by standardized and validated questionnaires at baseline and after treatment. We used a detailed list of terms related to quality of life, questionnaires, and uterine fibroids to conduct the search. METHODS Three reviewers screened titles and abstracts and then obtained full-text articles for further analysis. The reviewers assessed risk of bias using established Cochrane and Newcastle-Ottawa Scale guidelines. The quality of life scores of premenopausal women with fibroids were reviewed at baseline and compared with those of published quality of life scores in other disease populations in addition to after fibroid treatment. RESULTS A total of 57 studies were included in the review: 18 randomized controlled trials and 39 observational studies. Of note, the 36-Item Short Form Survey and European Quality of Life Five-Dimension Scale questionnaires both indicated a diagnosis of uterine fibroids to have a disability score that was similar to or exceeded (was a greater psychosocial stressor) a diagnosis of heart disease, diabetes mellitus, or breast cancer. Quality of life scores were lower at baseline than after treatment in all instruments measuring these variables in women with uterine fibroids, indicating significantly impaired psychosocial functioning. Uterine fibroids were associated with significant patient-reported health disabilities related to bodily pain, mental health, social functioning, and satisfaction with sex life. CONCLUSION A diagnosis of uterine fibroids was a significant psychosocial stressor among women at baseline and relative to other diseases. Validated quality of life instruments indicated therapeutic success and the improvement of both physical and emotional symptoms after treatment.
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Whang KA, Khanna R, Williams KA, Mahadevan V, Semenov Y, Kwatra SG. Health-Related QOL and Economic Burden of Chronic Pruritus. J Invest Dermatol 2020; 141:754-760.e1. [PMID: 32941916 DOI: 10.1016/j.jid.2020.08.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/19/2020] [Accepted: 08/24/2020] [Indexed: 02/06/2023]
Abstract
Chronic pruritus (CP) has considerable implications for QOL. However, its impact on health-related QOL and economic burden is not fully characterized. We administered a cross-sectional survey on 132 patients with CP using the Health Utilities Index Mark 3 instrument. Normative data from healthy adults (n = 4,187) were obtained from the Joint Canada/US Survey of Health. Quality-adjusted life-year loss and economic costs were estimated on the basis of Health Utilities Index Mark 3 scores of patients with CP versus controls. Patients with CP had lower overall health performance than the control (0.56 ± 0.03 vs. 0.86 ± 0.003, P < 0.001). In multivariable regression, CP was associated with worse overall health performance (coefficient = -0.30, 95% confidence interval = -0.33 to -0.27), most accentuated in the domains of pain (coefficient = -0.24, confidence interval = -0.28 to -0.21) and emotion (coefficient = -0.11, confidence interval = -0.13 to -0.10). The reduced Health Utilities Index Mark 3 score correlated with 5.5 average lifetime quality-adjusted life-years lost per patient. Using conservative estimates for willingness to pay, the quality-adjusted life-year loss translated to an individual lifetime economic burden of $274,921 and a societal burden of $88.8 billion. CP is associated with significant QOL impairment. The economic burden of CP highlights the necessity for further research into management options.
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Affiliation(s)
- Katherine A Whang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kyle A Williams
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Varun Mahadevan
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yevgeniy Semenov
- Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts, USA; Department of Biomedical Informatics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
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Francis A, Didsbury MS, van Zwieten A, Chen K, James LJ, Kim S, Howard K, Williams G, Bahat Treidel O, McTaggart S, Walker A, Mackie F, Kara T, Nassar N, Teixeira-Pinto A, Tong A, Johnson D, Craig JC, Wong G. Quality of life of children and adolescents with chronic kidney disease: a cross-sectional study. Arch Dis Child 2019; 104:134-140. [PMID: 30018070 DOI: 10.1136/archdischild-2018-314934] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/24/2018] [Accepted: 06/14/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim was to compare quality of life (QoL) among children and adolescents with different stages of chronic kidney disease (CKD) and determine factors associated with changes in QoL. DESIGN Cross-sectional. SETTING The Kids with CKD study involved five of eight paediatric nephrology units in Australia and New Zealand. PATIENTS There were 375 children and adolescents (aged 6-18 years) with CKD, on dialysis or transplanted, recruited between 2013 and 2016. MAIN OUTCOME MEASURES Overall and domain-specific QoL were measured using the Health Utilities Index 3 score, with a scale from -0.36 (worse than dead) to 1 (perfect health). QoL scores were compared between CKD stages using the Mann-Whitney U test. Factors associated with changes in QoL were assessed using multivariable linear and ordinal logistic regression. RESULTS QoL for those with CKD stages 1-2 (n=106, median 0.88, IQR 0.63-0.96) was higher than those on dialysis (n=43, median 0.67, IQR 0.39-0.91, p<0.001), and similar to those with kidney transplants (n=135, median 0.83, IQR 0.59-0.97, p=0.4) or CKD stages 3-5 (n=91, 0.85, IQR 0.60-0.98). Reductions were most frequent in the domains of cognition (50%), pain (42%) and emotion (40%). The risk factors associated with decrements in overall QoL were being on dialysis (decrement of 0.13, 95% CI 0.02 to 0.25, p=0.02), lower family income (decrement of 0.10, 95% CI 0.03 to 0.15, p=0.002) and short stature (decrement of 0.09, 95% CI 0.01 to 0.16, p=0.02). CONCLUSIONS The overall QoL and domains such as pain and emotion are substantially worse in children on dialysis compared with earlier stage CKD and those with kidney transplants.
