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Raybin JL, Zhou W, Pan Z, Hendricks-Ferguson VL, Jankowski C. Creative Arts Therapy Among Children With Cancer: Symptom Assessment Reveals Reduced Anxiety. Cancer Nurs 2024; 47:12-19. [PMID: 36624566 DOI: 10.1097/ncc.0000000000001186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Symptom distress is related to decreased quality of life (QOL) among children with cancer, with high levels of pain, nausea, and anxiety reported. Creative arts therapy (CAT) has been related to improved QOL and symptoms in pediatric oncology, but the quality of evidence is mixed. OBJECTIVE This article aims to examine the QOL symptom subscales in relation to CAT over time in children during the first year of cancer treatment. METHODS A secondary analysis of prospective data was performed with linear mixed modeling on 267 observations with predictors of 2 groups: No CAT (n = 18) vs CAT (n = 65). The covariate of time (6 months) was used to explore the CAT relationship with the Pediatric Quality of Life Inventory (PedsQL) symptom subscales (pain and hurt, nausea, procedural anxiety, treatment anxiety, worry, cognitive problems, perceived physical appearance, and communication). RESULTS Children (n = 83) were between 3 and 17 years old (M = 6), 51.2% female, and 32% minority. All tumor types were represented: liquid (37.3%), solid (24.1%), and central nervous system (38.6%). Reduced child report of procedural anxiety was significantly related to receiving CAT with a medium magnitude of association (adjusted effect size = 0.58, P = .01). CONCLUSION Creative arts interventions were associated with a longitudinal improvement in anxiety in children with cancer. Further work is needed to target interventions to the appropriate specific burdensome symptoms. IMPLICATION FOR PRACTICE Pediatric oncology nurses can advocate for CAT as an effective intervention to ameliorate the burdensome procedural anxiety experienced by patients.
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Affiliation(s)
- Jennifer L Raybin
- Author Affiliations: Oregon Health & Sciences University, Schools of Nursing and Medicine, Pediatric Hematology Oncology, Doernbecher Children's Hospital (Dr Raybin); College of Nursing and School of Medicine, University of Colorado Anschutz Medical Campus (Drs Raybin, Pan, and Jankowski); Colorado School of Public Health-Biostatistics and Informatics (Ms Zhou); and Trudy Busch Valentine School of Nursing, Saint Louis University (Dr Hendricks-Ferguson), Missouri
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Audhya IF, Szabo SM, Bever A, O'Sullivan F, Malone DC, Feeny D, Neumann P, Iannaccone ST, Jayasinghe P, Gooch KL. Estimating health state utilities in Duchenne muscular dystrophy using the health utilities index and EQ-5D-5L. J Patient Rep Outcomes 2023; 7:132. [PMID: 38100005 PMCID: PMC10724100 DOI: 10.1186/s41687-023-00671-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The progression of Duchenne muscular dystrophy (DMD) is characterized by loss of ambulation, respiratory insufficiency, cardiomyopathy, and early mortality. DMD profoundly impacts health-related quality-of-life (HRQoL). However, few health state utility data exist; published utilities tend to be derived from small samples for a limited number of health states and are often based on caregiver-reported patient health status. This study estimated utility values for varied clinical and functional health states in DMD, based on patient-reported health status. METHODS Individuals with DMD in the US aged 12-40 years completed the EQ-5D (5-level) and Health Utilities Index (HUI) preference-based instruments. Based on responses to a clinical questionnaire, participants self-classified into functional health states according to level of lower and upper limb function, use of respiratory support, and presence of cardiomyopathy. Mean [standard deviation (SD)] utility and EQ-5D visual analogue scale (VAS) scores were estimated according to health state; and median (interquartile range) attribute levels calculated to understand which domains of health are most severely affected in DMD. RESULTS Of 63 males with DMD, mean (SD) age was 19.8 (6.1) years and 11 (17.5%) were ambulatory. Mean (SD) utility values were 0.92 (0.08; HUI2), 0.84 (0.20; HUI3), and 0.84 (0.13; EQ-5D) for ambulatory patients without cardiomyopathy (n = 10). For non-ambulatory patients with moderately impaired upper limb function, night and daytime ventilation without cardiomyopathy, mean (SD) utilities were 0.49 (0.07) for the HUI2, 0.16 (0.15) for the HUI3 and 025 (0.14) for the EQ-5D. Mean (SD) VAS scores for the same health states were 91 (9) and 83 (21), respectively. In addition to impairments in mobility/ambulation, and self-care, attributes like usual activities and pain also showed notable effects of DMD. CONCLUSIONS In DMD, although a relationship between disease progression and HRQoL is observed, there is large variability in utility within functional health states, and across instruments. Utility values for less severe non-ambulatory health states described by level of upper limb function are novel. These utility values, derived based on direct patient feedback rather than from caregiver report, are relevant to individuals of varying functional statuses and augment scarce DMD-specific utility data.
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Affiliation(s)
| | - Shelagh M Szabo
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada.
| | - Andrea Bever
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | - Fiona O'Sullivan
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
| | | | | | | | | | - P Jayasinghe
- Broadstreet HEOR, 201-343 Railway St, Vancouver, BC, V6A 1A4, Canada
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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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Khanna D, Khadka J, Mpundu-Kaambwa C, Lay K, Russo R, Ratcliffe J. Are We Agreed? Self- Versus Proxy-Reporting of Paediatric Health-Related Quality of Life (HRQoL) Using Generic Preference-Based Measures: A Systematic Review and Meta-Analysis. PHARMACOECONOMICS 2022; 40:1043-1067. [PMID: 35997957 PMCID: PMC9550745 DOI: 10.1007/s40273-022-01177-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The aim of this study was to examine the level of agreement between self- and proxy-reporting of health-related quality of life (HRQoL) in children (under 18 years of age) using generic preference-based measures. METHODS A systematic review of primary studies that reported agreement statistics for self and proxy assessments of overall and/or dimension-level paediatric HRQoL using generic preference-based measures was conducted. Where available, data on intraclass correlation coefficients (ICCs) were extracted to summarise overall agreement levels, and Cohen's kappa was used to describe agreement across domains. A meta-analysis was also performed to synthesise studies and estimate the level of agreement between self- and proxy-reported paediatric overall and domain-level HRQoL. RESULTS Of the 30 studies included, 25 reported inter-rater agreement for overall utilities, while 17 reported domain-specific agreement. Seven generic preference-based measures were identified as having been applied: Health Utilities Index (HUI) Mark 2 and 3, EQ-5D measures, Child Health Utility 9 Dimensions (CHU9D), and the Quality of Well-Being (QWB) scale. A total of 45 dyad samples were included, with a total pooled sample of 3084 children and 3300 proxies. Most of the identified studies reported a poor inter-rater agreement for the overall HRQoL using ICCs. In contrast to more observable HRQoL domains relating to physical health and functioning, the inter-rater agreement was low for psychosocial-related domains, e.g., 'emotion' and 'cognition' attributes of both HUI2 and HUI3, and 'feeling worried, sad, or unhappy' and 'having pain or discomfort' domains of the EQ-5D. Parents demonstrated a higher level of agreement with children relative to health professionals. Child self- and proxy-reports of HRQoL showed lower agreement in cancer-related studies than in non-cancer-related studies. The overall ICC from the meta-analysis was estimated to be 0.49 (95% confidence interval 0.34-0.61) with poor inter-rater agreement. CONCLUSION This study provides evidence from a systematic review of studies reporting dyad assessments to demonstrate the discrepancies in inter-rater agreement between child and proxy reporting of overall and domain-level paediatric HRQoL using generic preference-based measures. Further research to drive the inclusion of children in self-reporting their own HRQoL wherever possible and limiting the reliance on proxy reporting of children's HRQoL is warranted.
