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Anagnostou A, Yaworsky A, Brova M, Ibrahim N, Kakked S, Spite S, Duluc L, Shields AL, Lee T, Leonard S, Przywara K, Smith A. Evaluation and Modification of a Shared Decision-Making Tool for Peanut Allergy Management. Curr Allergy Asthma Rep 2024:10.1007/s11882-024-01146-w. [PMID: 38639896 DOI: 10.1007/s11882-024-01146-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
PURPOSE OF REVIEW Based on shared decision-making (SDM) principles, a decision aid was previously developed to help patients, their caregivers, and physicians decide which peanut allergy management approach best suits them. This study refined the decision aid's content to better reflect patients' and caregivers' lived experience. RECENT FINDINGS Current standard of care for peanut allergy is avoidance, although peanut oral immunotherapy has been approved by the Food and Drug Administration for use in patients 4-17 years old. An advisory board of allergy therapy experts (n = 3) and patient advocates (n = 3) informed modifications to the decision aid. The revised tool underwent cognitive debriefing interviews (CDIs) among adolescents (12-17 years old) with peanut allergy and caregivers of patients 4-17 years old with peanut allergy to evaluate its relevance, understandability, and usefulness. The 20 CDI participants understood the information presented in the SDM tool and reported it was important and relevant. Some revisions were made based on participant feedback. Results support content validity of the Peanut Allergy Treatment SDM Tool.
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Affiliation(s)
| | - Andrew Yaworsky
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA.
| | - Monica Brova
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Nazifa Ibrahim
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Siddharth Kakked
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Sasha Spite
- California State University San Marcos, San Marcos, CA, USA
| | - Linette Duluc
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Alan L Shields
- Adelphi Values, One Lincoln Street, Suite 2400, Boston, MA, 02111, USA
| | - Tricia Lee
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA, USA
- American College of Allergy, Asthma, and Immunology, Arlington Heights, IL, USA
| | - Stephanie Leonard
- University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Kathy Przywara
- Asthma and Allergy Foundation of America, Arlington, VA, USA
| | - Amelia Smith
- Food Allergy and Anaphylaxis Connection Team, Liberty Twp, OH, USA
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Serrano D, Cella D, Husereau D, King-Kallimanis B, Mendoza T, Salmonson T, Stone A, Zaleta A, Dhanda D, Moshyk A, Liu F, Shields AL, Taylor F, Spite S, Shaw JW, Braverman J. Administering selected subscales of patient-reported outcome questionnaires to reduce patient burden and increase relevance: a position statement on a modular approach. Qual Life Res 2024:10.1007/s11136-023-03587-8. [PMID: 38265747 DOI: 10.1007/s11136-023-03587-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/25/2024]
Abstract
Patient-reported outcome (PRO) questionnaires considered in this paper contain multiple subscales, although not all subscales are equally relevant for administration in all target patient populations. A group of measurement experts, developers, license holders, and other scientific-, regulatory-, payer-, and patient-focused stakeholders participated in a panel to discuss the benefits and challenges of a modular approach, defined here as administering a subset of subscales out of a multi-scaled PRO measure. This paper supports the position that it is acceptable, and sometimes preferable, to take a modular approach when administering PRO questionnaires, provided that certain conditions have been met and a rigorous selection process performed. Based on the experiences and perspectives of all stakeholders, using a modular approach can reduce patient burden and increase the relevancy of the items administered, and thereby improve measurement precision and eliminate wasted data without sacrificing the scientific validity and utility of the instrument. The panelists agreed that implementing a modular approach is not expected to have a meaningful impact on item responses, subscale scores, variability, reliability, validity, and effect size estimates; however, collecting additional evidence for the impact of context may be desirable. It is also important to recognize that adequate rationale and evidence (e.g., of fit-for-purpose status and relevance to patients) and a robust consensus process that includes patient perspectives are required to inform selection of subscales, as in any other measurement circumstance, is expected. We believe that the considerations discussed within (content validity, administration context, and psychometric factors) are relevant across multiple therapeutic areas.
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Affiliation(s)
- Daniel Serrano
- Pharmerit International, Bethesda, MD, USA.
