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Lassen RB, Abild CB, Kristensen K, Kristensen LJ, Hørlück JT, Jensen AL. Involving children and adolescents with type 1 diabetes in health care: a qualitative study of the use of patient-reported outcomes. J Patient Rep Outcomes 2023; 7:20. [PMID: 36862233 PMCID: PMC9981819 DOI: 10.1186/s41687-023-00564-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/22/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Within pediatric health care services, Patient-reported Outcomes (PROs) regarding the patient's health status are mainly used for research purposes in a chronic care setting. However, PROs are also applied in clinical settings in the routine care of children and adolescents with chronic health conditions. PROs have the potential to involve patients because they 'place the patient at the center' of his or her treatment. The investigation of how PROs are used in the treatment of children and adolescents and how this use can influence the involvement of these patients is still limited. The aim of this study was to investigate how children and adolescents with type 1 diabetes (T1D) experience the use of PROs in their treatment with a focus on the experience of involvement. RESULTS Employing Interpretive Description, 20 semi-structured interviews were conducted with children and adolescents with T1D. The analysis revealed four themes related to the use of PROs: Making room for conversation, Applying PROs under the right circumstances, Questionnaire structure and content, and Becoming partners in health care. CONCLUSIONS The results clarify that, to some extent, PROs fulfill the potential they promise, including patient-centered communication, detection of unrecognized problems, a strengthened patient-clinician (and parent-clinician) partnership, and increased patient self-reflection. However, adjustments and improvements are needed if the potential of PROs is to be fully achieved in the treatment of children and adolescents.
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Affiliation(s)
| | - Caroline Bruun Abild
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Kurt Kristensen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lene Juel Kristensen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | | | - Annesofie Lunde Jensen
- grid.154185.c0000 0004 0512 597XSteno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Lassen RB, Abild CB, Kristensen K, Kristensen LJ, Jensen AL. Patient-reported outcome instruments for assessing the involvement of children and adolescents with type 1 diabetes in their treatment: a scoping review protocol. JBI Evid Synth 2023; 21:609-616. [PMID: 36170118 DOI: 10.11124/jbies-22-00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to identify available patient-reported outcome instruments used to assess the involvement of children and adolescents with type 1 diabetes in their treatment. Specifically, this review will examine the content, structure, and application of these instruments. INTRODUCTION It is considered meaningful to involve children and adolescents living with a chronic health condition, such as type 1 diabetes, in their own treatment. Despite a growing interest in patient involvement within pediatric health care, including the use of patient-reported outcomes, only a few patient-reported outcome instruments have been developed and are used to evaluate the experiences of children and adolescents with type 1 diabetes of being involved in their own treatment. INCLUSION CRITERIA This scoping review will examine patient-reported outcome instruments used to assess the experiences of children and adolescents (11 to 18 years of age) with type 1 diabetes of being involved in their own care. Patient-reported outcome instruments measuring parents' or clinicians' experiences of involvement will be excluded. METHODS The proposed review will follow JBI guidelines and all stages will involve 2 or more reviewers. PubMed, Embase, CINAHL, PsycINFO, JSTOR, and MedNar will be searched without limitations on the year or language of publication. Literature that is not written in English will be translated. Data extraction, charting, and analysis will be guided by a template developed for this review that focuses on the content, structure, and application of the patient-reported outcome instruments. Any modifications to the extraction template will be detailed in the review, and data will be presented in a descriptive format.
