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Atkinson TM, Lensing S, Lee JY, Chang D, Kim SY, Li Y, Lynch KA, Webb A, Holland SM, Lubetkin EI, Goldstone S, Einstein MH, Stier EA, Wiley DJ, Mitsuyasu R, Rosa-Cunha I, Aboulafia DM, Dhanireddy S, Schouten JT, Levine R, Gardner E, Logan J, Dunleavy H, Barroso LF, Bucher G, Korman J, Stearn B, Wilkin TJ, Ellsworth G, Pugliese JC, Arons A, Burkhalter JE, Cella D, Berry-Lawhorn JM, Palefsky JM. Construct validity and responsiveness of a health-related symptom index for persons either treated or monitored for anal high-grade squamous intraepithelial lesions (HSIL): AMC-A01/-A03. Qual Life Res 2023; 32:2293-2304. [PMID: 37020153 PMCID: PMC10330891 DOI: 10.1007/s11136-023-03391-4] [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] [Accepted: 03/04/2023] [Indexed: 04/07/2023]
Abstract
PURPOSE To determine whether treatment of anal high-grade squamous intraepithelial lesions (HSIL), vs active monitoring, is effective in reducing incidence of anal cancer in persons living with HIV, the US National Cancer Institute funded the Phase III ANal Cancer/HSIL Outcomes Research (ANCHOR) clinical trial. As no established patient-reported outcomes (PRO) tool exists for persons with anal HSIL, we sought to estimate the construct validity and responsiveness of the ANCHOR Health-Related Symptom Index (A-HRSI). METHODS The construct validity phase enrolled ANCHOR participants who were within two weeks of randomization to complete A-HRSI and legacy PRO questionnaires at a single time point. The responsiveness phase enrolled a separate cohort of ANCHOR participants who were not yet randomized to complete A-HRSI at three time points: prior to randomization (T1), 14-70 (T2), and 71-112 (T3) days following randomization. RESULTS Confirmatory factor analysis techniques established a three-factor model (i.e., physical symptoms, impact on physical functioning, impact on psychological functioning), with moderate evidence of convergent validity and strong evidence of discriminant validity in the construct validity phase (n = 303). We observed a significant moderate effect for changes in A-HRSI impact on physical functioning (standardized response mean = 0.52) and psychological symptoms (standardized response mean = 0.60) from T2 (n = 86) to T3 (n = 92), providing evidence of responsiveness. CONCLUSION A-HRSI is a brief PRO index that captures health-related symptoms and impacts related to anal HSIL. This instrument may have broad applicability in other contexts assessing individuals with anal HSIL, which may ultimately help improve clinical care and assist providers and patients with medical decision-making.
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Affiliation(s)
- Thomas M Atkinson
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA.
| | - Shelly Lensing
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeannette Y Lee
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Di Chang
- University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Soo Young Kim
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA
| | - Yuelin Li
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA
| | - Kathleen A Lynch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA
- School of Global Public Health, New York University, New York, NY, USA
| | - Andrew Webb
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA
| | - Susan M Holland
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA
| | | | | | | | | | - Dorothy J Wiley
- University of California, Los Angeles School of Nursing, Los Angeles, CA, USA
| | - Ronald Mitsuyasu
- UCLA Center for Clinical AIDS Research and Education, Los Angeles, CA, USA
| | | | | | | | - Jeffrey T Schouten
- Virginia Mason Medical Center, Seattle, WA, USA
- Harborview Medical Center, Seattle, WA, USA
| | | | - Edward Gardner
- Public Health Institute at Denver Health, Denver, CO, USA
| | - Jeffrey Logan
- Public Health Institute at Denver Health, Denver, CO, USA
| | | | - Luis F Barroso
- Atrium Health Wake Forest Baptist, Winston-Salem, NC, USA
| | - Gary Bucher
- Anal Dysplasia Clinic MidWest, Chicago, IL, USA
| | - Jessica Korman
- Metropolitan Gastroenterology Group, Washington, DC, USA
| | | | | | | | - Julia C Pugliese
- ANCHOR Data Management Center of The Emmes Company, LLC, Rockville, MD, USA
| | - Abigail Arons
- ANCHOR Data Management Center of The Emmes Company, LLC, Rockville, MD, USA
| | - Jack E Burkhalter
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 633 Third Ave, New York, NY, 10017, USA
| | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Atkinson TM, Lynch KA, Vera J, Olivares NM, Webb A, Diamond LC, González J, Lubetkin EI, Bucher G, Rosa-Cunha I, Berry-Lawhorn JM, Levine R, Aboulafia D, Schouten J, Holland SM, Cella D, Palefsky JM. Linguistic validation of the Spanish version of the Anal Cancer High-Grade squamous intraepithelial lesions outcomes Research Health-Related Symptom Index (A-HRSI): AMC-A04. J Patient Rep Outcomes 2022; 6:108. [PMID: 36219358 PMCID: PMC9552152 DOI: 10.1186/s41687-022-00515-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The Anal Cancer High-grade squamous intraepithelial lesions (HSIL) Outcomes Research (ANCHOR) Health-Related Symptom Index (A-HRSI) is a 25-item measure that assesses physical symptoms and impacts, and psychological symptoms. To promote generalizability and equity in the capture of these concepts in Spanish-speaking participants, we linguistically validated a Spanish version of A-HRSI. METHODS Following independent forward translation and reconciliation of A-HRSI from English to Spanish, two rounds of cognitive interviews were completed with ANCHOR participants who had been diagnosed with anal HSIL in the prior nine months and preferred delivery of their healthcare in Spanish. Interviews were coded to highlight any items and concepts that were reported as being difficult for any reason by ≥ 3 participants, with such items revised during a research team panel discussion and tested in a second round of interviews if applicable. RESULTS Seventeen participants representing 8 nationalities were enrolled (Round 1 n=10, Round 2 n=7); 7 participants reported not completing high school (41.2%). No difficulties were reported with respect to the theoretical concepts measured by A-HRSI. We made modifications to the Spanish translation of eight items and two response option terms in cases where participants had difficulty understanding a term, experienced problems in discriminating between terms, or preferred the use of an alternative term to represent the concept(s). CONCLUSION The Spanish version of A-HRSI is a linguistically valid tool that can be used to assess physical symptoms, impacts, and psychological symptoms related to anal HSIL. Language is a tremendous barrier to enrolling patients to clinical trials. The anal cancer high-grade squamous intraepithelial lesions (HSIL) outcomes research [ANCHOR] trial is a randomized clinical trial that recently established that the treatment of anal HSIL, versus active monitoring, is effective in reducing incidence of anal cancer in persons living with HIV (PLWH). The ANCHOR Health-Related Symptom Index (A-HRSI) is a 25-item patient-reported outcomes measure that was developed to assess physical symptoms, physical impacts, and psychological symptoms related to anal HSIL. As approximately 10% of ANCHOR participants preferred the delivery of their healthcare in Spanish, the purpose of the present study was to linguistically validate a Spanish version of A-HRSI. Based on feedback from interviews with 17 participants from the ANCHOR trial who had been diagnosed with anal HSIL in the prior nine months and preferred delivery of their healthcare in Spanish, we made modifications to the Spanish translation of eight items and two response option terms in cases where participants had difficulty understanding a term, experienced problems in discriminating between terms, or preferred the use of an alternative term to represent the concept(s). The Spanish version of A-HRSI is a linguistically valid tool that can be used to assess physical symptoms, impacts, and psychological symptoms related to anal HSIL as part of clinical trials or routine care.
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Affiliation(s)
- Thomas M. Atkinson
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Kathleen A. Lynch
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA ,grid.137628.90000 0004 1936 8753New York University, New York, NY USA
| | - Jacqueline Vera
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Nuria Mendoza Olivares
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA ,grid.137628.90000 0004 1936 8753New York University, New York, NY USA
| | - Andrew Webb
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Lisa C. Diamond
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Javier González
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - Erica I. Lubetkin
- grid.254250.40000 0001 2264 7145CUNY School of Medicine, New York, NY USA
| | - Gary Bucher
- Anal Dysplasia Clinic MidWest, Chicago, IL USA
| | | | | | - Rebecca Levine
- grid.240283.f0000 0001 2152 0791Montefiore Medical Center, New York, NY USA
| | - David Aboulafia
- grid.416879.50000 0001 2219 0587Virginia Mason Medical Center, Seattle, WA USA
| | - Jeffrey Schouten
- grid.416879.50000 0001 2219 0587Virginia Mason Medical Center, Seattle, WA USA
| | - Susan M. Holland
- grid.51462.340000 0001 2171 9952Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, 10022 New York, NY USA
| | - David Cella
- grid.16753.360000 0001 2299 3507Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Joel M. Palefsky
- grid.266102.10000 0001 2297 6811University of California-San Francisco, San Francisco, CA USA
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