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Affiliation(s)
- Anna Francis
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Madeleine S Didsbury
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kerry Chen
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Laura J James
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Siah Kim
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Gabrielle Williams
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Omri Bahat Treidel
- Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Steven McTaggart
- Child and Adolescent Renal Service, Children's Health Queensland, Herston, Queensland, Australia
| | - Amanda Walker
- Department of Nephrology, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Fiona Mackie
- Department of Nephrology, Sydney Children's Hospital at Randwick, Sydney, New South Wales, Australia
| | - Tonya Kara
- Department of Nephrology, Starship Children's Hospital, Auckland, New Zealand
| | - Natasha Nassar
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - David Johnson
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
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12
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Swan JS, Lennes IT, Stump NN, Temel JS, Wang D, Keller L, Donelan K. A Patient-Centered Utility Index for Non-Small Cell Lung Cancer in the United States. MDM Policy Pract 2018; 3:2381468318801565. [PMID: 30349874 PMCID: PMC6194926 DOI: 10.1177/2381468318801565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 08/17/2018] [Indexed: 11/16/2022] Open
Abstract
Background. A preference-based quality-of-life index for non–small cell lung cancer was developed with a subset of Functional Assessment of Cancer Therapy (FACT)–General (G) and FACT–Lung (L) items, based on clinician input and the literature. Design. A total of 236 non–small cell lung carcinoma patients contributed their preferences, randomly allocated among three survey groups to decrease burden. The FACT-L Utility Index (FACT-LUI) was constructed with two methods: 1) multiattribute utility theory (MAUT), where a visual analog scale (VAS)–based index was transformed to standard gamble (SG); and 2) an unweighted index, where items were summed, normalized to a 0 to 1.0 scale, and the result transformed to a scale length equivalent to the VAS or SG MAUT-based model on a Dead to Full Health scale. Agreement between patients’ direct utility and the indexes for current health was assessed. Results. The agreement of the unweighted index with direct SG was superior to the MAUT-based index (intraclass correlation for absolute agreement: 0.60 v. 0.35; mean difference: 0.03 v. 0.19; and mean absolute difference 0.09 v. 0.21, respectively). Mountain plots showed substantial differences, with the unweighted index demonstrating a median bias of 0.02 versus the MAUT model at 0.2. There was a significant difference (P = 0.0002) between early (I-II) and late stage (III-IV) patients, the mean difference for both indexes being greater than distribution-based estimates of minimal important difference. Limitations. The population was limited to non–small cell lung cancer patients. However, most quality-of-life literature consulted and the FACT instruments do not differentiate between lung cancer cell types. Minorities were also limited in this sample. Conclusions. The FACT-LUI shows early evidence of validity for informing economic analysis of lung cancer treatments.
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Affiliation(s)
- J Shannon Swan
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
| | - Inga T Lennes
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
| | - Natalie N Stump
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
| | - Jennifer S Temel
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
| | - David Wang
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
| | - Lisa Keller
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
| | - Karen Donelan
- Massachusetts General Hospital Institute for Technology Assessment (JSS, NNS, KD), Boston, Massachusetts.,Harvard Medical School (JSS, ITL, JST, KD), Boston, Massachusetts.,Massachusetts General Hospital Cancer Center (ITL, JST), Boston, Massachusetts.,Massachusetts General Hospital Department of Radiology (DW), Boston, Massachusetts.,Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia (DW).,University of Massachusetts, Amherst, Massachusetts (LK).,Massachusetts General Hospital Mongan Institute for Health Policy, Boston, Massachusetts (KD)
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13
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Caulley L, Hunink MG, Kilty S, Metha V, Scangas G, Rodin D, Randolph G, Shin JJ. Evidence-Based Medicine in Otolaryngology Part 9: Valuing Health Outcomes. Otolaryngol Head Neck Surg 2018; 160:11-21. [PMID: 30252610 DOI: 10.1177/0194599818800477] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Decisions about resource allocation are increasingly based on value trade-offs between health outcomes and cost. This process relies on comprehensive and standardized definitions of health status that accurately measure the physical, mental, and social well-being of patients across disease states. These metrics, assessed through clinical trials, observational studies, and health surveys, can facilitate the integration of patient preferences into clinical practice. This ninth installment in the Evidence-Based Medicine in Otolaryngology Series is a practical overview of health outcome valuation, as well as the integration of both quality and quantity of life into standardized metrics for health research, program planning, and resource allocation. Tools for measuring preference-based health states, measures of effectiveness, and the application of metrics in economic evaluations are discussed.
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Affiliation(s)
- Lisa Caulley
- 1 Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands.,2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Myriam G Hunink
- 4 Department of Epidemiology and Department of Radiology, Erasmus MC, Rotterdam, The Netherlands.,5 Center for Health Decision Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shaun Kilty
- 2 Department of Otolaryngology-Head and Neck Surgery, University of Ottawa, Ottawa, ON, Canada.,3 The Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Vikas Metha
- 6 Department of Otorhinolaryngology, Montefiore Medical Center, Bronx, New York, USA
| | - George Scangas
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Danielle Rodin
- 8 Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, Massachusetts, USA.,9 Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gregory Randolph
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer J Shin
- 7 Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, USA
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14
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Dupuis LL, Johnston DL, Baggott C, Hyslop S, Tomlinson D, Gibson P, Orsey A, Dix D, Price V, Vanan M, Portwine C, Kuczynski S, Spiegler B, Tomlinson GA, Sung L. Validation of the Symptom Screening in Pediatrics Tool in Children Receiving Cancer Treatments. J Natl Cancer Inst 2018; 110:661-668. [PMID: 29272441 PMCID: PMC6005103 DOI: 10.1093/jnci/djx250] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/02/2017] [Accepted: 10/27/2017] [Indexed: 01/22/2023] Open
Abstract
Background The objective was to evaluate the reliability and validity of the self-report Symptom Screening in Pediatrics Tool (SSPedi) from the perspective of children with cancer and pediatric hematopoietic stem cell transplant (HSCT) recipients. Methods In this multicenter study, respondents were children age eight to 18 years who had cancer or had received HSCT, and their parents. Two different child respondent populations were targeted. More symptomatic respondents were receiving active treatment for cancer, admitted to the hospital, and expected to be in the hospital three days later. Less symptomatic respondents were in maintenance therapy for acute lymphoblastic leukemia or had completed cancer therapy. Children completed SSPedi and then responded to validated self-report measures of mucositis, nausea, pain, and global quality of life. Children in the more symptomatic group repeated SSPedi and a global symptom change scale three days later. Parent proxy-report was optional. Reliability was evaluated using intraclass correlations while convergent validity was evaluated using Spearman correlations. Results Of 502 children enrolled, 302 were in the more symptomatic group and 200 were in the less symptomatic group. Intraclass correlation coefficients were 0.88 (95% confidence interval [CI] = 0.82 to 0.92) for test-retest reliability and 0.76 (95% CI = 0.71 to 0.80) for inter-rater reliability. The mean difference in SSPedi scores between more and less symptomatic groups was 7.8 (95% CI = 6.4 to 9.2). SSPedi was responsive to change in global symptoms. All hypothesized relationships among measures were observed. Conclusions SSPedi is a self-report symptom bother tool for children with cancer and HSCT recipients that is reliable, valid, and responsive to change. SSPedi can be used for clinical and research purposes. Future work should focus on integration into care delivery.