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Affiliation(s)
- Diana Khanna
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Jyoti Khadka
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
- Registry of Senior Australians, Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, SA Australia
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Kiri Lay
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
| | - Remo Russo
- Department of Paediatric Rehabilitation, Women’s and Children’s Hospital, Adelaide, SA Australia
- Faculty of Health Sciences, School of Medicine, Flinders University, Adelaide, SA Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA Australia
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Raybin JL, Zhou W, Pan Z, Jankowski C. Quality of Life Outcomes With Creative Arts Therapy in Children With Cancer. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2022; 39:155-167. [PMID: 35467438 DOI: 10.1177/27527530211055988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Introduction: Children with cancer experience distress and decreased quality of life (QOL). Creative arts therapy (CAT) is a therapeutic modality which may improve QOL. This study examined the relationship between CAT and QOL in children and adolescents with cancer. Secondary aims explored relationships between CAT and emotional reactions, resilience, and posture (to investigate future potential as an objective biomarker of QOL). Methods: Children aged 3-18 years undergoing cancer treatments and a parent proxy completed the PedsQL3.0 Cancer Module, Faces Scale for emotional reactions, Resilience Scale in adolescents (>12 years), and an inclinometer to measure thoracic kyphosis before and after CAT. CAT exposure (number of sessions) was recorded. Results: Ninety-eight children with cancer (mean age 7.8 years, range 3-17) and parent proxy were enrolled. Of the 83 participants included in the final analysis, 18 received no CAT, 32 received low dose, and 33 received high dose CAT. A significant improvement in QOL was seen with high dose CAT in (slope change, p = .015), but the overall time by group interaction was not significant. Slope change response patterns suggested that CAT led to improved posture as compared to no CAT (time by group interaction, p = .044). Discussion: CAT may be an effective intervention to improve QOL in this population. Because initial evidence suggests that posture also improves with CAT, further investigation of posture as a potential objective biomarker of QOL is supported. Further study with a randomized controlled trial is warranted.
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Affiliation(s)
- Jennifer L Raybin
- Pediatric Palliative Care, Center for Cancer and Blood Disorders, Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Wenru Zhou
- Colorado School of Public Health-Biostatistics and Informatics, CO, USA
| | - Zhaoxing Pan
- Department of Pediatrics, Anschutz School of Medicine, 129263University of Colorado, CO, USA
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Raybin JL, Hendricks-Ferguson V, Cook P, Jankowski C. Associations between demographics and quality of life in children in the first year of cancer treatment. Pediatr Blood Cancer 2021; 68:e29388. [PMID: 34626456 DOI: 10.1002/pbc.29388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 11/05/2022]
Abstract
Symptom distress and decreased quality of life (QOL) among children with cancer are well documented. Research is emerging on the child's voice in QOL-symptom reports, but existing QOL questionnaires are burdensome and objective biologic markers are lacking. We examined children's symptoms and QOL from parent and child perspectives and compared the results to one biologic marker (body posture). A cross-sectional secondary analysis of prospective data from children receiving creative arts therapy explored potential associations among demographics with and between QOL measures (PedsQL, Faces Scale, posture). Children (n = 98) ranged in age from 3 to 17 years (M = 7.8) and were in the first year of cancer treatment. No significant associations were found among the child's sex, race/ethnicity, socioeconomic status (SES), or distance from hospital, and total PedsQL. Older age was associated with worse total PedsQL, pain, nausea, worry, and posture (all P < 0.05). Greater worry (β = 0.51) and worse posture (β = 0.41) were the QOL variables most strongly correlated with older age. Poorer posture was associated with worse child PedsQL (total score, nausea, treatment anxiety, cognitive) and parent PedsQL (pain, nausea). Worse scores on the Faces Scale, PedsQL, and posture were all correlated (r = 0.21-0.39, all P < 0.05). Interventions to improve QOL could target nausea, worry, and older patients. Accuracy and interpretation of symptom distress in children are problematic. The Faces Scale and posture may be suitable, readily obtained measures of QOL in pediatric oncology that hold promise.
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Affiliation(s)
- Jennifer L Raybin
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado.,University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | | | - Paul Cook
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
| | - Catherine Jankowski
- University of Colorado Anschutz Medical Campus, College of Nursing and School of Medicine, Aurora, Colorado
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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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Raybin JL, Krajicek M. Creative Arts Therapy in the Context of Children With Cancer: A Concept Analysis. J Pediatr Oncol Nurs 2019; 37:82-90. [PMID: 31592707 DOI: 10.1177/1043454219878397] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim: To report an analysis of the concept of creative arts therapy (CAT) in the context of pediatric cancer. Background: Literature supports the intuitive conclusion that creative interventions improve a patient's journey through the cancer trajectory. However, a new definition is needed to encompass CAT and creative expression interventions in order to better understand the concept of creativity in health care, specifically in pediatric oncology. Design: Concept analysis. Data Sources: The scientific databases CINAHL, PsycInfo (Ovid), AMED (Allied and Complementary Medicine), and PubMed were queried for English language research articles published between 2008 and 2018 using the search terms: creative arts therapy and cancer. Method: The Walker and Avant method of concept analysis was implemented. Results: CAT is a broad concept bringing creative arts in a therapeutic manner to children with cancer. Attributes include expression of feelings; creating art, music, or movement; and improvement of symptoms. CAT is frequently measured using quality of life and symptom assessment scales. Antecedents include the diagnosis of cancer, the distress caused by cancer, and a child's willingness to participate in creative activity. Consequences include improved quality of life, improved sense of well-being, decreased psychosocial symptoms, and less cancer pain. Conclusion: The literature supports CAT as a concept that may decrease distress for children with cancer.