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Affiliation(s)
| | - Caroline Bruun Abild
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Annesofie Lunde Jensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Rothmund M, Meryk A, Rumpold G, Crazzolara R, Sodergren S, Darlington AS, Riedl D. A critical evaluation of the content validity of patient-reported outcome measures assessing health-related quality of life in children with cancer: a systematic review. J Patient Rep Outcomes 2023; 7:2. [PMID: 36656407 PMCID: PMC9851583 DOI: 10.1186/s41687-023-00540-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND With increasing survival rates in pediatric oncology, the need to monitor health-related quality of life (HRQOL) is becoming even more important. However, available patient-reported outcome measures (PROMs) have been criticized. This review aims to systematically evaluate the content validity of PROMs for HRQOL in children with cancer. METHODS In December 2021, a systematic literature search was conducted in PubMed. PROMs were included if they were used to assess HRQOL in children with cancer and had a lower age-limit between 8 and 12 years and an upper age-limit below 21 years. The COSMIN methodology for assessing the content validity of PROMs was applied to grade evidence for relevance, comprehensiveness, and comprehensibility based on quality ratings of development studies (i.e., studies related to concept elicitation and cognitive interviews for newly developed questionnaires) and content validity studies (i.e., qualitative studies in new samples to evaluate the content validity of existing questionnaires). RESULTS Twelve PROMs were included. Due to insufficient patient involvement and/or poor reporting, the quality of most development studies was rated 'doubtful' or 'inadequate'. Few content validity studies were available, and these were mostly 'inadequate'. Following the COSMIN methodology, evidence for content validity was 'low' or 'very low' for almost all PROMs. Only the PROMIS Pediatric Profile had 'moderate' evidence. In general, the results indicated that the PROMs covered relevant issues, while results for comprehensiveness and comprehensibility were partly inconsistent or insufficient. DISCUSSION Following the COSMIN methodology, there is scarce evidence for the content validity of available PROMs for HRQOL in children with cancer. Most instruments were developed before the publication of milestone guidelines and therefore were not able to fulfill all requirements. Efforts are needed to catch up with methodological progress made during the last decade. Further research should adhere to recent guidelines to develop new instruments and to strengthen the evidence for existing PROMs.
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Affiliation(s)
- Maria Rothmund
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinic of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria.
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
| | - Andreas Meryk
- Department of Pediatrics I, Medical University Innsbruck, Innsbruck, Austria
| | - Gerhard Rumpold
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinic of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
| | - Roman Crazzolara
- Department of Pediatrics I, Medical University Innsbruck, Innsbruck, Austria
| | | | | | - David Riedl
- Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, University Clinic of Psychiatry II, Medical University Innsbruck, Innsbruck, Austria
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
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Schuchard J, Kaplan-Kahn EA, Carle AC, Holmes LG, Law K, Miller JS, Parish-Morris J, Forrest CB. Using percentiles in the interpretation of Patient-Reported Outcomes Measurement Information System scores: Guidelines for autism. Autism Res 2022; 15:2336-2345. [PMID: 36259546 DOI: 10.1002/aur.2833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022]
Abstract
The objectives of this study were to (1) demonstrate the application of percentiles to advance the interpretation of patient-reported outcomes and (2) establish autism-specific percentiles for four Patient-Reported Outcomes Measurement Information System (PROMIS) measures. PROMIS measures were completed by parents of autistic children and adolescents ages 5-17 years as part of two studies (n = 939 parents in the first study and n = 406 parents in the second study). Data from the first study were used to develop autism-specific percentiles for PROMIS parent-proxy sleep disturbance, sleep-related impairment, fatigue, and anxiety. Previously established United States general population percentiles were applied to interpret PROMIS scores in both studies. Results of logistic regression models showed that parent-reported material hardship was associated with scoring in the moderate-severe range (defined as ≥75th percentile in the general population) on all four PROMIS measures (odds ratios 1.7-2.2). In the second study, the percentage of children with severe scores (defined as ≥95th percentile in the general population) was 30% for anxiety, 25% for sleep disturbance, and 17% for sleep-related impairment, indicating a high burden of these problems among autistic children. Few children had scores at or above the autism-specific 95th percentile on these measures (3%-4%), indicating that their scores were similar to other autistic children. The general population and condition-specific percentiles provide two complementary reference points to aid interpretation of PROMIS scores, including corresponding severity categories that are comparable across different PROMIS measures.