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Affiliation(s)
- L Lee Dupuis
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Donna L Johnston
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christina Baggott
- Pediatric Hematology/Oncology, Stanford University Cancer Clinical Trials Office, Palo Alto, CA
| | - Shannon Hyslop
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Deborah Tomlinson
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
| | - Paul Gibson
- Haematology/Oncology, Department of Pediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Andrea Orsey
- Division of Pediatric Hematology/Oncology, Connecticut Children's Medical Center, Hartford, CT
| | - David Dix
- Division of Hematology/Oncology/BMT, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Vicky Price
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Magimairajan Vanan
- Pediatric Hematology/Oncology/BMT, CancerCare Manitoba, Research Institute in Oncology and Hematology, Departments of Pediatrics and Child Health and Biochemistry and Medical Genetics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carol Portwine
- Division of Haematology/Oncology, McMaster Children’s Hospital, Health Sciences Centre, Hamilton, Ontario, Canada
| | - Susan Kuczynski
- Ontario Parents Advocating for Children with Cancer (OPACC), Toronto, Ontario, Canada
| | - Brenda Spiegler
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - George A Tomlinson
- Department of Medicine, Toronto General Hospital, Toronto, Ontario, Canada
| | - Lillian Sung
- Program in Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, Ontario, Canada
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
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15
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Xin Y, McIntosh E. Assessment of the construct validity and responsiveness of preference-based quality of life measures in people with Parkinson’s: a systematic review. Qual Life Res 2016; 26:1-23. [DOI: 10.1007/s11136-016-1428-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 10/20/2022]
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16
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Vercher P, Hung YJ, Ko M. The Effectiveness of Incorporating a Play-based Intervention to Improve Functional Mobility for a Child with Relapsed Acute Lymphoblastic Leukaemia: A Case Report. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2016; 21:264-270. [PMID: 26892073 DOI: 10.1002/pri.1663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 09/14/2015] [Accepted: 12/09/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND PURPOSE Acute lymphoblastic leukaemia (ALL) is one of the most common forms of cancer seen in children, accounting for one-fourth of all childhood cancers. These children typically present with decreased functional mobility, weakened lower extremity muscle strength and reduced exercise endurance and interests because of disease progressions and chemotherapy treatments. The purpose of this case report was to examine the effectiveness of incorporating a play-based physical therapy (PT) intervention programme to improve functional mobility for an inpatient with relapsed ALL undergoing chemotherapy. CASE DESCRIPTION The patient was a 3-year-old male admitted to the hospital for relapsed ALL. He was diagnosed approximately 1 year earlier for which he had undergone chemotherapy and was later considered in remission at that time. When the patient relapsed, he underwent another round of chemotherapy and was waiting for a bone marrow transplant during his treatment during the course of this case report. For PT intervention, therapeutic exercises were incorporated into play to strengthen his lower extremity strength and muscle endurance. Functional activities were also incorporated into play to improve his aerobic capacity and overall quality of life. Multi-attribute health status classification system (HUI3) utility scores, 6-minute walk test distance (6MWT), lower extremity (LE) strength, transfer and tolerated treatment time were assessed to identify the effect of a PT intervention. OUTCOMES Despite experiencing fatigue, the patient completed most of the treatments incorporated into play. After 5 weeks of PT intervention, the participant improved on HUI3 (pre: 0.72 and post: 0.92), 6MWT (pre: 156 ft and post: 489 ft), LE strength (squat), transfer (sit to stand) and tolerated treatment time (pre: 16 minutes and post: 44 minutes). DISCUSSION This case report suggests that incorporating a play-based PT intervention programme could be physically tolerable and functionally beneficial for a young child with relapsed ALL undergoing inpatient chemotherapy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Paula Vercher
- A to Z Pediatric Therapy, North Richland Hills, TX, USA
| | - You-Jou Hung
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
| | - Mansoo Ko
- Department of Physical Therapy, Angelo State University, San Angelo, TX, USA
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17
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Gidman W, Meacock R, Symmons D. The humanistic and economic burden of juvenile idiopathic arthritis in the era of biologic medication. Curr Rheumatol Rep 2016; 17:31. [PMID: 25874347 DOI: 10.1007/s11926-015-0508-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a poorly understood, heterogeneous, incurable, inflammatory syndrome. Long-term outcomes are uncertain, and this painful condition can result in lifelong disability. JIA is associated with considerable financial and humanistic burden for those affected and the healthcare system. Early diagnosis and effective treatment are indicated to optimise outcomes. Modern treatment aims to achieve remission and preserve joint function by using disease-modifying antirheumatic drugs (DMARDs) early. DMARDs can be classified as conventional/traditional or biologic. Biologic medications may be more effective but cost approximately ten times more than traditional DMARDs. Decision-makers in healthcare are increasingly comparing the cost and consequences of alternative treatment strategies to guide resource allocation decisions. There have been few economic evaluations to date to guide medicines optimisation in JIA. This systematic review highlights the lack of existing evidence relating to the humanistic and economic burden of JIA in the era of biologic medication.
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Affiliation(s)
- Wendy Gidman
- Centre for Health Economics, University of Manchester, Oxford Road, Manchester, UK,
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18
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Chen G, Ratcliffe J. A Review of the Development and Application of Generic Multi-Attribute Utility Instruments for Paediatric Populations. PHARMACOECONOMICS 2015; 33:1013-28. [PMID: 25985933 DOI: 10.1007/s40273-015-0286-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Multi-attribute utility instruments (MAUIs) are increasingly being used as a means of quantifying utility for the calculation of quality-adjusted life-years within the context of cost utility analysis. Traditionally, MAUIs have been developed and applied in adult populations. However, increasingly, researchers in health economics and other disciplines are recognising the importance of the measurement and valuation of health in both children and adolescents. Presently, there are nine generic MAUIs available internationally that have been used in paediatric populations: the Quality of Well-Being Scale (QWB), the Health Utility Index Mark 2 (HUI2), the HUI3, the Sixteen-dimensional measure of health-related quality of life (HRQoL) (16D), the Seventeen-dimensional measure of HRQoL (17D), the Assessment of Quality of Life 6-Dimension (AQoL-6D) Adolescent, the Child Health Utility 9D (CHU9D), the EQ-5D Youth version (EQ-5D-Y) and the Adolescent Health Utility Measure (AHUM). This paper critically reviews the development and application of the above nine MAUIs and discusses the specific challenges of health utility measurement in children and adolescents. Areas for further research relating to the development and application of generic MAUIs in paediatric populations are highlighted.
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Affiliation(s)
- Gang Chen
- Flinders Health Economics Group, School of Medicine, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
| | - Julie Ratcliffe
- Flinders Clinical Effectiveness, Flinders University, Bedford Park, Adelaide, SA, 5042, Australia.