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Affiliation(s)
- Jennifer L Raybin
- Children's Hospital Colorado, Aurora, CO, USA.,School of Medicine, University of Colorado, Aurora, CO, USA
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Hidalgo-Rasmussen CA, Chávez-Flores YV, Yanez-Peñúñuri LY, Navarro SRM. [Suicide-related behavior and health-related quality of life among first-year university students in a Mexican university]. CIENCIA & SAUDE COLETIVA 2019; 24:3763-3772. [PMID: 31577007 DOI: 10.1590/1413-812320182410.26732017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 03/12/2018] [Indexed: 01/10/2023] Open
Abstract
The objective was to determine if suicide-related behavior (SRB) and health-related quality of life (HRQL) are associated and whether this association is independent of substance use, violence, and sociodemographic variables. It involved a cross-sectional study with 1,229 Mexican university students: 62.4% women; 37.6% men; age 18.2± .6 years. The YRBS and KISDSCREEN questionnaires were applied. The results were as follows: 14.2% students reported despair; 4.7% had suicidal ideation (SI); 4% had suicidal tendencies (ST); and 2.3% had attempted suicide. Multiple logistic regression models show that despair increased the possibility of lower scores in all HRQL domains except economic resources with odds ratio OR (CI 95%) ranging from 1.5 (1.0-2.3) for autonomy to 4.6 (3.1-6.8) for state of mind. The SI increased the possibility of a lower score in relationships with parents and family life (3.9, 1.7-8.9) and in friends and social support (2.9, 1.3-6.4). The ST increased the possibility for lower physical (2.7, 1.2-6.1) and psychological well-being (3.1, 1.3-7.2). HRQL is associated with SRB among Mexican students even after adjustment for substance use and violence. It highlights the fact that despair is negatively associated with different domains of the HRQL of the students.
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Affiliation(s)
- Carlos Alejandro Hidalgo-Rasmussen
- Centro de Investigación en Riesgos y Calidad de Vida, Departamento de Promoción, Preservación y Desarrollo de la Salud, Universidad de Guadalajara. Centro de Estudios Avanzados, Universidad de Playa Ancha. Av. Juárez 976, col Americana. 44160 Cd. Guzmán Jalisco México.
| | | | | | - Sergio R Muñoz Navarro
- Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera. Temuco, Chile
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Khadka J, Kwon J, Petrou S, Lancsar E, Ratcliffe J. Mind the (inter-rater) gap. An investigation of self-reported versus proxy-reported assessments in the derivation of childhood utility values for economic evaluation: A systematic review. Soc Sci Med 2019; 240:112543. [PMID: 31586777 DOI: 10.1016/j.socscimed.2019.112543] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/24/2019] [Accepted: 09/07/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Evidence surrounding utilities for health states, derived either directly from the application of preference-based valuation methods or indirectly from the application of preference-based quality of life instruments, is increasingly being utilised to inform the cost-effectiveness of child health interventions. Proxy (parent or health professional) assessments are common in this area. This study sought to investigate the degree of convergence in childhood utilities generated directly or indirectly within dyad child and proxy assessments. METHODS A systematic literature review was conducted following PRISMA guidelines. A comprehensive literature search strategy conducted across six search engines (PubMed, Embase, Web of Science, PsychoINFO, EconLit, CINAHL and Cochrane Library). Original peer-reviewed articles that reported utilities derived directly or indirectly using simultaneous dyad child and proxy assessments were extracted. Mean and median utilities, correlation coefficients and levels of agreement were extracted, catalogued and assessed. RESULTS A total of 35 studies that reported utilities for two or more respondent types were identified. Of these, 29 studies reported dyad childhood self-report and proxy utilities whilst six studies reported levels of agreement and/or correlations only without documenting overall utilities. Proxy assessment was most often conducted by parents with the HUI3 representing the most commonly applied instrument across a range of health conditions. The utilities derived from child and parent proxy assessment were bidirectional with parental proxies tending to underestimate and health professional proxies tending to overestimate relative to child self-reports. Inter-rater agreement between child self-reports and parent-proxy reports were poorer for more subjective attributes (cognition, emotion and pain), relative to physical attributes (mobility, self-care, speech, vision) of health-related quality of life. CONCLUSIONS Childhood utilities derived from children or proxies are not interchangeable. The choice of self or proxy assessor may have potentially significant implications for economic evaluations of child health interventions.
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Affiliation(s)
- Jyoti Khadka
- Health and Social Care Economics Group, College of Nursing and Health Science, Flinders University, Bedford Park, South Australia, Australia; Institute for Choice, Business School, University of South Australia, South Australia, Australia; Registry of Senior Australians, Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
| | - Joseph Kwon
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Emily Lancsar
- Department of Health Services Research and Policy, School of Population Health, The Australian National University, Canberra, Australia
| | - Julie Ratcliffe
- Health and Social Care Economics Group, College of Nursing and Health Science, Flinders University, Bedford Park, South Australia, Australia
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Crane S, Backus L, Stockman B, Carpenter JS, Lin L, Haase J. Understanding Treatment Burden and Quality of Life Impact of Participating in an Early-Phase Pediatric Oncology Clinical Trial: A Pilot Study. J Pediatr Oncol Nurs 2017; 35:25-35. [PMID: 28849701 DOI: 10.1177/1043454217723863] [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] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Early-phase clinical trials (EPTs) have led to new, more effective treatment options for children with cancer. Despite the extensive use of EPTs in pediatric oncology, little is known about parent and child experiences during EPT participation. The purposes of this pilot study were to assess the feasibility and preliminary results of having children with cancer and their parents complete measures of treatment burden and quality of life (QOL) concurrent with EPT participation. METHODS In this descriptive, longitudinal, pilot study, parents and children were followed for the first 60 days of an EPT. Feasibility was assessed by participant enrollment and retention and completion of measures. Measures completed included the following: demographic form (completed at baseline); Diary of Trial Experiences to capture treatment burden (completed ongoing); and PedsQL™ Quality of Life Inventories, Cancer Modules, and Family Impact Module (completed at baseline, post-first disease evaluation, and off-study). Data were analyzed using descriptive statistics. RESULTS Feasibility goals of enrollment, retention, and measure completion were partially met. Preliminary treatment burden and QOL results are provided. CONCLUSIONS While QOL assessments may provide insight into EPT experiences, future studies need to be conducted at multiple sites and enrollment goals must account for participant attrition.