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Affiliation(s)
- Julia Schuchard
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Elizabeth A Kaplan-Kahn
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Adam C Carle
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio, USA
| | | | - Kiely Law
- Kennedy Krieger Institute, Baltimore, Maryland, USA
| | - Judith S Miller
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julia Parish-Morris
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christopher B Forrest
- Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Patient-reported outcomes are under-utilised in evaluating supportive therapies in paediatric oncology - A systematic review of clinical trial registries. Crit Rev Oncol Hematol 2022; 176:103755. [PMID: 35803454 DOI: 10.1016/j.critrevonc.2022.103755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/24/2022] [Accepted: 07/02/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Children with cancer suffer from numerous symptoms and side-effects, making supportive interventions indispensable to improve their quality of life. The gold standard for evaluating the latter is patient-reported outcome (PRO) assessment. This systematic review investigates the current practice of clinical outcome assessment (COA) in clinical trials on supportive interventions. METHODS ClinicalTrials.gov and EudraCT were searched for trials including children and adolescents (≤21 years) with cancer receiving supportive care registered 2007-2020. The use of different types of COAs was analysed, focusing on PRO assessment and the domains measured with PRO measures (PROMs). Associations with trial characteristics were investigated using univariate and multivariable analyses. RESULTS Of 4789 identified trials, 229 were included. Among them, 44.1 % relied on PROMs, the most commonly used COA. The proportion of trials using PROMs did not significantly differ over time. In the multivariable analysis, intervention type (higher PROM use in behavioural vs. medical interventional trials) and cancer type (higher PROM use in mixed and solid tumour samples vs. haematological samples) were significant predictors of PROM use. The majority of trials using PROMs (59.6 %) measured more than one health domain. 'Physical health' was the most frequently assessed domain (92.6 %). CONCLUSION Less than half of registered clinical trials investigating supportive interventions for children with cancer used PROMs. This result is striking since supportive care explicitly focuses on patients' quality of life, which is best assessed using PROMs. Our systematic review underlines the need to identify barriers for PROM implementation and to improve PRO research in paediatric oncology.
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Hinz A, Zenger M, Schmalbach B, Brähler E, Hofmeister D, Petrowski K. Quality of Life Domains in Breast Cancer Survivors: The Relationship Between Importance and Satisfaction Ratings. Front Psychol 2022; 13:923537. [PMID: 35814141 PMCID: PMC9257209 DOI: 10.3389/fpsyg.2022.923537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/01/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives Quality of life (QoL) has been the focus of increasing interest in oncology. QoL assessment instruments implicitly assume that each QoL domain has the same meaning for each patient. The objective of this study was to analyze the importance of and the satisfaction with QoL domains and to analyze the relationship between the two. Methods A sample of 308 breast cancer survivors was examined twice with a three-month time interval. The women completed the two QoL questionnaires Questions of Life Satisfaction (FLZ-M), which measures participants' satisfaction with eight QoL domains and the subjective importance of those domains to them, and the EORTC QLQ-C30. A sample of 1,143 women from the general population served as controls. Results Compared with the general population sample, the patients were less satisfied with their health and more satisfied with all other QoL domains. The subjective importance of health was lower in the patients' sample (Effect size: d = 0.38). Satisfaction with health and importance of health were slightly positively correlated (r between 0.05 and 0.08). The effect of QoL domain importance on general QoL was small (beta between −0.05 and 0.11), and interaction effects between domain importance and satisfaction on the prediction of global QoL were negligible. Conclusion In addition to satisfaction with QoL dimensions, the subjective importance of these dimensions is relevant for psychooncological research and treatment. Health is not the only relevant QoL domain in breast cancer survivors, other domains such as finances also deserve health care providers' attention.
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Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
- *Correspondence: Andreas Hinz
| | - Markus Zenger
- Department of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Stendal, Germany
- Integrated Research and Treatment Center Adiposity Diseases, University of Leipzig, Leipzig, Germany
| | - Bjarne Schmalbach
- Department of Medical Psychology and Medical Sociology, University of Mainz, Mainz, Germany
| | - Elmar Brähler
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Mainz, Mainz, Germany
| | - Dirk Hofmeister
- Department of Medical Psychology and Medical Sociology, University of Leipzig, Leipzig, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University of Mainz, Mainz, Germany
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Plummer K, McCarthy M, Newall F, Manias E. The influence of contextual factors on children's communication of pain during pediatric Haematopoietic Stem Cell Transplantation: A qualitative case study. J Pediatr Nurs 2022; 64:e119-e129. [PMID: 35086748 DOI: 10.1016/j.pedn.2021.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/08/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The aim of this study was to describe how contextual factors related to the clinical setting of a pediatric HSCT unit influenced children's communication of pain to their health-care providers and parents during hospitalization. DESIGN AND METHODS A qualitative case study design was conducted in two-phases in a tertiary level pediatric HSCT unit. The Social Communication Model of Pain provided the conceptual framework for the study. In phase one participants were parents and phase two participants were health-care providers and children in a pediatric HSCT unit. Parents participated in semi-structured interviews at 30- and 90-days post-transplantation regarding their child's communication of pain. Naturalistic observations of children receiving clinical care were conducted and health-care providers participated in semi-structured interviews. RESULTS Children extensively denied pain to their parents and health-care providers. When children did communicate pain, they were motivated by a need to seek interventions for their pain. Children's willingness to communicate pain was influenced by the physiological impact of HSCT therapy, their previous experiences of pain, their relationship with parents and health-care providers and parents and an environment of fear and uncertainty. CONCLUSIONS There is a pressing need for child-centric approaches to support children to communicate their pain experiences to overcome the limitations imposed by the complexity of their medical treatment and the clinical environment in which they receive healthcare. PRACTICE IMPLICATIONS In the context of HSCT therapy children may not communicate pain until pain is severe, and no longer bearable, or outright deny the presence of pain.