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Deighton J, Croudace T, Fonagy P, Brown J, Patalay P, Wolpert M. Measuring mental health and wellbeing outcomes for children and adolescents to inform practice and policy: a review of child self-report measures. Child Adolesc Psychiatry Ment Health 2014; 8:14. [PMID: 24834111 PMCID: PMC4022575 DOI: 10.1186/1753-2000-8-14] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 04/10/2014] [Indexed: 12/03/2022] Open
Abstract
There is a growing appetite for mental health and wellbeing outcome measures that can inform clinical practice at individual and service levels, including use for local and national benchmarking. Despite a varied literature on child mental health and wellbeing outcome measures that focus on psychometric properties alone, no reviews exist that appraise the availability of psychometric evidence and suitability for use in routine practice in child and adolescent mental health services (CAMHS) including key implementation issues. This paper aimed to present the findings of the first review that evaluates existing broadband measures of mental health and wellbeing outcomes in terms of these criteria. The following steps were implemented in order to select measures suitable for use in routine practice: literature database searches, consultation with stakeholders, application of inclusion and exclusion criteria, secondary searches and filtering. Subsequently, detailed reviews of the retained measures' psychometric properties and implementation features were carried out. 11 measures were identified as having potential for use in routine practice and meeting most of the key criteria: 1) Achenbach System of Empirically Based Assessment, 2) Beck Youth Inventories, 3) Behavior Assessment System for Children, 4) Behavioral and Emotional Rating Scale, 5) Child Health Questionnaire, 6) Child Symptom Inventories, 7) Health of the National Outcome Scale for Children and Adolescents, 8) Kidscreen, 9) Pediatric Symptom Checklist, 10) Strengths and Difficulties Questionnaire, 11) Youth Outcome Questionnaire. However, all existing measures identified had limitations as well as strengths. Furthermore, none had sufficient psychometric evidence available to demonstrate that they could reliably measure both severity and change over time in key groups. The review suggests a way of rigorously evaluating the growing number of broadband self-report mental health outcome measures against standards of feasibility and psychometric credibility in relation to use for practice and policy.
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Affiliation(s)
- Jessica Deighton
- Evidence Based Practice Unit (EBPU), UCL and the Anna Freud Centre, 21 Maresfield Gardens, London NW3 5SD, UK
| | - Tim Croudace
- Mental Health and Addiction Research Group (MHARG), HYMS and Department of Health Sciences, Room 204, 2nd Floor (Area 4) ARRC Building, University of York, York, Heslington YO10 5DD, UK
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, UCL, Gower Street, London WC1E 6BT, UK
| | - Jeb Brown
- Center for Clinical Informatics, 2061 Murray Holliday Blvd, Salt Lake City, UT 84117, USA
| | - Praveetha Patalay
- Evidence Based Practice Unit (EBPU), UCL and the Anna Freud Centre, 21 Maresfield Gardens, London NW3 5SD, UK
| | - Miranda Wolpert
- Evidence Based Practice Unit (EBPU), UCL and the Anna Freud Centre, 21 Maresfield Gardens, London NW3 5SD, UK
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20
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Hosli E, Detmar S, Raat H, Bruil J, Vogels T, Verrips E. Self-report form of the Child Health Questionnaire in a Dutch adolescent population. Expert Rev Pharmacoecon Outcomes Res 2014; 7:393-401. [DOI: 10.1586/14737167.7.4.393] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Klaassen RJ, Barrowman N, Merelles-Pulcini M, Vichinsky EP, Sweeters N, Kirby-Allen M, Neufeld EJ, Kwiatkowski JL, Wu J, Vickars L, Blanchette VS, Forgie M, Yamashita R, Wong-Rieger D, Young NL. Validation and reliability of a disease-specific quality of life measure (the TranQol) in adults and children with thalassaemia major. Br J Haematol 2013; 164:431-7. [PMID: 24180641 DOI: 10.1111/bjh.12631] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 09/17/2013] [Indexed: 01/19/2023]
Abstract
This study aimed to demonstrate the validity, reliability and responsiveness of a new disease-specific quality of life (QoL) questionnaire for children and adults with thalassaemia major, the Transfusion-dependent QoL questionnaire (TranQol). 106 participants (51 adults and 55 children) were recruited from six North American thalassaemia treatment centres with a mean age of 20·7 years (standard deviation [SD] 9, range 7-51 years). The mean total TranQol score was 71 (SD 17, 32-97) on a scale of 0-100. Patients with co-morbidities had significantly lower scores (63 vs. 75, P = 0·001). TranQol scores showed substantial agreement (P < 0·001) with the Health Utilities Index Mark 3 (all patients, r = 0·65), the Pediatric QoL (children, r = 0·77) and the Short Form (36) physical (adults, r = 0·69) and mental summary scores (r = 0·76). In the subgroup who rated their QoL as better, there was a 4·0 point (SD 9·0) improvement in TranQol scores, from baseline of 67·1-71·1 one week later (P = 0·008). Test-retest reliability was excellent (intra-class correlation coefficient, 0·93). The TranQol was valid, with acceptable correlation for all administered measures and was reliable and responsive to change. The TranQol can be incorporated into future studies of thalassaemia major.
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Affiliation(s)
- Robert J Klaassen
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Anthony SJ, Selkirk E, Sung L, Klaassen RJ, Dix D, Scheinemann K, Klassen AF. Considering quality of life for children with cancer: a systematic review of patient-reported outcome measures and the development of a conceptual model. Qual Life Res 2013; 23:771-89. [PMID: 23907613 DOI: 10.1007/s11136-013-0482-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2013] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An appraisal of pediatric cancer-specific quality-of-life (QOL) instruments revealed a lack of clarity about what constitutes QOL in this population. This study addresses this concern by identifying the concepts that underpin the construct of QOL as determined by a content analysis of all patient-reported outcome (PRO) instruments used in childhood cancer research. METHODS A systematic review was performed of key databases (i.e., MEDLINE, CINAHL, PsychINFO) to identify studies of QOL in children with cancer. A content analysis process was used to code and categorize all items from generic and cancer-specified PRO instruments. Our objective was to provide clarification regarding the conceptual underpinnings of these instruments, as well as to help inform the development of theory and contribute to building a conceptual framework of QOL for children with cancer. RESULTS A total of 6,013 English language articles were screened, identifying 148 studies. Ten generic and ten cancer-specific PRO instruments provided 957 items. Content analysis led to the identification of four major domains of QOL (physical, psychological, social, and general health), with 11 subdomains covering 98 different concepts. While all instruments reflected items relating to the broader domains of QOL, there was substantial heterogeneity in terms of the content and variability in the distribution of items. CONCLUSIONS This systematic review and the proposed model represent a useful starting point in the critical appraisal of the conceptual underpinnings of PRO instruments used in pediatric oncology and contribute to the need to place such tools under a critical, yet reflective and analytical lens.