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Affiliation(s)
| | - Lori Backus
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Beth Stockman
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Li Lin
- 2 Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Joan Haase
- 1 Indiana University, Indianapolis, IN, USA
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V. K. A, Onta M, Joshi S. Health-Related Quality of Life of Nepalese Children With Leukemia Using Pediatric Quality of Life Inventory 4.0 Generic Core Scale. J Pediatr Oncol Nurs 2017; 34:322-330. [DOI: 10.1177/1043454217703593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Health-related quality of life (HRQOL) is an essential measure to consider when evaluating the full impact of illness in children diagnosed with leukemia. The purpose of the current study was to assess the overall HRQOL and specific functioning subscales of Nepalese children with leukemia using Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL 4.0), compare self-report with parent proxy report of HRQOL and to identify the determinants affecting HRQOL. After cultural linguistic validation of PedsQL, a descriptive cross-sectional study was conducted on 43 children with leukemia and their parents in B. P. Koirala Memorial Cancer Hospital, Bharatpur via interview schedule. Among the subscales of HRQOL both the child’s self-report and parent proxy report scores were highest in social functioning and lowest in emotional functioning subscale. Intraclass correlation coefficient between proxy reports and self-reports were highest (0.828) in physical functioning and lowest (0.493) in social functioning subscales. Age group was significantly associated with the total score, physical functioning subscale, and emotional functioning subscale of only proxy scores. Leukemic children’s age-specific needs should be addressed properly to improve their overall HRQOL.
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Affiliation(s)
- Anu V. K.
- Shree Medical and Technical College, Chitwan, Nepal
| | - Mandira Onta
- Nursing Campus, Maharajgunj, Institute of Medicine, Tribhuvan University, Nepal
| | - Sarala Joshi
- Nursing Campus, Maharajgunj, Institute of Medicine, Tribhuvan University, Nepal
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Villalonga-Olives E, Kawachi I, Almansa J, von Steinbüchel N. Longitudinal changes in health related quality of life in children with migrant backgrounds. PLoS One 2017; 12:e0170891. [PMID: 28151986 PMCID: PMC5289509 DOI: 10.1371/journal.pone.0170891] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 01/12/2017] [Indexed: 11/18/2022] Open
Abstract
Background Little is known about longitudinal changes in the Health Related Quality of Life (HRQoL) among children with migrant backgrounds. Methods The sample comprised 350 children with predominantly migrant backgrounds enrolled in 7 kindergartens in Frankfurt and Darmstadt, Germany. At baseline, the participants’ mean age was 4.4 years (SD 0.9). Data collection started in May 2009. Two waves of data were collected one year apart (94% response rate). HRQoL was evaluated with the Kiddy-KINDL. The other variables under study were sex, age, socioeconomic status, country of origin, developmental status (WET) and individual behavior (VBV). Data were collected from the children, parents and teachers. Structural equation modeling (SEM) was used to assess the Wilson and Cleary theoretical framework on changes in HRQoL and Generalized Estimated Equations (GEE) to model the longitudinal trend in HRQoL. Results Overall HRQoL remained stable between baseline and follow-up. SEM model fit was χ2 = 8.51; df = 5; p = 0.13; SRMR = 0.02 RMSEA = 0.06 and indicated that there were differences in kindergarten activities (p<0.05). The GEE model elucidated that the differences in HRQoL between the baseline and follow-up varied according to kindergarten activities that the children were assigned to (music, art, or no activities) (p<0.05), but that there were no differences in terms of country of origin. On average, girls reported better HRQoL. Conclusion Overall HRQoL scores remained stable over follow-up in a sample of migrant children and there were no differences in terms of origin. However, there was heterogeneity in the results depending on the kindergarten activities that the children were assigned to.
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Affiliation(s)
- Ester Villalonga-Olives
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
- * E-mail:
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Josue Almansa
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Nicole von Steinbüchel
- Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany
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Mitchell HR, Lu X, Myers RM, Sung L, Balsamo LM, Carroll WL, Raetz E, Loh ML, Mattano LA, Winick NJ, Devidas M, Hunger SP, Maloney K, Kadan-Lottick NS. Prospective, longitudinal assessment of quality of life in children from diagnosis to 3 months off treatment for standard risk acute lymphoblastic leukemia: Results of Children's Oncology Group study AALL0331. Int J Cancer 2015; 138:332-9. [PMID: 26235006 DOI: 10.1002/ijc.29708] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 06/24/2015] [Indexed: 11/09/2022]
Abstract
Standard risk acute lymphoblastic leukemia (SR-ALL) has high cure rates, but requires 2-3 years of therapy. We aimed to (i) prospectively evaluate health-related quality of life (HRQOL) during and after SR-ALL therapy, and (ii) identify associated predictors. Parents of 160 SR-ALL patients enrolled on Children's Oncology Group (COG) therapeutic trial AALL0331 at 31 sites completed the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales (physical, emotional and social functioning) and Family Assessment Device-General Functioning (FAD-GF) at 1, 6 and 12 months after diagnosis, and 3 months post-therapy. Mean PedsQL scores in physical, emotional and social functioning were impaired 1 month after diagnosis but steadily improved. Three months post-therapy, impaired physical and social functioning was observed in 27.8 and 25.8% of patients, respectively. In repeated-measures analysis, problematic family functioning predicted emotional (OR = 1.85, 95% CI 1.03-3.34) and social (OR = 1.99, 95% CI 1.21-3.27) impairment. Larger household size was associated with social impairment (OR = 1.21, 95% CI 1.02-1.45). Adverse neurological event(s) during therapy predicted post-therapy physical (OR = 5.17, 95% CI 1.61-16.63) and social (OR = 8.17, 95% CI 1.19-56.16) impairment. HRQOL 1 month after diagnosis was not predictive of HRQOL 3 months after therapy completion. In conclusion, children with SR-ALL experience considerable impairment in HRQOL at the end of induction, but rapidly improve. However, many still experience physical and social impairment 3 months post-therapy, suggesting a role for continued family and physical functioning support. Longer follow-up is needed to determine if post-therapy deficits change over time.