- The Psychometrics Team, Sheridan, WY, USA.
| | | | | | | | - Tito Mendoza
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA
| | | | - Arthur Stone
- University of Southern California, Los Angeles, CA, USA
| | - Alexandra Zaleta
- Independent Consultant, Philadelphia, PA, USA
- CancerCare, New York, NY, USA
| | | | | | - Fei Liu
- Bristol Myers Squibb, Princeton, NJ, USA
| | | | | | - Sasha Spite
- Adelphi Values, Boston, MA, USA
- Private Consultant, Escondido, CA, USA
| | | | - Julia Braverman
- Bristol Myers Squibb, Princeton, NJ, USA
- CSL Behring, King of Prussia, PA, USA
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Peyrin-Biroulet L, Arenson E, Rubin DT, Siegel CA, Lee S, Stephen Laroux F, Zhou W, Finney-Hayward T, Sanchez Gonzalez Y, Shields AL. A Comparative Evaluation of the Measurement Properties of Three Histological Indices of Mucosal Healing in Ulcerative Colitis: Geboes Score, Robarts Histopathology Index and Nancy Index. J Crohns Colitis 2023; 17:1733-1743. [PMID: 37225135 PMCID: PMC10673803 DOI: 10.1093/ecco-jcc/jjad087] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/27/2023] [Accepted: 05/22/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND AIMS To inform their future use in regulated clinical trials to evaluate treatment efficacy hypotheses, the measurement properties of three histological indices, Geboes Score [GS], Robarts Histopathology Index [RHI] and Nancy Index [NI], were evaluated among patients with ulcerative colitis. METHODS Analyses were conducted on data from a Phase 3 clinical trial of adalimumab [M14-033, n = 491] and focused on evaluating the measurement properties of the GS, RHI and NI. Specifically, internal consistency and inter-rater reliability, convergent, discriminant and known-group validity, and sensitivity to change were assessed at Baseline, and at Weeks 8 and 52. RESULTS Internal consistency for the RHI showed lower alpha [α] values at Baseline [α = 0.62] relative to Weeks 8 [α = 0.82] and 52 [α = 0.81]. The inter-rater reliability values of RHI [0.91], NI [0.64] and GS [0.53] were excellent, good and fair, respectively. Regarding validity, Week 52 correlations were moderate to strong between full and partial Mayo scores and Mayo subscale scores and the RHI and GS, and were weak to moderate for the NI. Significant differences between mean scores of all three histological indices were observed across known-groups based on Mayo endoscopy subscores and full Mayo scores at Weeks 8 and 52 [p < 0.001]. CONCLUSIONS The GS, RHI and NI are each capable of producing reliable and valid scores that are sensitive to changes in disease activity over time, in patients with moderately to severely active ulcerative colitis. While all three indices demonstrated relatively acceptable measurement properties, the GS and RHI performed better than the NI.
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Affiliation(s)
| | | | - David T Rubin
- University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL, USA
| | | | - Scott Lee
- University of Washington Medical Center, Seattle, WA, USA
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Shields AL, Taylor F, Lamoureux RE, Padilla B, Severson K, Green T, Boral AL, Akin C, Siebenhaar F, Mar B. Psychometric evaluation of the Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF ©) and determination of a threshold score for moderate symptoms. Orphanet J Rare Dis 2023; 18:69. [PMID: 36964624 PMCID: PMC10039595 DOI: 10.1186/s13023-023-02661-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/11/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND The Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF) (©Blueprint Medicines Corporation), a 12-item daily diary that assesses 11 signs and symptoms of indolent systemic mastocytosis (ISM) and smoldering systemic mastocytosis (SSM), was psychometrically evaluated among patients with ISM. Additionally, thresholds of the ISM-SAF total symptom score (TSS) to distinguish patients with moderate to severe symptoms from those with mild symptoms were evaluated. METHODS The ISM-SAF was completed daily as an electronic diary in a prospective, observational study utilizing an online survey of patients with ISM in the United States. Descriptive statistics, psychometric analyses, and analyses to estimate ISM-SAF TSS clinical cutoff values were conducted. RESULTS A total of 103 patients (81.6% female; mean age = 50.2 [± 12.6]) with a self-reported diagnosis of ISM or SSM (58 of whom also had a medically documented diagnosis) contributed to the analyses. Psychometric analysis supported the trustworthiness of the biweekly TSS, which was reliable (α > 0.8, ICC > 0.9), construct-valid, and able to distinguish among clinically distinct groups as specified by the Patient Global Impression of Severity, 12-item Short-Form Health Survey, and Mastocytosis Quality of Life Questionnaire (p < 0.01). A biweekly ISM-SAF TSS from 21 to 28 begins to distinguish the moderately to severely symptomatic ISM/SSM patients from mildly symptomatic patients. CONCLUSION The biweekly TSS of ISM-SAF was reliable, construct-valid, and able to distinguish among clinically distinct groups. A cut-off value of 28 is a conservative threshold that can be used for screening purposes in future clinical studies to identify patients with at least a moderate severity of ISM symptoms.
