Cross-Cultural Validation of the McGill Quality of Life Questionnaire-Revised (MQOL-R), Korean Version; A Focus on People at the End of Life

Purpose

The purpose of this study was to confirm the factor structure of the McGill Quality of Life Questionnaire-Revised (MQOL-R) in the context of Korean culture and to verify its reliability and validity.

Methods

The participants comprised terminal cancer patients aged 25 or older, and data from 164 participants were analyzed. The study was conducted in the following order translation, expert review, reverse translation, preliminary investigation and interviews, and completion of the final version. Confirmatory factor analysis was applied to evaluate the validity of the instrument, and the Beck Depression Inventory, Korean version (K-BDI) was applied to confirm the criterion validity of the MQOL-R Korean version. The Cronbach's alpha coefficient, representing internal consistency, was measured to evaluate reliability.

Results

Cronbach's alpha for all 14 questions was 0.862. The model fit indices for confirmatory factor analysis were within the acceptance criteria. The factor loadings of all four factors were over 0.50, and convergent validity and discriminant validity were confirmed. Regarding criterion validity, a negative correlation was found between the four factors of MQOL-R Korean version and the K-BDI.

Conclusion

The MQOL-R Korean version, the reliability and validity of which were verified in this study, is a 15-item tool consisting of 14 items dealing with four physical, psychological, existential, and social factors and a single item evaluating the overall quality of life. The MQOL-R Korean version is an instrument that can more concisely and effectively measure the quality of life of patients with life-threatening diseases.

Cancer-related fatigue measures in palliative care: A psychometric systematic review

INTRODUCTION

In palliative care, the prevention and relief of fatigue are regarded as crucial goals in patients with cancer.

METHODS

A systematic review was carried out according to the COnsensus-based Standards for the selection of health status Measurement INstruments methodology. Searches were conducted in Medline (through PubMed), Web of Science, Open Gray, Scielo, Cochrane, CINAHL and EMBASE. All instruments found in each study were assessed using the COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS

A total of 5598 articles were identified in the different databases. In total, 57 studies describing 19 instruments were included in this study. The main properties evaluated were internal consistency, cross-cultural validity, hypotheses testing and responsiveness. All studies were evaluated with the Strobe scale with a score greater than 6 points.

CONCLUSIONS

According to the quality methodological results, Edmonton Symptom Assessment System, Problems and Needs in Palliative Care Questionnaire, European Organisation for Research and Treatment of Cancer Quality of Life 15-item Questionnaire for Palliative Care and Palliative Care Quality of Life Instrument are the recommended instruments used for assessing cancer-related fatigue in palliative care. PROPESRO registration number: CRD42020206783.

Understanding domains of health-related quality of life concerns of Singapore Chinese patients with advanced cancer: a qualitative analysis

PURPOSE

Quality of life concerns in patients with advanced diseases might be different from other patients and are shaped by sociocultural context. The objective of this qualitative study was to identify domains and themes of health-related quality of life (HRQoL) that Chinese patients with advanced cancer in Singapore considered relevant and important.

METHODS

English- and Chinese-speaking patients with advanced solid cancer were recruited from a tertiary cancer center and a community-based hospice for in-depth interview or focused group discussion. Thematic analysis was used to identify subthemes, themes, and domains from the transcripts.

RESULTS

Forty-six ethnic Chinese (aged 26-86, 48% male) participated in the study. Six domains of HRQoL concerns were identified: pain and suffering, physical health, social health, mental health, financial well-being, and spiritual health. Pain and suffering are not limited to the physical domain, reflecting the multidimensional nature of this concept. Pain and suffering must also be understood within the cultural context. Healthcare relations (i.e., social health), existential well-being and religious well-being (i.e., spiritual health), and suffering (i.e., pain and suffering) are not fully captured in the existing HRQoL instruments. In addition, financial issues and the practice of secrecy in interpersonal relationships emerged as unique features possibly arising from our sociocultural context and healthcare financing landscape.

CONCLUSION

Socioculturally specific issues not measured by the existing HRQoL instruments for use in patients with advanced cancers or terminal diseases were found in our study. These are non-physical pain and suffering, meaning of illness, meaning of death, financial issues, and practice of secrecy in interpersonal relationships.

