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A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning. J Neurol 2017; 265:98-107. [PMID: 29143208 DOI: 10.1007/s00415-017-8677-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/08/2017] [Accepted: 11/09/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Huntington disease is a fatal inherited neurodegenerative disease. Because the end result of Huntington disease is death due to Huntington disease-related causes, there is a need for better understanding and caring for individuals at their end of life. AIM The purpose of this study was to develop a new measure to evaluate end of life planning. DESIGN We conducted qualitative focus groups, solicited expert input, and completed a literature review to develop a 16-item measure to evaluate important aspects of end of life planning for Huntington disease. Item response theory and differential item functioning analyses were utilized to examine the psychometric properties of items; exploratory factor analysis was used to establish meaningful subscales. PARTICIPANTS Participants included 508 individuals with pre-manifest or manifest Huntington disease. RESULTS Item response theory supported the retention of all 16 items on the huntington disease quality of life ("HDQLIFE") end of life planning measure. Exploratory factor analysis supported a four-factor structure: legal planning, financial planning, preferences for hospice care, and preferences for conditions (locations, surroundings, etc.) at the time of death. Although a handful of items exhibited some evidence of differential item functioning, these items were retained due to their relevant clinical content. The final 16-item scale includes an overall total score and four subscale scores that reflect the different end of life planning constructs. CONCLUSIONS The 16-item HDQLIFE end of life planning measure demonstrates adequate psychometric properties; it may be a useful tool for clinicians to clarify patients' preferences about end of life care.
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Carlozzi NE, Downing NR, McCormack MK, Schilling SG, Perlmutter JS, Hahn EA, Lai JS, Frank S, Quaid KA, Paulsen JS, Cella D, Goodnight SM, Miner JA, Nance MA. New measures to capture end of life concerns in Huntington disease: Meaning and Purpose and Concern with Death and Dying from HDQLIFE (a patient-reported outcomes measurement system). Qual Life Res 2016; 25:2403-2415. [PMID: 27393121 DOI: 10.1007/s11136-016-1354-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Huntington disease (HD) is an incurable terminal disease. Thus, end of life (EOL) concerns are common in these individuals. A quantitative measure of EOL concerns in HD would enable a better understanding of how these concerns impact health-related quality of life. Therefore, we developed new measures of EOL for use in HD. METHODS An EOL item pool of 45 items was field tested in 507 individuals with prodromal or manifest HD. Exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted to establish unidimensional item pools. Item response theory (IRT) and differential item functioning analyses were applied to the identified unidimensional item pools to select the final items. RESULTS EFA and CFA supported two separate unidimensional sets of items: Concern with Death and Dying (16 items), and Meaning and Purpose (14 items). IRT and DIF supported the retention of 12 Concern with Death and Dying items and 4 Meaning and Purpose items. IRT data supported the development of both a computer adaptive test (CAT) and a 6-item, static short form for Concern with Death and Dying. CONCLUSION The HDQLIFE Concern with Death and Dying CAT and corresponding 6-item short form, and the 4-item calibrated HDQLIFE Meaning and Purpose scale demonstrate excellent psychometric properties. These new measures have the potential to provide clinically meaningful information about end-of-life preferences and concerns to clinicians and researchers working with individuals with HD. In addition, these measures may also be relevant and useful for other terminal conditions.
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Affiliation(s)
- N E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
| | - N R Downing
- College of Nursing, The University of Iowa, Iowa City, IA, USA
| | - M K McCormack
- Department of Pathology, Rowan University, Piscataway, NJ, USA
| | - S G Schilling
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - J S Perlmutter
- Departments of Neurology, Radiology, and Anatomy and Neurobiology, Washington University School of Medicine, St. Louis, MO, USA
- Program in Occupational Therapy and Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - E A Hahn
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - J S Lai
- Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, Northwestern University, Evanston, IL, USA
- Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S Frank
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K A Quaid
- Department of Medical and Molecular Genetics, Indiana University, Indianapolis, IN, USA
| | - J 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 Psychology, The University of Iowa, Iowa City, IA, USA
| | - D Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
- Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, Northwestern University, Evanston, IL, USA
- Institute for Health Services Research and Policy Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S M Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - J A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - M A Nance
- Hennepin County Medical Center, Minneapolis, MN, USA
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