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Reeve BB, Withycombe JS, Baker JN, Hooke MC, Lyons JC, Mowbray C, Wang J, Freyer DR, Joffe S, Sung L, Tomlinson D, Gold SH, Hinds PS. The first step to integrating the child's voice in adverse event reporting in oncology trials: a content validation study among pediatric oncology clinicians. Pediatr Blood Cancer 2013; 60:1231-6. [PMID: 23335328 DOI: 10.1002/pbc.24463] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Accepted: 12/10/2012] [Indexed: 11/06/2022]
Abstract
PURPOSE Children with cancer experience significant toxicities while undergoing treatment. Documentation of adverse events (AEs) in clinical trials is mandated by federal agencies. Although many AEs are subjective, the current standard is clinician reporting. Our long-term goal is to create and validate a self-report measure of subjective AEs for children aged 7 years and older that will inform AE reporting for the National Cancer Institute's Common Terminology Criteria for Adverse Events (CTCAE). This content validation study aimed to identify which of the AEs in the current CTCAE should be included in a pediatric self-report measure. METHODS We sought expert panel review and consensus among 187 pediatric clinicians from seven Children's Oncology Group institutions to determine which of the 790 AEs are amenable to child self-report. Two survey iterations were used to identify suitable AEs, and clinician agreement estimated by the content-validity ratio (CVR) was assessed. RESULTS Response rates for surveys 1 and 2 were 72% and 67%, respectively. After the surveys, 64 CTCAE terms met the criteria of being subjective, relevant for use in pediatric cancer trials, and amenable to self-report by a child. The most frequent reasons for removal of CTCAE terms were that they relied on laboratory or clinical measures or were not applicable to children. CONCLUSION The 64 CTCAE terms will be translated into child-friendly terms as the basis of the child-report toxicity measure. Ultimately, systematic collection of these data will improve care by enhancing the accuracy and completeness of treatment toxicity reports for childhood cancer.
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Affiliation(s)
- Bryce B Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina 27599-7411, USA.
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Ungar WJ, Boydell K, Dell S, Feldman BM, Marshall D, Willan A, Wright JG. A parent-child dyad approach to the assessment of health status and health-related quality of life in children with asthma. PHARMACOECONOMICS 2012; 30:697-712. [PMID: 22788260 PMCID: PMC4931918 DOI: 10.2165/11597890-000000000-00000] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND Assessment of health state and health-related quality of life (HR-QOL) are limited by a child's age and cognitive ability. Parent-proxy reports are known to differ from children's reports. Simultaneous assessment using a parent-child dyad is an alternative approach. OBJECTIVE Our objective was to assess the validity, reliability and responsiveness of a parent-child dyad approach to utility and HR-QOL assessment of paediatric asthma health states. METHODS The setting was specialist care in a hospital-based asthma clinic. Participants were 91 girls and boys with asthma aged 8 to 17 years and 91 parents. The intervention employed was parent-child dyad administration of the Health Utilities Index (HUI) 2 and 3, the Pediatric Quality of Life Inventory™ (PedsQL™) Core and Asthma modules, and the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). Questionnaires were administered by interview to children and parents separately and then together as a dyad to assess the child's health state. The dyad interview was repeated at the next clinic visit. Dyad-child agreement was measured by intra-class correlation (ICC) coefficient; Spearman correlations were used to assess convergent validity. Test-retest reliability was assessed in 28 children who remained clinically stable between visits with a two-way ICC coefficient. Responsiveness to change from baseline was assessed with Spearman coefficients in 30 children who demonstrated clinical change between visits. RESULTS There was no significant agreement between parent and child for the HUI2 or HUI3 whereas agreement between dyad and child was 0.55 (95% confidence interval [CI] 0.36, 0.69) for the HUI2 and 0.74 (95% CI 0.61, 0.82) for the HUI3 overall. With respect to dyad performance characteristics, both HUI2 and HUI3 overall scores demonstrated moderate convergent validity with the generic PedsQL™ Core domains (range r = 0.30-0.52; p < 0.01). Dyad HUI2 attributes demonstrated moderate convergent validity with the generic PedsQL™ Core domains of similar constructs (range r = 0.35-0.43; p < 0.001) and weaker convergent validity with disease-specific domains (range r = 0.13-0.32). Dyad HUI3 attributes demonstrated weaker convergent validity compared with the HUI2. For the assessment of test-retest reliability, significant agreement between baseline and follow-up was observed for dyad HUI2 total (r = 0.53), dyad PedsQL™ Core summary (r = 0.70) and select dyad disease-specific domains. Significant responsiveness (r > 0.4; p < 0.05) was observed for dyad HUI2 total score change over time as correlated with dyad HUI3, dyad PedsQL™ Core summary and select disease-specific domains. CONCLUSIONS The parent-child dyad approach demonstrated moderate to strong performance characteristics in generic and disease-specific questionnaires suggesting it may be a valuable alternative to relying on parent proxies for assessing children's utility and HR-QOL. Future research in additional paediatric populations, younger children and a population-based sample would be useful.
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Affiliation(s)
- Wendy J Ungar
- The Hospital for Sick Children, Toronto, ON, Canada.
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An assessment of the psychometric performance of the Health Utilities Index 2 and 3 in children following discharge from a U.K. pediatric intensive care unit. Pediatr Crit Care Med 2012; 13:387-92. [PMID: 22198813 DOI: 10.1097/pcc.0b013e318238969a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Our objective was to assess the psychometric performance of the Health Utilities Index 2 and 3 in a pediatric population following admission to a pediatric intensive care unit. DESIGN As part of a larger study of pediatric intensive care outcomes, children were followed up at 6 and 12 months post admission from pediatric intensive care using the Health Utilities Index 2 and 3. We evaluated and compared the psychometric performance of the Health Utilities Index 2 and 3 in this population by assessing their practicality, reliability, and limited information regarding validity. SETTING Twenty-two pediatric intensive care units in the United Kingdom. PATIENTS A total of 685 children aged 5 yrs and over. INTERVENTIONS The Health Utilities Index 2 and 3, which are both generic preference-based measures of health-related quality of life, were completed by proxy and children over 11 yrs of age were invited to self-complete. MEASUREMENT AND MAIN RESULTS Both Health Utilities Index 2 and 3 demonstrated good practicality, with excellent completion rates (>97%) and a mean time to complete of around 8 mins. Both Health Utilities Index 2 and 3 demonstrated very good inter-rater reliability and evidence of sensitivity to change. At 6 months after admission, mean scores of the Health Utilities Index 2 and 3 were different in some groups of children with different degrees of in-hospital severity of illness, but those differences were not found at 12 months of follow-up. CONCLUSIONS The Health Utilities Index 2 and 3 both perform well in a pediatric intensive care setting whether by self-complete or proxy complete. Evidence of good inter-rater reliability gives confidence that the measures can be reliably used with a proxy completer, such as parent or caregiver. Additional research is important to investigate their construct validity further in this population, ideally using baseline data collected at the time of hospital stay in pediatric intensive care and other measures of health status at the times of follow-up.