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Affiliation(s)
- Hannah-Rose Mitchell
- Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT
| | - Xiaomin Lu
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainsville, FL
| | - Regina M Myers
- Department of Pediatrics, Columbia University, New York, NY
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lyn M Balsamo
- Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT
| | - William L Carroll
- Pediatric Oncology, Cancer Institute, New York University Medical Center, New York, NY
| | - Elizabeth Raetz
- Department of Pediatrics, University of Utah, Salt Lake City, NY
| | - Mignon L Loh
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | | | - Naomi J Winick
- Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas, TX
| | - Meenakshi Devidas
- Department of Biostatistics, College of Public Health and Health Professions, University of Florida, Gainsville, FL
| | - Stephen P Hunger
- Division of Oncology and Center for Childhood Cancer Research, The Children's Hospital of Philadelphia (CHOP), Philadelphia, PA
| | - Kelly Maloney
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO
| | - Nina S Kadan-Lottick
- Department of Pediatric Hematology & Oncology, Yale University School of Medicine, New Haven, CT
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Patient-Reported Outcome Coordinator Did Not Improve Quality of Life Assessment Response Rates: A Report from the Children's Oncology Group. PLoS One 2015; 10:e0125290. [PMID: 25915772 PMCID: PMC4411136 DOI: 10.1371/journal.pone.0125290] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 03/23/2015] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Health related quality of life (HRQL) assessments during therapy for pediatric cancer provide valuable information to better understand the patient experience. Our objective was to determine the impact of a patient-reported outcome (PRO) coordinator on HRQL questionnaire completion rates during a pediatric acute myeloid leukemia (AML) trial. METHODS AAML1031 is a multicenter Children's Oncology Group therapeutic trial for de novo AML with a secondary aim to assess HRQL of children and adolescents treated with chemotherapy and hematopoietic stem cell transplantation (HSCT). Parents/guardians are the primary respondents and four questionnaires are administered at eight time points. The questionnaires are the PedsQL 4.0 Generic Core Scales, PedsQL 3.0 Acute Cancer Module, PedsQL Multidimensional Fatigue Scale, and the Pediatric Inventory for Parents. To improve response rates, a central PRO coordinator was instituted and reminded sites about upcoming and delinquent questionnaires. The proportion of HRQL questionnaires completed were compared prior to, and following institution of the PRO coordinator. This analysis evaluated the first five assessment time points. RESULTS There were231 families who consented to participate in the HRQL aim. Overall response rates for all questionnaires were 73-83%. At time point 1, within 14 days of chemotherapy initiation, post-PRO coordinator completion rates were significantly higher for three of four questionnaires. However, the effect was not sustained and at time point 4, one month following last chemotherapy or HSCT, completion rates were significantly lower post-PRO coordinator for all four questionnaires. CONCLUSION Addition of a central PRO coordinator did not result in sustained improvement in HRQL questionnaire completion rates. Efforts to improve response rates must consider other strategies.
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Pollack MM, Holubkov R, Funai T, Clark A, Moler F, Shanley T, Meert K, Newth CJL, Carcillo J, Berger JT, Doctor A, Berg RA, Dalton H, Wessel DL, Harrison RE, Dean JM, Jenkins TL. Relationship between the functional status scale and the pediatric overall performance category and pediatric cerebral performance category scales. JAMA Pediatr 2014; 168:671-6. [PMID: 24862461 PMCID: PMC4589215 DOI: 10.1001/jamapediatrics.2013.5316] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Functional status assessment methods are important as outcome measures for pediatric critical care studies. OBJECTIVE To investigate the relationships between the 2 functional status assessment methods appropriate for large-sample studies, the Functional Status Scale (FSS) and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category (POPC/PCPC) scales. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study with random patient selection at 7 sites and 8 children's hospitals with general/medical and cardiac/cardiovascular pediatric intensive care units (PICUs) in the Collaborative Pediatric Critical Care Research Network. Participants included all PICU patients younger than 18 years. MAIN OUTCOMES AND MEASURES Functional Status Scale and POPC/PCPC scores determined at PICU admission (baseline) and PICU discharge. We investigated the association between the baseline and PICU discharge POPC/PCPC scores and the baseline and PICU discharge FSS scores, the dispersion of FSS scores within each of the POPC/PCPC ratings, and the relationship between the FSS neurologic components (FSS-CNS) and the PCPC. RESULTS We included 5017 patients. We found a significant (P < .001) difference between FSS scores in each POPC or PCPC interval, with an FSS score increase with each worsening POPC/PCPC rating. The FSS scores for the good and mild disability POPC/PCPC ratings were similar and increased by 2 to 3 points for the POPC/PCPC change from mild to moderate disability, 5 to 6 points for moderate to severe disability, and 8 to 9 points for severe disability to vegetative state or coma. The dispersion of FSS scores within each POPC and PCPC rating was substantial and increased with worsening POPC and PCPC scores. We also found a significant (P < .001) difference between the FSS-CNS scores between each of the PCPC ratings with increases in the FSS-CNS score for each higher PCPC rating. CONCLUSIONS AND RELEVANCE The FSS and POPC/PCPC system are closely associated. Increases in FSS scores occur with each higher POPC and PCPC rating and with greater magnitudes of change as the dysfunction severity increases. However, the dispersion of the FSS scores indicated a lack of precision in the POPC/PCPC system when compared with the more objective and granular FSS. The relationship between the PCPC and the FSS-CNS paralleled the relationship between the FSS and POPC/PCPC system.
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Affiliation(s)
- Murray M. Pollack
- Department of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona,Department of Child Health, University of Arizona College of Medicine–Phoenix
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Tomohiko Funai
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Amy Clark
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Frank Moler
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Thomas Shanley
- Department of Pediatrics, University of Michigan, Ann Arbor
| | - Kathy Meert
- Department of Pediatrics, Children’s Hospital of Michigan, Detroit
| | - Christopher J. L. Newth
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital Los Angeles, Los Angeles, California
| | - Joseph Carcillo
- Department of Critical Care Medicine, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John T. Berger
- Department of Pediatrics, Children’s National Medical Center, Washington, DC
| | - Allan Doctor
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri,Department of Biochemistry, Washington University School of Medicine, St Louis, Missouri
| | - Robert A. Berg
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Heidi Dalton
- Department of Critical Care Medicine, Phoenix Children’s Hospital, Phoenix, Arizona,Department of Child Health, University of Arizona College of Medicine–Phoenix
| | - David L. Wessel
- Department of Pediatrics, Children’s National Medical Center, Washington, DC
| | | | - J. Michael Dean
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City
| | - Tammara L. Jenkins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
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Johnston DL, Nagarajan R, Caparas M, Schulte F, Cullen P, Aplenc R, Sung L. Reasons for non-completion of health related quality of life evaluations in pediatric acute myeloid leukemia: a report from the Children's Oncology Group. PLoS One 2013; 8:e74549. [PMID: 24040278 PMCID: PMC3765362 DOI: 10.1371/journal.pone.0074549] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/02/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Health related quality of life (HRQL) assessments during therapy for pediatric cancer are important. The objective of this study was to describe reasons for failure to provide HRQL assessments during a pediatric acute myeloid leukemia (AML) clinical trial. METHODS We focused on HRQL assessments embedded in a multicenter pediatric AML clinical trial. The PedsQL 4.0 Generic Core Scales, PedsQL 3.0 Acute Cancer Module, PedsQL Multidimensional Fatigue Scale, and Pediatric Inventory for Parents were obtained from parent/guardian respondents at a maximum of six time points. Children provided self-report optionally. A central study coordinator contacted sites with delinquent HRQL data. Reasons for failure to submit the HRQL assessments were evaluated by three pediatric oncologists and themes were generated using thematic analysis. RESULTS There were 906 completed and 1091 potential assessments included in this analysis (83%). The median age of included children was 12.9 years (range 2.0 to 18.9). The five themes for non-completion were: patient too ill; passive or active refusal by respondent; developmental delay; logistical challenges; and poor knowledge of study processes from both the respondent and institutional perspective. CONCLUSIONS We identified reasons for non-completion of HRQL assessments during active therapy. This information will facilitate recommendations to improve study processes and future HRQL study designs to maximize response rates.