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Affiliation(s)
- Karin Plummer
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Australia; Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, Melbourne Medical School, University of Melbourne, Australia.
| | - Maria McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, Melbourne Medical School, University of Melbourne, Australia.
| | - Fiona Newall
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Australia; Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia; Department of Pediatrics, Melbourne Medical School, University of Melbourne, Australia; Department of Nursing Research, Royal Children's Hospital, Melbourne, Australia.
| | - Elizabeth Manias
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Australia; School of Nursing and Midwifery, Deakin University, Melbourne, Australia; Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia.
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Hinz A, Schulte T, Ernst J, Mehnert-Theuerkauf A. Importance of and Satisfaction with Domains of Health-Related Quality of Life in Cancer Rehabilitation. Cancers (Basel) 2022; 14:cancers14081991. [PMID: 35454898 PMCID: PMC9031483 DOI: 10.3390/cancers14081991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/16/2022] Open
Abstract
Instruments for measuring health-related quality of life (HRQoL) generally do not consider the subjective importance of the dimensions they comprise. The aims of this study were to analyze the subjectively perceived importance of the dimension of HRQoL and to investigate their relationship to the satisfaction ratings with these dimensions. A total of 1108 participants enrolled in a cancer rehabilitation program were surveyed. Patients rated eight dimensions of HRQoL (physical functioning, autonomy, emotional stability, cognitive functioning, social relationships, vitality, absence of pain, and sleep quality), as well as global health in terms of how important those dimensions are to them, and how satisfied they are with them. The dimensions with the highest importance ratings were autonomy and social relationships. There were only small sex differences in the importance ratings, but younger patients rated health as being more important than older patients did. The correlations between the importance ratings and the satisfaction ratings of the specific HRQoL dimensions ranged from −0.06 to 0.40, and the correlation between importance and satisfaction for global health was 0.01. Importance ratings provide relevant information for health care professionals in addition to the HRQoL assessments in the context of cancer rehabilitation.
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Affiliation(s)
- Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany; (J.E.); (A.M.-T.)
- Correspondence: ; Tel.: +49-341-9718820
| | - Thomas Schulte
- Rehabilitation Clinic Bad Oexen, 32549 Bad Oeynhausen, Germany;
| | - Jochen Ernst
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany; (J.E.); (A.M.-T.)
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig, Germany; (J.E.); (A.M.-T.)
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Hirschfeld S, Goodman E, Barkin S, Faustman E, Halfon N, Riley AW. Health Measurement Model-Bringing a Life Course Perspective to Health Measurement: The PRISM Model. Front Pediatr 2021; 9:605932. [PMID: 34178878 PMCID: PMC8222802 DOI: 10.3389/fped.2021.605932] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 04/27/2021] [Indexed: 01/04/2023] Open
Abstract
Health is a multidimensional concept that is challenging to measure, and in the rapidly evolving developmental changes that occur during the first 21 years of human life, requires a dynamic approach to accurately capture the transitions, and overall arc of a complex process of internal and external interactions. We propose an approach that integrates a lifecourse framework with a layered series of assessments, each layer using a many to many mapping, to converge on four fundamental dimensions of health measurement-Potential, Adaptability, Performance, and Experience. The four dimensions can conceptually be mapped onto a plane with each edge of the resulting quadrilateral corresponding to one dimension and each dimensions assessment calibrated against a theoretical ideal. As the plane evolves over time, the sequential measurements will form a volume. We term such a model the Prism Model, and describe conceptually how single domain assessments can be built up to generate the holistic description through the vehicle of a layer of Exemplar Cases. The model is theoretical but future work can use the framework and principles to generate scalable and adaptable applications that can unify and improve the precision of serial measurements that integrate environmental and physiologic influences to improve the science of child health measurement.