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Quinn GP, Knapp C, Murphy D, Sawczyn K, Sender L. Congruence of reproductive concerns among adolescents with cancer and parents: pilot testing an adapted instrument. Pediatrics 2012; 129:e930-6. [PMID: 22430446 PMCID: PMC3313639 DOI: 10.1542/peds.2011-2568] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify whether a health-related quality of life (HRQoL) instrument intended to capture reproductive concerns is sensitive and appropriate for adolescent patients with cancer. METHODS Pilot testing was completed by administering a 10-item instrument designed to identify reproductive concerns of female adolescent patients with cancer aged 12-18. Parents were also asked to predict their daughters' responses. Fourteen patients and parents participated. The main outcome measures were language, relevance, accuracy, sensitivity, and missing content regarding the HRQoL instrument. Two pediatric hospitals and 1 local support group for patients and survivors served as the setting for this study. RESULTS The majority of parents provided inaccurate predictions of their daughters' responses regarding their reproductive concerns. Overall, parents underestimated their daughters' concerns because the majority of adolescents reported a strong desire for future parenthood whereas parents expected their daughters to be satisfied with survivorship. CONCLUSIONS Adolescent patients with cancer have strong reproductive concerns; however, this may not be captured on current HRQoL instruments and may be further neglected due to parents' unawareness. Discussions should be encouraged with adolescent patients before beginning treatment regarding their concerns and values about parenting in the future and cannot rely on parent-proxy reports.
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Affiliation(s)
- Gwendolyn P Quinn
- College of Medicine, University of South Florida, Tampa, Florida, USA.
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Functional and Health-Related Quality of Life Outcomes After Pediatric Trauma. ACTA ACUST UNITED AC 2011; 70:1532-8. [PMID: 21427613 DOI: 10.1097/ta.0b013e31820e8546] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Baggott CR, Dodd M, Kennedy C, Marina N, Matthay KK, Cooper B, Miaskowski C. An evaluation of the factors that affect the health-related quality of life of children following myelosuppressive chemotherapy. Support Care Cancer 2011; 19:353-61. [PMID: 20157746 PMCID: PMC2909452 DOI: 10.1007/s00520-010-0824-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 01/18/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE The purposes of this study, in children who were assessed 1 week after the administration of myelosuppressive chemotherapy were: to compare the total and subscale scores on a generic measure of health-related quality of life (HRQOL) to normative data from healthy children and describe the relationships between demographic, clinical, and symptom characteristics of children with cancer and generic and disease-specific dimensions of HRQOL. METHODS Patients (n = 61) were predominantly male (52.5%), minority (63.9%), and 14.7 years of age. Children completed the Memorial Symptom Assessment Scale for 10- to 18-year olds, the PedsQL™ Generic and Cancer Modules, and the Karnofsky Performance Status (KPS) scale 1 week after the start of a chemotherapy cycle. RESULTS The mean number of symptoms per patient was 10.6. Compared with the normative sample, children with cancer reported significantly lower scores for the total scale and all of the subscales except emotional and social functioning. No significant differences were found between any demographic characteristics and total or subscale scores on the generic or disease-specific measures of HRQOL. Lower KPS scores were associated with poorer generic and disease-specific HRQOL scores. In addition, a higher number of symptoms was associated with poorer generic and disease-specific HRQOL scores. Finally, higher symptom distress scores were associated with poorer generic and disease-specific HRQOL scores. CONCLUSION Among the demographic, clinical, and symptom characteristics studied, poorer functional status and higher symptom burden were associated with significant decreases in HRQOL in children who received myelosuppressive chemotherapy.
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Affiliation(s)
- Christina R Baggott
- Department of Physiological Nursing, University of California, San Francisco, San Francisco, CA 94143, USA.
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Klaassen RJ, Barr RD, Hughes J, Rogers P, Anderson R, Grundy P, Ali SK, Yanofsky R, Abla O, Silva M, Carret AS, Cappelli M. Nurses provide valuable proxy assessment of the health-related quality of life of children with Hodgkin disease. Cancer 2010; 116:1602-7. [DOI: 10.1002/cncr.24888] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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McAuley KA, Taylor RW, Farmer VL, Hansen P, Williams SM, Booker CS, Mann JI. Economic evaluation of a community-based obesity prevention program in children: the APPLE project. Obesity (Silver Spring) 2010; 18:131-6. [PMID: 19444231 DOI: 10.1038/oby.2009.148] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Effective strategies are urgently required to reduce the prevalence of obesity during growth. Determining which strategies are most successful should also include analysis of their relative costs. To date, few obesity prevention studies in children have reported data concerning cost-effectiveness. The aim of this study was to assess the costs and health benefits of implementing the APPLE (A Pilot Program for Lifestyle and Exercise) project, a 2-year controlled community-based obesity prevention initiative utilizing activity coordinators (ACs) in schools and nutrition promotion in New Zealand children (5-12 years). The marginal costs of the project in 2006 prices were estimated and compared with the kilograms (kg) of weight-gain prevented for children in the intervention relative to the control arm. The children's health-related quality of life (HRQoL) was also measured using the Health Utilities Index (HUI). The total project cost was NZ$357,490, or NZ$1,281 per intervention child for 2 years (NZ$1 = US$0.67 = UK pound 0.35 = EUR euro 0.52). Weight z-score was reduced by 0.18 (0.13, 0.22) units at 2 years and 0.17 (0.11, 0.23) units at 4 years in intervention relative to control children. Mean HUI values did not differ between intervention and control participants. The reduction in weight z-score observed is equivalent to 2.0 kg of weight-gain prevented at 15 years of age. The relatively simple intervention approach employed by the APPLE project was successful in significantly reducing the rate of excessive weight gain in children, with implementation costs of NZ$664-1,708 per kg of weight-gain prevented over 4 years.