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Affiliation(s)
- Donna L. Johnston
- Division of Hematology/Oncology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- * E-mail:
| | - Rajaram Nagarajan
- Division of Oncology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Mae Caparas
- Children’s Oncology Group, Monrovia, California, United States of America
| | - Fiona Schulte
- Departments of Oncology and Paediatrics, University of Calgary, Alberta Children's Hospital Research Institute, and Haematology, Oncology and Transplant Program, Alberta Children's, Calgary, Alberta, Canada
| | - Patricia Cullen
- Loretto Heights School of Nursing, Regis University, Denver, Colorado, United States of America
| | - Richard Aplenc
- Pediatric Oncology/Stem Cell Transplant, Children's Hospital of Philadelphia, Department of Pediatrics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, 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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van Litsenburg RRL, Kunst A, Huisman J, Ket JCF, Kaspers GJL, Gemke RJBJ. Health status utilities in pediatrics: a systematic review of acute lymphoblastic leukemia. Med Decis Making 2013; 34:21-32. [PMID: 23886678 DOI: 10.1177/0272989x13497263] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measuring utilities and health-related quality of life (HRQL) in children is challenging due to their cognitive abilities and changing developmental stages. PURPOSE . To identify methodological issues on utility measurements in children, we performed a systematic review on utilities measured with a single instrument, the Health Utilities Index (HUI), in pediatric acute lymphoblastic leukemia (ALL). The secondary goal was to facilitate future cost-utility analyses without the need for time-consuming assessments. Data Sources. PubMed, Embase, Cochrane Library, CINAHL, and PsycINFO were searched from inception to June 2012. Studies had to report on utility scores in pediatric ALL, either on or after treatment, to be included. RESULTS . Fifteen studies were included. Most studies had methodological shortcomings, which mainly concerned STUDY DESIGN and definition and representativeness of the study group. Utility scores were dependent on treatment variables, and there generally was an improvement in HRQL as treatment or survivorship advanced. In general, proxy-respondents were less reliable for subjective phenomena than for observable conditions. HUI2 and HUI3 scores were not interchangeable. Limitations. Studies may have been missed because no validated search method for utility studies exists, due to language bias or the exclusion of non-peer-reviewed papers. CONCLUSIONS . Most studies in this review were methodologically suboptimal. Future developments should focus on including developmentally appropriate items for the whole pediatric age group. Adding disease-specific domains may enhance the sensitivity and responsiveness of instruments. Efforts should be undertaken to elicit valuation of health states from older children and teenagers as much as possible. For now, it remains difficult to make valid and informed decisions on the financing of interventions until health state valuation in children has become more methodologically robust.
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Affiliation(s)
- Raphaële R L van Litsenburg
- Department of Pediatrics, Division of Oncology-Hematology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (RRLVL, GJLK)
| | - Annemieke Kunst
- Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (AK, RJBJG)
| | - Jaap Huisman
- Department of Pediatric Psychology & Social Work, University Medical Center Utrecht, Utrecht, the Netherlands (JH)
| | - Johannes C F Ket
- VU University Library Amsterdam, Amsterdam, the Netherlands (JCFK)
| | - Gertjan J L Kaspers
- Department of Pediatrics, Division of Oncology-Hematology, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (RRLVL, GJLK)
| | - Reinoud J B J Gemke
- Department of Pediatrics, VU University Medical Center Amsterdam, Amsterdam, the Netherlands (AK, RJBJG)
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The impact of Hunter syndrome (mucopolysaccharidosis type II) on health-related quality of life. Orphanet J Rare Dis 2013; 8:101. [PMID: 23837440 PMCID: PMC3722040 DOI: 10.1186/1750-1172-8-101] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/08/2013] [Indexed: 11/21/2022] Open
Abstract
Background Hunter syndrome (mucopolysaccharidosis type II (MPS II)) is a rare metabolic disease that can severely compromise health, well-being and life expectancy. Little evidence has been published on the impact of MPS II on health-related quality of life (HRQL). The objective of this study was to describe this impact using the Hunter Syndrome-Functional Outcomes for Clinical Understanding Scale (HS-FOCUS) questionnaire and a range of standard validated questionnaires previously used in paediatric populations. Methods Clinical and demographic characteristics collected in a clinical trial and responses to four HRQL questionnaires completed both by patients and parents prior to enzyme replacement treatment were used. The association between questionnaire scores and clinical function parameters were tested using Spearman rank-order correlations. Results were compared to scores in other paediatric populations with chronic conditions obtained through a targeted literature search of published studies. Results Overall, 96 male patients with MPS II and their parents were enrolled in the trial. All parents completed the questionnaires and 53 patients above 12 years old also completed the self-reported versions. Parents’ and patients’ responses were analysed separately and results were very similar. Dysfunction according to the HS-FOCUS and the CHAQ was most pronounced in the physical function domains. Very low scores were reported in the Self Esteem and Family Cohesion domains in the CHQ and HUI3 disutility values indicated a moderate impact. Scores reported by patients and their parents were consistently lower than scores in the other paediatric populations identified (except the parent-reported Behaviour score); and considerably lower than normative values. Conclusions This study describes the impact on HRQL in patients with MPS II and provides a broader context by comparing it with that of other chronic paediatric diseases. Physical function and the ability to perform day-to-day activities were the most affected areas and a considerable impact on the psychological aspects of patients’ HRQL was also found, with a higher level of impairment across most dimensions (particularly Pain and Self Esteem) than that of other paediatric populations. Such humanistic data provide increasingly important support for establishing priorities for health care spending, and as a component of health economic analysis.