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Affiliation(s)
| | | | | | | | | | | | | | - Cem Akin
- University of Michigan, Ann Arbor, MI, USA
| | - Frank Siebenhaar
- Institute of Allergology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Fraunhofer Institute of Translational Medicine and Pharmacology ITMP, Immunology and Allergology IA, Berlin, Germany
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Taher AT, Musallam KM, Viprakasit V, Kattamis A, Lord-Bessen J, Yucel A, Guo S, Pelligra C, Shields AL, Shetty JK, Miteva D, Bueno LM, Cappellini MD. Psychometric evaluation of the NTDT-PRO questionnaire for assessing symptoms in patients with non-transfusion-dependent beta-thalassaemia. BMJ Open 2023; 13:e066683. [PMID: 36948565 PMCID: PMC10040027 DOI: 10.1136/bmjopen-2022-066683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES The non-transfusion-dependent beta-thalassaemia-patient-reported outcome (NTDT-PRO) questionnaire was developed for assessing anaemia-related tiredness/weakness (T/W) and shortness of breath (SoB) among patients with NTDT. Psychometric properties were evaluated using blinded data from the BEYOND trial (NCT03342404). DESIGN Analysis of a phase 2, double-blind, randomised, placebo-controlled trial. SETTING USA, Greece, Italy, Lebanon, Thailand and the UK. PARTICIPANTS Adults (≥18 years) (N=145) with NTDT who had not received a red blood cell transfusion within 8 weeks prior to randomisation, with mean baseline haemoglobin level ≤100 g/L. MEASURES NTDT-PRO daily scores from baseline until week 24, and scores at select time points for the 36-Item Short Form Health Survey version 2 (SF-36v2), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) and Patient Global Impression of Severity (PGI-S). RESULTS Cronbach's alpha at weeks 13-24 was 0.95 and 0.84 for the T/W and SoB domains, respectively, indicating acceptable internal consistency reliability. Among participants self-reporting no change in thalassaemia symptoms via the PGI-S between baseline and week 1, intraclass correlation coefficients were 0.94 and 0.92 for the T/W and SoB domains, respectively, indicating excellent test-retest reliability. In a known-groups validity analysis, least-squares mean T/W and SoB scores at weeks 13-24 were worse in participants with worse scores for the FACIT-F Fatigue Subscale (FS), SF-36v2 vitality or PGI-S. Indicating responsiveness, changes in T/W and SoB domain scores were moderately correlated with changes in haemoglobin levels, and strongly correlated with changes in SF-36v2 vitality, FACIT-F FS, select FACIT-F items and the PGI-S. Improvements in least-squares mean T/W and SoB scores were higher in participants with greater improvements in scores on other PROs measuring similar constructs. CONCLUSIONS The NTDT-PRO demonstrated adequate psychometric properties to assess anaemia-related symptoms in adults with NTDT and can be used to evaluate treatment efficacy in clinical trials.
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Affiliation(s)
- Ali T Taher
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khaled M Musallam
- Thalassemia Center, Burjeel Medical City, Abu Dhabi, UAE
- International Network of Hematology, London, UK
| | - Vip Viprakasit
- Division of Hematology & Oncology, Department of Pediatrics & Siriraj Thalassemia Center, Siriraj Research Hospital, Mahidol University, Bangkok, Thailand
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Aylin Yucel
- Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Shien Guo
- Evidera, Waltham, Massachusetts, USA
| | | | | | - Jeevan K Shetty
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Dimana Miteva
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Luciana Moro Bueno
- Celgene International Sàrl, a Bristol-Myers Squibb Company, Boudry, Switzerland
| | - Maria Domenica Cappellini
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Policlinico Hospital, University of Milan, Milan, Italy
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Gwaltney C, Stokes J, Aiudi A, Mazar I, Ollis S, Love E, Karaa A, Houts CR, Wirth RJ, Shields AL. Psychometric performance of the Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) in a randomized, double-blind, placebo-controlled crossover study in subjects with mitochondrial disease. J Patient Rep Outcomes 2022; 6:129. [PMID: 36562873 PMCID: PMC9789285 DOI: 10.1186/s41687-022-00534-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Primary Mitochondrial Myopathy Symptom Assessment (PMMSA) is a 10-item patient-reported outcome (PRO) measure designed to assess the severity of mitochondrial disease symptoms. Analyses of data from a clinical trial with PMM patients were conducted to evaluate the psychometric properties of the PMMSA and to provide score interpretation guidelines for the measure. METHODS The PMMSA was completed as a daily diary for approximately 14 weeks by individuals in a Phase 2 randomized, placebo-controlled crossover trial evaluating the safety, tolerability, and efficacy of subcutaneous injections of elamipretide in patents with mitochondrial disease. In addition to