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Affiliation(s)
- Kirsten A McAuley
- Edgar National Centre for Diabetes Research, Department of Medical and Surgical Sciences, University of Otago, Dunedin, New Zealand
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Mapping analyses to estimate health utilities based on responses to the OM8-30 Otitis Media Questionnaire. Qual Life Res 2009; 19:65-80. [PMID: 19941078 DOI: 10.1007/s11136-009-9558-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the statistical relationship between the OM8-30 health-related quality of life measure for children with otitis media with effusion (OME) and measures of health utility (Health Utilities Index [HUI] Mark 3 and Mark 2) and to develop models to estimate HUI3 and HUI2 health utilities from OM8-30 scores. METHODS A placebo-controlled, randomised trial (GNOME) evaluating intranasal mometasone in 217 children with OME provided concurrent responses to OM8-30 and HUI at three time points. Ordinary least squares (OLS), generalised linear models and two-step regression analyses were used to predict HUI3 and HUI2 utilities based on OM8-30 facet and domain scores. RESULTS OLS models including all nine OM8-30 facets with or without predicted hearing level (HL) produced the best predictions of HUI3 utilities (mean absolute error: 0.134 with HL and 0.132 without; R(2): 0.63 with HL and 0.596 without). An OLS model predicting HUI3 utilities based on the two OM8-30 domain scores, reported hearing difficulties, predicted HL, age and sex also produced accurate predictions. CONCLUSION Regression equations predicting HUI3 and HUI2 utilities based on OM8-30 facet and domain scores have been developed. These provide an empirical basis for estimating quality-adjusted life years (QALYs) for interventions in children with OME.
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Janssens L, Gorter JW, Ketelaar M, Kramer WLM, Holtslag HR. Health-related quality-of-life measures for long-term follow-up in children after major trauma. Qual Life Res 2008; 17:701-13. [PMID: 18437531 PMCID: PMC2440951 DOI: 10.1007/s11136-008-9339-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Accepted: 03/30/2008] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Our objective was to review measures of health-related quality of life (HRQL) for long-term follow up in children after major trauma and to determine the measures that are suitable for a large age range, reliable and valid, and cover a substantial amount of the domains of functioning using the International Classification of Functioning, Disability, and Health (ICF) of the World Health Organization (WHO). METHODS The Medline and EMBASE databases were searched in all years up to October 2007 for generic HRQL measures suitable for children aged 5-18 years old and validated in English or Dutch. Measures were reviewed with respect to the age range for which the measure was suitable and reliability, validity, and content related to the ICF. RESULTS The search resulted in 1,235 hits and 21 related articles. Seventy-nine papers met the inclusion criteria, describing in total 14 measures: Child Health and Illness Profile Adolescent and Child Edition (CHIP-AE/CE), Child Health Questionnaire Child and Parent Forms (CHQ-CF87/PF50/PF28), DISABKIDS, Functional Status II (FS II)(R), Health Utilities Index Mark 2 (HUI 2), KIDSCREEN 52/27, KINDL, Pediatric Quality of Life Inventory (PedsQL), TNO Institute of Prevention and Health and the Leiden University Hospital (TNO-AZL), TNO-AZL Children's Quality Of Life (TACQOL), and Youth Quality of Life Instrument--Research Version (YQOL-R). Measures that were suitable for a large age range were CHQ-PF50/PF28, DISABKIDS, FS II(R), HUI 2, KIDSCREEN, PedsQL, and TACQOL. All measures had moderate to good psychometric properties, except for CHQ-PF50/PF28, KINDL, and TACQOL, which had either low internal consistency or bad test-retest reliability. The measures that covered more than six chapters of the ICF domains were CHIP-AE/CE, CHQ-CF87/PF50, DISABKIDS, KIDSCREEN-52, PedsQL, and TACQOL. CONCLUSIONS DISABKIDS, KIDSCREEN 52, and PedsQL are suitable for long-term follow-up measurement of HRQL in children after major trauma. They cover a large age range, have good psychometric properties, and cover the ICF substantially.
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Affiliation(s)
- Loes Janssens
- Department of Rehabilitation and Sports Medicine, University Medical Center Utrecht, PO Box 85500, HP F00.810, 3508 GA Utrecht, The Netherlands
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Abstract
BACKGROUND Information regarding changes in the health-related quality of life (HRQL) of children during chemotherapy is scarce. Furthermore, there exists a general lack of consensus as to which measures are best suited to assess changes in HRQL in this population. The purpose of this study is to compare the responsiveness of 3 pediatric HRQL measures: the Pediatric Quality of Life Inventory (PedsQL), the Child's Health Questionnaire (CHQ), and the Health Utilities Index (HUI). METHODS Consecutive pediatric oncology patients and their parents completed the questionnaires at 1-week intervals for a total of 4 weeks, starting on the third day of the patient's chemotherapy treatment cycle. RESULTS Twenty-nine patients were enrolled with the majority (62%) having a diagnosis of leukemia with an average age of 9 years. The parent proxy reports from time 1 to 4 showed a mean change in the PedsQL of 17 for the generic core scale and 12 for the cancer specific module. The mean change in CHQ physical functioning scale was 6, while the psychosocial scale was only 2, while the HUI 2 was 3 (x100), and HUI 3 was 4 (x100). There was significantly more change in the PedsQL generic scores when compared with the HUI 2 and 3 and the CHQ psychosocial scale (P<0.01). CONCLUSIONS When measuring HRQL repeatedly in a heterogeneous population, the PedsQL is the measure most responsive to change.
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Grange A, Bekker H, Noyes J, Langley P. Adequacy of health-related quality of life measures in children under 5 years old: systematic review. J Adv Nurs 2007; 59:197-220. [PMID: 17627625 DOI: 10.1111/j.1365-2648.2007.04333.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a systematic review to assess the adequacy of measures evaluating generic health-related quality of life outcomes in children less than 5 years old. BACKGROUND Evaluating generic health-related quality of life outcomes in children is important to assess the effectiveness of interventions, nursing care and services. METHODS A methodological systematic review was carried out for the period 1980-2005 in accord with the UK Centre of Reviews and Dissemination guidelines on systematic reviews. We searched multiple electronic databases, hand-searched key texts, and contacted investigators. We included all English language publications describing primary empirical research of generic health-related quality of life, health status, functional status or wellbeing measures, with published psychometric evidence. All measures (proxy and/or self-complete) for use in children under 5 years were included; single dimension measures were excluded. RESULTS Seventy-six papers (70 studies) referring to 16 generic health-related quality of life measures met our inclusion criteria. None of the 16 measures were adequate in terms of their conceptual content or psychometric criteria; quality scores were poor (0-8). No current, generic health-related quality of life measure is both psychometrically and conceptually robust, although the Health Utilities Index has the most comprehensive psychometric data published. However, not all dimensions of health are assessed, with little evidence of reliability in children under 5 years of age. CONCLUSION There is a need to develop empirically robust and conceptually comprehensive health-related quality of life measures, particularly in the context of proxy-completion measures for very young children.