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Furlong W, Rae C, Feeny D, Gelber RD, Laverdiere C, Michon B, Silverman L, Sallan S, Barr R. Health-related quality of life among children with acute lymphoblastic leukemia. Pediatr Blood Cancer 2012; 59:717-24. [PMID: 22294502 PMCID: PMC4123756 DOI: 10.1002/pbc.24096] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 01/05/2012] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective was to quantify the health-related quality of life (HRQL) of children treated for acute lymphoblastic leukemia (ALL) and identify specific disabilities for remediation. PROCEDURE Two types of subjects were included: ALL patients 5 plus years old in a multi-center clinical trial and general population control groups. Patients were assessed during all four major phases of active treatment and approximately 2 years after treatment. Health status and HRQL were measured using HEALTH UTILITIES INDEX® (HUI®) Mark 2 (HUI2) and Mark 3 (HUI3). HRQL scores were used to calculate quality-adjusted life years (QALYs). Excess disability rates identified attributes for remediation. RESULTS HUI assessments (n = 749) were collected during the five phases. Mean HRQL increased from induction through the post-treatment phase (P < 0.001). There were no significant demographic or treatment effects on HRQL, except for type of asparaginase during continuation therapy (P = 0.005 for HUI2 and P = 0.007 for HUI3). Differences in mean HRQL scores between patients and controls were important (P < 0.001) during the active treatment phases but not during the post-treatment phase. Relative to controls, patients lost approximately 0.2 QALYs during active treatment. Disability was evident in mobility/ambulation, emotion, self-care and pain, and declined over time. CONCLUSIONS Patients with ALL experienced important but declining deficits in HRQL during active treatment phases: Equivalent to losing approximately 2 months of life in perfect health. HRQL within the 2-years post-treatment phase was similar to controls. The policy challenge is to develop new treatment protocols producing fewer disabilities in mobility/ambulation, emotion, self-care, and pain without compromising survival.
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Affiliation(s)
- William Furlong
- Centre for Health Economics and Policy Analysis, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
| | - Charlene Rae
- Centre for Health Economics and Policy Analysis, and Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON, Canada
| | - David Feeny
- Health Utilities Inc., Dundas ON, Canada., The Center for Health Research, Kaiser Permanente Northwest Region, Portland OR, USA
| | - Richard D Gelber
- Dana Farber Cancer Institute, and Children's Hospital, Boston MA, USA
| | | | - Bruno Michon
- Le Centre Hospitalier de L'Universite Laval, Québec City QC, Canada
| | - Lewis Silverman
- Dana Farber Cancer Institute, and Children's Hospital, Boston MA, USA
| | - Stephen Sallan
- Dana Farber Cancer Institute, and Children's Hospital, Boston MA, USA
| | - Ronald Barr
- Department of Pediatrics, McMaster University, Hamilton ON, Canada and McMaster Children's Hospital, Hamilton ON, Canada
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Boran P, Horsman J, Tokuc G, Furlong W, Muradoglu PU, Vagas E. Translation and cultural adaptation of health utilities index with application to pediatric oncology patients during neutropenia and recovery in Turkey. Pediatr Blood Cancer 2011; 56:812-7. [PMID: 21370416 DOI: 10.1002/pbc.22835] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 08/19/2010] [Indexed: 11/09/2022]
Abstract
BACKGROUND This is a report on the translation and cultural adaptation from English to Turkish languages of a standard HEALTH UTILITIES INDEX® (HUI®) questionnaire for interviewer-administration and proxy assessment of patients' health status, and its use for assessing 50 consecutive pediatric oncology patients during periods of and subsequent recovery from neutropenia. PROCEDURE Preparation of the Turkish-language questionnaire was a collaborative effort by physician-researchers in Turkey, senior Health Utilities, Inc. staff with extensive experience in the development and translation of HUI questionnaires, and Turkish-born residents of Canada. Standard HUI questionnaires cover both HUI Mark 2 (HUI2) and HUI Mark 3 (HUI3). RESULTS The mean improvement in overall health-related quality of life (HRQL) scores between neutropenic and non-neutropenic phases was clinically important according to both HUI2 and HUI3 instruments. Single-attribute utility scores showed clinically important size improvements between phases for HUI2 mobility, emotion, and HUI2 self-care. Significant reductions in disability rates between phases were also detected for pain (HUI2 and HUI3 rate decreases of 30%, P < 0.001) and HUI3 ambulation (rate decline of 14%, P = 0.020). CONCLUSIONS The study results provide evidence that the Turkish-language questionnaire is acceptable, valid and useful for collecting parental assessments of health-status among young cancer patients in Turkey. Neutropenia was associated with important deficits in overall HRQL and disabilities in ambulation/mobility, emotion, self-care, and pain. Treatment plans should include strategies for addressing emotion and pain problems to improve the HRQL of neutropenic patients.
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Affiliation(s)
- Perran Boran
- Dr. Lutfi Kirdar Kartal Research and Training Hospital, Pediatric Oncology Clinic, Istanbul, Turkey.
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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, Krahn M, Gaboury I, Hughes J, Anderson R, Grundy P, Ali SK, Jardine L, Abla O, Silva M, Barnard D, Cappelli M. Evaluating the ability to detect change of health-related quality of life in children with Hodgkin disease. Cancer 2010; 116:1608-14. [PMID: 20143448 DOI: 10.1002/cncr.24883] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND We evaluated 4 different health-related quality of life (HRQL) measures prospectively to determine their ability to detect change over time: the Health Utilities Index Mark 2 and Mark 3, the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core and Cancer Module, the EuroQol EQ-5D visual analogue scale (EuroQol), and the Lansky Play-Performance Scale. METHODS Children with all stages of Hodgkin disease from 12 centers across Canada were asked to complete the 4 measures at 4 time points: 2 weeks after the first course of chemotherapy, on the third day of the second course of chemotherapy, during the third week of radiation, and 1 year after diagnosis. RESULTS Fifty-one patients were enrolled in the study between May 1, 2002 and March 31, 2005. Two patients were excluded: 1 patient died shortly after the first time point and the other patient failed to complete any of the questionnaires. All measures showed a significant change between Time 1 and Time 4 (<0.05). When the change in child scores was analyzed between the time points using the child's self-reported change in HRQL, the PedsQL and the EuroQol showed significant change at all time points. CONCLUSIONS All of the measures were able to detect change in a diverse group of children with Hodgkin disease. The PedsQL and the EuroQol appeared to be the most sensitive to change.