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Affiliation(s)
- Steven Hirschfeld
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - Elizabeth Goodman
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, United States
| | - Shari Barkin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Elaine Faustman
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Neal Halfon
- Department of Health Policy and Management, University of California, Los Angeles, Los Angeles, CA, United States
| | - Anne W. Riley
- Department of Population, Family, and Reproductive Health, Johns Hopkins University, Baltimore, MD, United States
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Carlozzi NE, Boileau NR, Hahn EA, Barton SK, Cella D, McCormack MK, Ready RE. Responsiveness to Change Over Time: An Examination of the Neuro-QoL Social Function Measures in Persons with Huntington's Disease. J Huntingtons Dis 2021; 9:83-97. [PMID: 31744014 DOI: 10.3233/jhd-190385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social health is an important concern in persons with Huntington's disease (HD); however, there is little literature examining this construct in this population. OBJECTIVE While cross-sectional data supports the clinical utility of two Neuro-QoL social health measures in persons with HD, data is still needed to establish their longitudinal validity. METHODS Participants (N = 358) completed baseline and at least one follow-up (12- and 24-month) assessment that included the completion of Neuro-QoL Social Health computer adaptive tests (CATs) and short forms (for Ability to Participate in Social Roles and Activities [SRA] and Satisfaction with SRA). Test-retest reliability was examined using intra class correlations, and one-way ANOVAs with Bonferroni post-hoc contrasts were used to determine whether there were group differences among premanifest, early- and late-stage HD participants on the Social health measures. In addition, standardized response means were used to examine longitudinal responsiveness, and mixed or general linear models were used to examine change over time (relative to self-reported change on an associated anchor item about social health and clinician-rated change based on Total Functional Capacity scores from the UHDRS). RESULTS Test-retest reliability of the measures was excellent (ICCs ranged from 0.82 to 0.87 across the different measures) and persons with greater disease burden reported more problems with social health than those at earlier stages in the disease process (all p < 0.0001). Responsiveness was supported for all measures except the Ability to Participate in SRA CAT; participants who had self-reported or clinician-rated declines in health generally had 12- and 24-month declines on the Neuro-QoL measures. CONCLUSIONS Findings indicate that these measures may be useful for studies attempting to assess change in social health over time.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Stacey K Barton
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael K McCormack
- Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, NJ, USA.,Department of Pathology, Rowan School of Medicine, Stratford, NJ, USA
| | - Rebecca E Ready
- Department of Psychological and Brain Sciences, University of Massachusetts, Amherst, MA, USA
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Pierzynski JA, Clegg JL, Sim JA, Forrest CB, Robison LL, Hudson MM, Baker JN, Huang IC. Patient-reported outcomes in paediatric cancer survivorship: a qualitative study to elicit the content from cancer survivors and caregivers. BMJ Open 2020; 10:e032414. [PMID: 32423926 PMCID: PMC7239535 DOI: 10.1136/bmjopen-2019-032414] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Content elucidation for patient-reported outcomes (PROs) in paediatric cancer survivorship is understudied. We aimed to compare differences in the contents of five PRO domains that are important to paediatric cancer survivorship through semistructured interviews with paediatric cancer survivors and caregivers, and identified new concepts that were not covered in the item banks of the Patient-Reported Outcomes Measurement Information System (PROMIS). DESIGN Semistructured interviews to collect qualitative PRO data from survivors and caregivers. SETTING A survivorship care clinic of a comprehensive cancer centre in the USA. PARTICIPANTS The study included 51 survivors (<18 years old) and 35 caregivers who completed interviews between August and December 2016. Content experts coded the transcribed interviews into 'meaningful concepts' per PROMIS item concepts and identified new concepts per a consensus. Frequencies of meaningful concepts used by survivors and caregivers were compared by Wilcoxon rank-sum test. RESULTS For pain and meaning and purpose, 'Hurt a lot' and 'Purpose in life' were top concepts for survivors and caregivers, respectively. For fatigue and psychological stress, 'Needed to sleep during the day'/'Trouble doing schoolwork' and 'Felt worried' were top concepts for survivors, and 'Felt tired' and 'Felt distress'/'Felt stressed' for caregivers. Survivors reported more physically relevant contents (eg, 'Hard to do sport/exercise'; 0.78 vs 0.23, p=0.007) for pain, fatigue and stress, whereas caregivers used more emotionally relevant concepts (eg, 'Too tired to enjoy things I like to do'; 0.31 vs 0.05, p=0.025). Both groups reported positive thoughts for meaning and purpose (eg, 'Have goals for myself'). One (psychological stress, meaning and purpose) to eleven (fatigue) new concepts were generated. CONCLUSIONS Important PRO contents in the form of meaningful concepts raised by survivors and caregivers were different and new concepts emerged. PRO measures are warranted to include survivorship-specific items by accounting for the child's and the caregiver's viewpoints.