the PMMSA, performance-based assessments, clinician ratings, and other PRO measures were also completed. Descriptive statistics, psychometric analyses, and score interpretation guidelines were evaluated for the PMMSA. RESULTS Participants (N = 30) had a mean age of 45.3 years, with the majority of the sample being female (n = 25, 83.3%) and non-Hispanic white (n = 29, 96.6%). The 10 PMMSA items assessing a diverse symptomology were not found to form a single underlying construct. However, four items assessing tiredness and muscle weakness were grouped into a "general fatigue" domain score. The PMMSA Fatigue 4 summary score (4FS) demonstrated stable test-retest scores, internal consistency, correlations with the scores produced by reference measures, and the ability to differentiate between different global health levels. Changes on the PMMSA 4FS were also related to change scores produced by the reference measures. PMMSA severity scores were higher for the symptom rated as "most bothersome" by each subject relative to the remaining nine PMMSA items (most bothersome symptom mean = 2.88 vs. 2.18 for other items). Distribution- and anchor-based evaluations suggested that reduction in weekly scores between 0.79 and 2.14 (scale range: 4-16) may represent a meaningful change on the PMMSA 4FS and reduction in weekly scores between 0.03 and 0.61 may represent a responder for each of the remaining six non-fatigue items, scored independently. CONCLUSIONS Upon evaluation of its psychometric properties, the PMMSA, specifically the 4FS domain, demonstrated strong reliability and construct-related validity. The PMMSA can be used to evaluate treatment benefit in clinical trials with individuals with PMM. Trial registration ClinicalTrials.gov identifier, NCT02805790; registered June 20, 2016; https://clinicaltrials.gov/ct2/show/NCT02805790 .
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Affiliation(s)
- Chad Gwaltney
- Gwaltney Consulting Group, 1 Bucks Trail, Westerly, RI USA
| | - Jonathan Stokes
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Anthony Aiudi
- grid.476731.00000 0004 0414 8723Stealth BioTherapeutics Inc., Newton, MA USA
| | - Iyar Mazar
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Sarah Ollis
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Emily Love
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
| | - Amel Karaa
- grid.32224.350000 0004 0386 9924Massachusetts General Hospital, Boston, MA USA
| | | | - R. J. Wirth
- Vector Psychometric Group LLC, Chapel Hill, NC USA
| | - Alan L. Shields
- Adelphi Values (or employed at Adelphi Values at time of conduct of research), Boston, MA USA
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Padilla B, Shields AL, Taylor F, Li X, Mcdonald J, Green T, Boral AL, Lin HM, Akin C, Siebenhaar F, Mar B. Psychometric evaluation of the Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF) in a phase 2 clinical study. Orphanet J Rare Dis 2021; 16:434. [PMID: 34663404 PMCID: PMC8522163 DOI: 10.1186/s13023-021-02037-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background Indolent systemic mastocytosis (ISM) is a rare, clonal mast cell neoplasm characterized by severe, unpredictable symptoms. The Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF) items compose a Total Symptom Score (TSS), Gastrointestinal Symptom Score (GSS), and Skin Symptom Score (SSS) to assess symptom severity. This study evaluated the psychometric performance of ISM-SAF among ISM patients. Methods In PIONEER, a Phase 2 trial evaluating safety and efficacy of selective kinase inhibitor avapritinib in patients with ISM, the 12-item ISM-SAF was administered daily. Psychometric evaluation of score reliability, validity, and clinical interpretation was conducted using the trial data. Results Thirty-eight patients contributed to analyses (78.9% female; mean age = 49). Baseline internal consistency reliability (α) for bi-weekly TSS, GSS, and SSS was 0.86, 0.83, and 0.82, respectively. Test–retest reliability among patients exhibiting no change in Patient Global Impression of Symptom Severity (PGIS) between Baseline and Day 15 exceeded 0.74 universally. Construct validity and known-groups analysis showed moderate to strong ISM-SAF score correlation (r = 0.382–0.881) to supportive patient-reported questionnaires (e.g., PGIS and Mastocytosis Quality of Life Questionnaire) symptom and skin scores, and ability to distinguish among clinically unique groups. Correlations of ISM-SAF and other assessment change scores reflect evidence of score sensitivity. Clinically important difference and response estimates were 7–10 and 19, respectively. Discussion ISM-SAF produced reliable, construct-valid, sensitive scores when administered in PIONEER to patients in the target population. Results of this study support the use of the ISM-SAF as a reliable and valid measure to evaluate disease symptomology in ISM patients. Trial registration ClinicalTrials.gov, NCT03731260. Registered 10 October 2018, https://clinicaltrials.gov/ct2/show/study/NCT03731260. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02037-3.