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Affiliation(s)
- Angela Grange
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford Royal Infirmary, Bradford, UK. [corrected]
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Hinds PS, Burghen EA, Zhou Y, Zhang L, West N, Bashore L, Pui CH. The Health Utilities Index 3 invalidated when completed by nurses for pediatric oncology patients. Cancer Nurs 2007; 30:169-77. [PMID: 17510579 DOI: 10.1097/01.ncc.0000270700.11425.4d] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
When health-related quality of life instruments developed for and validated in 1 respondent group are completed by a different respondent group, findings could be invalid. The purpose of this study was to summarize the instrument outcomes when a widely used health-related quality of life instrument (the Health Utilities Index 3 [HUI3]) created from a population-based strategy was completed by pediatric oncology nurses for their patients during cancer treatment. Fifty-four nurses completed the HUI3 a total of 261 times at 1 to 3 sequential data points (106, 94, and 61, respectively) for pediatric patients who were enrolled on a frontline therapeutic clinical trial for acute lymphoblastic leukemia. Data were collected at 2 children's hospitals. HUI3 scores could not be calculated for 52% to 61% of the nurse reports at each of the 3 data points because of nurses' use of the "do not know" response option. Missing data of this proportion indicate that the nurse serving as a proxy rater independent of directly soliciting responses from the patient will not be able to rate certain attributes of the HUI3 more than half of the time despite having ongoing familiarity with the patient. Because of this, use of the HUI3 by nurse proxies for patients with pediatric acute lymphoblastic leukemia is not recommended.
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Affiliation(s)
- Pamela S Hinds
- Division of Nursing Research, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Drotar D, Schwartz L, Palermo TM, Burant C. Factor structure of the child health questionnaire-parent form in pediatric populations. J Pediatr Psychol 2005; 31:127-38. [PMID: 16467313 DOI: 10.1093/jpepsy/jsi078] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To conduct separate exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) of the Child Health Questionnaire-Parent Form 50 (CHQ-PF-50) with a sample of children and adolescents with chronic conditions and physically healthy children seen in a pediatric setting. METHOD Parents of 329 children with chronic conditions including cancer, epilepsy, recurrent headache, inflammatory bowel disease (IBD), juvenile rheumatoid arthritis (JRA), sickle cell disease (SCD), and recurrent sleep disturbance and 332 physically healthy children completed CHQ-PF-50. RESULTS The EFA yielded a 27-item measure with seven factors for children with chronic conditions and a 28-item measure with eight factors for physically healthy children. Structural equation modeling procedures were used to conduct a second order CFA, which yielded the secondary factors of physical health and psychosocial health. A CFA yielded an excellent fit to the data for each group, but the models were different for each group. CONCLUSIONS CFA-derived models of the CHQ-PF-50 demonstrated construct validity for measuring the latent constructs of physical and psychosocial health in children and adolescents with chronic conditions and physically healthy children and adolescents. However, somewhat different factor solutions emerged for each group, suggesting that the specific domains assessed by the CHQ-PF-50 were not equivalent across groups. Findings have implications for applications of the CHQ-PF-50.
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Affiliation(s)
- Dennis Drotar
- Division of Behavioral Pediatrics and Psychology, 11100 Euclid Avenue, Cleveland, Ohio 44106, USA.
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Sung L, Young NL, Greenberg ML, McLimont M, Samanta T, Wong J, Rubenstein J, Ingber S, Doyle JJ, Feldman BM. Health-related quality of life (HRQL) scores reported from parents and their children with chronic illness differed depending on utility elicitation method. J Clin Epidemiol 2005; 57:1161-6. [PMID: 15567632 DOI: 10.1016/j.jclinepi.2004.05.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2004] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the relationship between health-related quality of life (HRQL) as measured by utility when elicited from parents and their children with chronic illness. STUDY DESIGN AND SETTING We enrolled families of children admitted for cancer chemotherapy and those attending outpatient rheumatology, hemophilia and bone marrow transplantation clinics. Children in grade 6 or higher were included. The child's HRQL was rated by parent and child using the Standard Gamble (SG), Visual Analogue Scale (VAS), Time Trade-Off (TTO), and Health Utilities Index Mark 2/3 (HUI2 and HUI3). RESULTS 22 families were included. The mean parent SG was 0.92 +/- 0.09, which was similar to the mean SG elicited from their children of 0.92 +/- 0.10. The parent and child SG were moderately concordant (ICC=0.64, 95% CI=0.30, 0.83; P=.0005). In contrast, TTO scores were not concordant (ICC=0.14, 95% CI=-0.29, 0.53; P=.3), with parents (mean TTO=0.77 +/- 0.31) rating HRQL worse than children (mean TTO=0.92 +/- 0.11; P=.04). Similarly, the mean parent HUI2 of 0.82 +/- 0.22 was lower than the child HUI2 of 0.95 +/- 0.07; P=.02 and HUI2 were not concordant (ICC=0.11, 95% CI=-0.35, 0.53; P=.3) between parents and children. CONCLUSION Parents and children rate HRQL similarly according to SG, but parents rate HRQL significantly worse using TTO and HUI2.
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Affiliation(s)
- L Sung
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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Sung L, Greenberg ML, Young NL, McLimont M, Ingber S, Rubenstein J, Wong J, Samanta T, Doyle JJ, Stain AM, Feldman BM. Validity of a modified standard gamble elicited from parents of a hospital-based cohort of children. J Clin Epidemiol 2003; 56:848-55. [PMID: 14505769 DOI: 10.1016/s0895-4356(03)00160-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine the validity of a modified standard gamble (Mod SG) (nondeath baseline) by comparing these scores to SG (death baseline), time trade off (TTO), visual analog scale (VAS), Health Utilities Index (HUI), and Child Health Questionnaire (CHQ). METHODS Respondents were parents of in-patients with cancer receiving chemotherapy and parents of children without cancer attending outpatient clinics. Construct validity was determined by comparing a priori hypotheses to actual correlations between measures. Discriminant validity was examined by anticipating that in-patients with cancer would have lower HRQL than outpatients. RESULTS 85 families were included. Both Mod SG and SG were moderately correlated with TTO (r=0.50 and r=0.49; P<.01 for both). Both Mod SG and SG were moderately correlated with TTO (r=0.47 and r=0.05, P<0.002 for both). CONCLUSION The Mod SG did not perform better than SG. Two nonoverlapping groups of HRQL measures were demonstrated.
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Affiliation(s)
- L Sung
- Division of Hematology/Oncology, and Population Health Sciences, Hospital for Sick Children, Toronto, Ontario, M5G 1X8
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