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Affiliation(s)
- Jeanne A Pierzynski
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | | | - Jin-Ah Sim
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Christopher B Forrest
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Leslie L Robison
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Melissa M Hudson
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Oncology, St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St Jude Children's Research Hospital, Memphis, Tennessee, USA
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van Deuren S, Boonstra A, van Dulmen‐den Broeder E, Blijlevens N, Knoop H, Loonen J. Severe fatigue after treatment for childhood cancer. Cochrane Database Syst Rev 2020; 3:CD012681. [PMID: 32124971 PMCID: PMC7059965 DOI: 10.1002/14651858.cd012681.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Treatment strategies for childhood cancer are improving, resulting in higher survival rates. However, the consequences of childhood cancer do not end with the successful completion of cancer treatment. Most patients will develop late effects after cessation of treatment. Severe fatigue is seen as a common and debilitating late effect in cancer survivors. Although most research on fatigue has been performed in patients after adult-onset cancer, our review focuses on fatigue after childhood cancer. OBJECTIVES To estimate the prevalence of severe fatigue after treatment for childhood cancer. Secondary objectives are to describe the course of severe fatigue following cancer treatment and to examine risk factors for fatigue, or factors associated with it. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (the Cochrane Library 2019; issue 8 March 2019), MEDLINE/PubMed (from 1945 to 8 March 2019), Embase/Ovid (from 1947 to 8 March 2019), reference lists of included articles and several conference proceedings from 2011 to 2018. SELECTION CRITERIA Observational studies, randomised controlled trials and controlled clinical trials reporting on fatigue in participants after treatment for childhood cancer. Case series and case reports were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risks of bias. If the publication did not present the prevalence of severe fatigue, we contacted study authors for additional information. MAIN RESULTS We included 30 studies (18,682 participants in total). Eighteen studies contributed to the main objective and 22 studies contributed to the secondary objectives. We found substantial differences between studies in cancer diagnosis, cancer treatment, age of participants, questionnaires used to assess fatigue, and sample size. All included studies scored at least one 'Risk of bias' item as unclear or high risk. We identified both clinical and statistical heterogeneity and therefore could not pool results, so we present them descriptively. Eighteen studies (describing 14,573 survivors) reported the prevalence of severe fatigue, which ranged from 0% to 61.7%. In a subgroup of three studies including children aged up to 18 years at fatigue assessment (268 survivors), prevalence rates ranged from 6.7% to 12.5%. In comparison, in a subgroup of 12 studies including participants aged 16 and over (13,952 survivors), prevalence rates ranged from 4.4% to 61.7%. The prevalence of severe fatigue in a subgroup of survivors of haematological cancer was presented in seven studies and ranged from 1.8% to 35.9% (1907 survivors). Prevalence of severe fatigue in brain cancer survivors was presented in two studies (252 survivors) and was 14.6% and 21.1% respectively. One study presented a prevalence for bone cancer survivors of 0.0% (17 survivors). Four studies provided prevalence rates of severe fatigue in control groups of siblings or population-based controls, which ranged from 3.1% to 10.3%. In these four studies, survivors were more often fatigued than controls, but this difference was statistically significant in only two studies. Studies assessing risk and associated factors for fatigue were heterogeneous, and definitions of the factors under study were often inconsistent, with results therefore presented descriptively. They found that depression might be associated with fatigue. In contrast, age at diagnosis and education level did not seem to be associated with fatigue. We were unable to calculate any overall risk estimate for any of the reported risks and associated factors, because we could not conduct meta-analysis. One study provided information about the course of fatigue over time, and found that over the course of 2.7 years, 32 of the 102 participants (31.4%) reported persistent severe fatigue. AUTHORS' CONCLUSIONS It is unclear how many childhood cancer survivors suffer from severe fatigue. This review encountered several difficulties. We found statistical and clinical heterogeneity and great variation in the reporting of possible risk and associated factors. The evidence in this review is therefore weak, and the exact prevalence of severe fatigue after treatment for childhood cancer remains to be determined. This is also the case for the course of severe fatigue following treatment and the strength of the relationship between fatigue and associated and risk factors. Despite these limitations, our review does provide a comprehensive overview of the existing literature about severe fatigue after treatment for childhood cancer.