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Affiliation(s)
- Brad Padilla
- Adelphi Values, 290 Congress Street 6th Floor, Boston, MA, 02210, USA
| | - Alan L Shields
- Adelphi Values, 290 Congress Street 6th Floor, Boston, MA, 02210, USA
| | - Fiona Taylor
- Adelphi Values, 290 Congress Street 6th Floor, Boston, MA, 02210, USA.
| | - Xiaoran Li
- Adelphi Values, 290 Congress Street 6th Floor, Boston, MA, 02210, USA
| | - Jeffrey Mcdonald
- Adelphi Values, 290 Congress Street 6th Floor, Boston, MA, 02210, USA
| | | | | | | | - Cem Akin
- University of Michigan, Ann Arbor, MI, USA
| | - Frank Siebenhaar
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Taylor F, Akin C, Lamoureux RE, Padilla B, Green T, Boral AL, Mazar I, Mar B, Shields AL, Siebenhaar F. Development of symptom-focused outcome measures for advanced and indolent systemic mastocytosis: the AdvSM-SAF and ISM-SAF ©. Orphanet J Rare Dis 2021; 16:414. [PMID: 34627355 PMCID: PMC8501694 DOI: 10.1186/s13023-021-02035-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/19/2021] [Indexed: 12/01/2022] Open
Abstract
Background Advanced systemic mastocytosis (AdvSM), indolent systemic mastocytosis (ISM), and smoldering systemic mastocytosis (SSM) are rare diseases characterized by neoplastic mast cell infiltration of more than one organ. A content-valid patient-reported outcome (PRO) questionnaire that assesses relevant signs and symptoms that are important and understandable to individuals with a condition is critical for assessing new treatment benefit as well as supporting product labeling claims. Notably, no such PRO questionnaire has been developed in accordance with regulatory and scientific guidelines for use in AdvSM, ISM, and SSM patient populations. To fill that gap, this study documents the development and content validity of instruments evaluating signs and symptoms of systemic mastocytosis. Methods A review of peer-reviewed literature, advice meetings with clinical therapeutic area experts, patient concept elicitation interviews, concept selection and questionnaire construction meetings, and patient cognitive debriefing interviews were conducted, and regulatory feedback was incorporated. Results For AdvSM, 26 sign- and symptom-level concepts were identified in literature, 39 by clinicians, and 33 by patients. For ISM/SSM, 38 sign- and symptom-level concepts were identified in the literature, 39 by clinicians, and 57 by patients. Two patient-reported instruments, the Advanced Systemic Mastocytosis Symptom Assessment Form (AdvSM-SAF) and Indolent Systemic Mastocytosis Symptom Assessment Form (ISM-SAF)(©Blueprint Medicines Corporation), were developed based on consolidated findings. Cognitive debriefing interviews with AdvSM and ISM patients showed the AdvSM-SAF and ISM-SAF were understood and interpreted as intended by the majority of patients. Conclusion The AdvSM-SAF and ISM-SAF are content-valid tools measuring symptoms from AdvSM and ISM patients’ perspective. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-02035-5.
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Affiliation(s)
- Fiona Taylor
- Adelphi Values, 225 Franklin St 10th Floor, Boston, MA, 02110, USA.