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Affiliation(s)
- Robert J Klaassen
- Division of Hematology/Oncology, Department of Pediatrics, Children's Hospital of Eastern Ontario, 401 Smyth, Ottawa, Ontario, Canada K1H 8L1.
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Williams NA, Davis G, Hancock M, Phipps S. Optimism and pessimism in children with cancer and healthy children: confirmatory factor analysis of the youth life orientation test and relations with health-related quality of life. J Pediatr Psychol 2009; 35:672-82. [PMID: 19797406 DOI: 10.1093/jpepsy/jsp084] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To test the measurement equivalence of the Youth Life Orientation Test (YLOT) in children with cancer (N = 199) and healthy controls (N = 108), and to examine optimism and pessimism as predictors of children's health-related quality of life (HRQL). METHODS Confirmatory factor analysis (CFA) was conducted to establish the two factor structure of the YLOT and to test for metric invariance. RESULTS A two-factor structure for the YLOT was confirmed and found to be stable across our study groups. There were no differences in mean levels of optimism and pessimism between cancer patients and controls after controlling for race/ethnicity. Higher optimism was associated with lower self-reports of pain and better emotional/behavioral functioning, whereas pessimism was related to poorer mental health and general behavior, and greater impact on the family. CONCLUSIONS Optimism and pessimism appear to be differentially related to certain aspects of children's HRQL, and should be investigated separately in relation to these outcomes.
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Affiliation(s)
- Natalie A Williams
- Department of Behavioral Medicine, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105-2794, USA
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Varni JW, Limbers CA. The pediatric quality of life inventory: measuring pediatric health-related quality of life from the perspective of children and their parents. Pediatr Clin North Am 2009; 56:843-63. [PMID: 19660631 DOI: 10.1016/j.pcl.2009.05.016] [Citation(s) in RCA: 232] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Health-related quality of life (HRQOL) has been recognized as an important outcome, some contend the most important outcome for children's health care interventions. The PedsQL Measurement Model was designed as a modular approach to measuring pediatric health-related quality of life, developed to integrate the relative merits of generic and disease-specific approaches. We suggest that part of the process of improving the quality of health care includes measuring HRQOL outcomes from the perspective of children and their parents on a routine basis, consistent with a consumer-based health care system approach.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Texas A&M University, College Station, TX 77843, USA.
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Lau JTF, Yu XN, Chu Y, Shing MMK, Wong EMC, Leung TF, Li CK, Fok TF, Mak WWS. Validation of the Chinese version of the Pediatric Quality of Life Inventory (PedsQL) Cancer Module. J Pediatr Psychol 2009; 35:99-109. [PMID: 19420227 DOI: 10.1093/jpepsy/jsp035] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The psychometric properties of the Chinese version of the Pediatric Quality of Life Inventory (PedsQL) Cancer Module were investigated. METHODS This instrument and the Generic Core Scales were administered to 359 pediatric patients with cancer (5-18 years) and 413 parents of such patients (2-18 years old). RESULTS Seven and eight factors were, respectively, identified for the patient and parent versions. The Cronbach's alpha coefficients were respectively .89 and .92 for the total scale, and respectively .75-.90 and .76-.93 for the subscales of the patient and parent versions. Test-retest reliability coefficients exceeded .60 for most cases. The total/subscale scores of the Cancer Module significantly correlated with those of the Generic Core Scales. Some of the subscales could distinguish between on-treatment and off-treatment patients. CONCLUSIONS The psychometric properties of the patient and parent versions of the Chinese PedsQL Cancer Module were found acceptable.
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Affiliation(s)
- Joseph T F Lau
- Centre for Epidemiology and Biostatistics, School of Public Health, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
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Roizen M, Rodríguez S, Bauer G, Medin G, Bevilacqua S, Varni JW, Dussel V. Initial validation of the Argentinean Spanish version of the PedsQL 4.0 Generic Core Scales in children and adolescents with chronic diseases: acceptability and comprehensibility in low-income settings. Health Qual Life Outcomes 2008; 6:59. [PMID: 18687134 PMCID: PMC2533649 DOI: 10.1186/1477-7525-6-59] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Accepted: 08/07/2008] [Indexed: 11/17/2022] Open
Abstract
Background To validate the Argentinean Spanish version of the PedsQL™ 4.0 Generic Core Scales in Argentinean children and adolescents with chronic conditions and to assess the impact of socio-demographic characteristics on the instrument's comprehensibility and acceptability. Reliability, and known-groups, and convergent validity were tested. Methods Consecutive sample of 287 children with chronic conditions and 105 healthy children, ages 2–18, and their parents. Chronically ill children were: (1) attending outpatient clinics and (2) had one of the following diagnoses: stem cell transplant, chronic obstructive pulmonary disease, HIV/AIDS, cancer, end stage renal disease, complex congenital cardiopathy. Patients and adult proxies completed the PedsQL™ 4.0 and an overall health status assessment. Physicians were asked to rate degree of health status impairment. Results The PedsQL™ 4.0 was feasible (only 9 children, all 5 to 7 year-olds, could not complete the instrument), easy to administer, completed without, or with minimal, help by most children and parents, and required a brief administration time (average 5–6 minutes). People living below the poverty line and/or low literacy needed more help to complete the instrument. Cronbach Alpha's internal consistency values for the total and subscale scores exceeded 0.70 for self-reports of children over 8 years-old and parent-reports of children over 5 years of age. Reliability of proxy-reports of 2–4 year-olds was low but improved when school items were excluded. Internal consistency for 5–7 year-olds was low (α range = 0.28–0.76). Construct validity was good. Child self-report and parent proxy-report PedsQL™ 4.0 scores were moderately but significantly correlated (ρ = 0.39, p < 0.0001) and both significantly correlated with physician's assessment of health impairment and with child self-reported overall health status. The PedsQL™ 4.0 discriminated between healthy and chronically ill children (72.72 and 66.87, for healthy and ill children, respectively, p = 0.01), between different chronic health conditions, and children from lower socioeconomic status. Conclusion Results suggest that the Argentinean Spanish PedsQL™ 4.0 is suitable for research purposes in the public health setting for children over 8 years old and parents of children over 5 years old. People with low income and low literacy need help to complete the instrument. Steps to expand the use of the Argentinean Spanish PedsQL™ 4.0 include an alternative approach to scoring for the 2–4 year-olds, further understanding of how to increase reliability for the 5–7 year-olds self-report, and confirmation of other aspects of validity.
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Affiliation(s)
- Mariana Roizen
- Committee on Quality of Life, Hospital de Pediatria Prof. Dr. Juan P Garrahan, Pichincha 1890, Buenos Aires, Argentina.
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