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Affiliation(s)
- Sylvia van Deuren
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Amilie Boonstra
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nicole Blijlevens
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
| | - Hans Knoop
- Amsterdam UMC, University of AmsterdamDepartment of Medical PsychologyMeibergdreef 9AmsterdamNetherlands1105 AZ
| | - Jacqueline Loonen
- Radboud University Medical CenterDepartment of HematologyGeert Grooteplein Zuid 8NijmegenNetherlands6500 HB
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Landman-Parker J. I feel pain here! Arch Pediatr 2019; 26:252-253. [DOI: 10.1016/j.arcped.2019.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/30/2019] [Indexed: 11/26/2022]
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Carlozzi NE, Boileau NR, Paulsen JS, Perlmutter JS, Lai JS, Hahn EA, McCormack MK, Nance MA, Cella D, Barton SK, Downing NR. End-of-life measures in Huntington disease: HDQLIFE Meaning and Purpose, Concern with Death and Dying, and End of Life Planning. J Neurol 2019; 266:2406-2422. [PMID: 31190171 DOI: 10.1007/s00415-019-09417-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/30/2019] [Accepted: 06/01/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Huntington disease (HD) is a progressive neurodegenerative disorder. There are no HD-specific measures to assess for end-of-life (EOL) preferences that have been validated for clinical use. The purpose of this study is to demonstrate reliability and validity of three HD-specific EOL measures for use in and clinical research settings. METHODS We examined internal reliability, test-retest reliability, floor and ceiling effects, convergent and discriminant validity, known groups' validity, measurement error, and change over time to systematically examine reliability and validity of the HDQLIFE EOL measures. RESULTS Internal consistency and test-retest reliability were > 0.70. The measures were generally free of floor and ceiling effects and measurement error was minimal. Convergent and discriminant validity were consistent with well-known constructs in the field. Hypotheses for known groups validity were partially supported (there were generally group differences for the EOL planning measures, but not for meaning and purpose or concern with death and dying). Measurement error was acceptable and there were minimal changes over time across the EOL measures. CONCLUSIONS Results support the clinical utility of the HDQLIFE EOL measures in persons with HD.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 8109-2800, USA.
| | - Nicholas R Boileau
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Building NCRC B14, Room G216, Ann Arbor, MI, 8109-2800, USA
| | - Jane S Paulsen
- Department of Psychiatry, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.,Department of Neurology, Carver College of Medicine, The University of Iowa, Iowa City, IA, USA.,Department of Psychological and Brain Sciences, The University of Iowa, Iowa City, IA, USA
| | - Joel S Perlmutter
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
| | - Jin-Shei Lai
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Elizabeth A Hahn
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Michael K McCormack
- Department of Pathology, Rowan University-SOM, Stratford, NJ, USA.,Department of Psychiatry, Rutgers University, RWJMS, Piscataway, NJ, USA
| | - Martha A Nance
- Struthers Parkinson's Center, Golden Valley, MN, USA.,Hennepin County Medical Center, Minneapolis, MN, USA
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA.,Northwestern University, Evanston, IL, USA
| | - Stacey K Barton
- Neurology, Radiology, Neuroscience, Physical Therapy, Occupational Therapy, Washington University in St. Louis, St. Louis, MO, USA
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