A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review

BACKGROUND

Patient-reported outcome validation needs to achieve validity and reliability standards. Among reliability analysis parameters, test-retest reliability is an important psychometric property. Retested patients must be in a clinically stable condition. This is particularly problematic in palliative care (PC) settings because advanced cancer patients are prone to a faster rate of clinical deterioration. The aim of this study was to evaluate the methods by which multi-symptom and health-related qualities of life (HRQoL) based on patient-reported outcomes (PROs) have been validated in oncological PC settings with regards to test-retest reliability.

METHODS

A systematic search of PubMed (1966 to June 2013), EMBASE (1980 to June 2013), PsychInfo (1806 to June 2013), CINAHL (1980 to June 2013), and SCIELO (1998 to June 2013), and specific PRO databases was performed. Studies were included if they described a set of validation studies. Studies were included if they described a set of validation studies for an instrument developed to measure multi-symptom or multidimensional HRQoL in advanced cancer patients under PC. The COSMIN checklist was used to rate the methodological quality of the study designs.

RESULTS

We identified 89 validation studies from 746 potentially relevant articles. From those 89 articles, 31 measured test-retest reliability and were included in this review. Upon critical analysis of the overall quality of the criteria used to determine the test-retest reliability, 6 (19.4%), 17 (54.8%), and 8 (25.8%) of these articles were rated as good, fair, or poor, respectively, and no article was classified as excellent. Multi-symptom instruments were retested over a shortened interval when compared to the HRQoL instruments (median values 24 hours and 168 hours, respectively; p = 0.001). Validation studies that included objective confirmation of clinical stability in their design yielded better results for the test-retest analysis with regard to both pain and global HRQoL scores (p < 0.05). The quality of the statistical analysis and its description were of great concern.

CONCLUSION

Test-retest reliability has been infrequently and poorly evaluated. The confirmation of clinical stability was an important factor in our analysis, and we suggest that special attention be focused on clinical stability when designing a PRO validation study that includes advanced cancer patients under PC.

Reliability and validity of the Hospice Quality of Life Scale for Korean cancer patients

The Hospice Quality of Life Scale (HQLS) for Korean cancer patients was developed as follows: 1) item generation by semi-structured interviews and review of existing scales, 2) item reduction by the Delphi method, and 3) reliability and validity test. The final HQLS consisted of 40 questions within 13 domains and the internal consistency was 0.41-0.93. The domain "Family and Economy" was uniquely separated from the general social issues, which reflects the family-oriented Asian culture. For construct validity, the HQLS scores differed significantly according to their Eastern Cooperative Oncology Group Performance Status (known-group validity). Convergent and discriminant success rates were optimal in nine and four subscales, respectively. Total and subscale scores were significantly correlated with the related subscales in the European Organization for Research and Treatment of Cancer QLQ-C30 and the McMaster Quality of Life Scale, which supported the concurrent validity. HQLS was approved as an efficient tool for assessing the quality of life of Korean cancer patients who were receiving hospice and palliative care.

The Korean version of the Multicultural Quality of Life Index (MQLI-Kr): development and validation

Our research team of multilingual and multicultural members designed comprehensive, yet efficient, culture-informed, and self-rated Multicultural Quality of Life Indexes for both English-speaking individuals and for growing immigrant groups in the United States. A Korean version of the Multicultural Quality of Life Index (MQLI-Kr) was developed as part of this multilingual project. The team tested the MQLI-Kr on 130 Koreans (100 psychiatric patients and 30 professionals). MQLI-Kr was quite efficient and easy to use. The internal consistency attained a Cronbach's alpha of 0.97 for the combined sample. A factor analysis yielded one single factor, which accounted for 81.5% of the items' variance. The test-retest reliability correlation coefficient of the MQLI-Kr was 0.85. Significant differences in the mean MQLI-Kr scores were observed between the patients' group and the professionals' group (p < 0.001). Thus the results of this study showed high feasibility, internal consistency, reliability, and discriminant validity for the MQLI-Kr.