| | - Cem Akin
- University of Michigan, Ann Arbor, MI, USA
| | | | - Brad Padilla
- Adelphi Values, 225 Franklin St 10th Floor, Boston, MA, 02110, USA
| | | | | | - Iyar Mazar
- Adelphi Values, 225 Franklin St 10th Floor, Boston, MA, 02110, USA.,Sanofi, Cambridge, MA, USA
| | | | - Alan L Shields
- Adelphi Values, 225 Franklin St 10th Floor, Boston, MA, 02110, USA
| | - Frank Siebenhaar
- Dermatological Allergology, Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Taylor F, Li X, Yip C, Padilla B, Mar B, Green T, Oren R, Boral AL, Lin HM, Shields AL, Gotlib J. Psychometric evaluation of the Advanced Systemic Mastocytosis Symptom Assessment Form (AdvSM-SAF). Leuk Res 2021; 108:106606. [PMID: 34004551 DOI: 10.1016/j.leukres.2021.106606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/09/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Advanced Systemic Mastocytosis Symptom Assessment Form (AdvSM-SAF) was developed to evaluate symptoms of advanced systemic mastocytosis (AdvSM). This study aimed to psychometrically evaluate AdvSM-SAF scores and provide score interpretation guidelines. METHODS The 10-item AdvSM-SAF was administered daily (scored as a seven-day average) in EXPLORER, an open-label Phase 1 study in AdvSM. Score distribution, reliability, construct-related validity, sensitivity to change, and interpretation guidelines were evaluated for AdvSM-SAF items, gastrointestinal symptom score (GSS), skin symptom score (SSS), and total symptom score (TSS). RESULTS Thirty-one patients contributed to the analyses. At Baseline, the GSS, SSS, and TSS had adequate internal consistency (α > 0.7) and test-retest reliability (intraclass correlation coefficients >0.7). AdvSM-SAF scores were moderately to strongly correlated with variables as expected, and distinguished among clinically distinct groups. Observed relationships between change scores in the AdvSM-SAF and other assessments reflect evidence that AdvSM-SAF scores change in concert with other assessments designed to measure similar constructs. The magnitude of AdvSM-SAF weekly TSS mean change scores based on different anchor groupings was as expected (improvement > stable > worsening). Candidate clinically meaningful between-group difference estimates (GSS = 2-4, SSS = 2-3, and TSS = 4-7 points) and within-person change estimates (GSS = 6-9, SSS = 1-4, TSS = 9-14) for AdvSM-SAF weekly scores were generated. CONCLUSION The AdvSM-SAF produced reliable, construct-valid, and sensitive scores when administered in the target patient population. These results, along with its strong development history and evidence of content validity, indicate that the AdvSM-SAF is fit for the purpose of measuring treatment benefit in individuals with AdvSM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Jason Gotlib
- Stanford University Medical Center, Palo Alto, CA, USA
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Shields AL, Lamoureux RE, Taylor F, Barth JA, Mulberg AE, Kessler V, Skuban N. FABry Disease Patient-Reported Outcome-GastroIntestinal (FABPRO-GI): A new Fabry disease-specific gastrointestinal outcomes instrument. Qual Life Res 2021; 30:2983-2994. [PMID: 33914257 PMCID: PMC8481178 DOI: 10.1007/s11136-021-02847-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Fabry disease is a rare multisystemic disorder caused by functional deficiency of the lysosomal enzyme alpha-galactosidase A. Gastrointestinal (GI) signs and symptoms are among the earliest clinical manifestations in patients with Fabry disease but are often nonspecific, misdiagnosed, and untreated. No instruments have been developed specifically to assess GI signs and symptoms in Fabry disease. The FABry disease Patient-Reported Outcome-GastroIntestinal (FABPRO-GI) was developed to address this unmet need and is intended for use in clinical trials (24-h FABPRO-GI) and real-world settings (7-day FABPRO-GI). METHODS Findings from a literature review, expert advisory meetings, and patient concept elicitation interviews (CEIs) were summarized into conceptual models. These conceptual models were used to develop preliminary versions of the 24-h and 7-day FABPRO-GI. Cognitive debriefing interviews (CDIs) were conducted with additional patients to assess content validity, including understandability, relevance, and comprehensiveness of the preliminary versions of the 24-h and 7-day FABPRO-GI. RESULTS Literature review (n = 17 articles), expert advisory meetings (n = 5), and patient CEIs (n = 17) identified mostly overlapping Fabry disease-related GI signs and symptoms, including abdominal cramps, bloating, and diarrhea, and informed development of the preliminary 24-h and 7-day FABPRO-GI. CDIs (n = 15) provided evidence of content validity and informed revisions of the 24-h and 7-day FABPRO-GI. CONCLUSION With evidence of content validity, the 24-h and 7-day FABPRO-GI are the first Fabry disease-specific patient-reported outcomes to assess GI signs and symptoms in patients with Fabry disease with potential for use in clinical trials and real-world settings, respectively.
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Affiliation(s)
- Alan L. Shields
- Adelphi Values, 290 Congress Street, 6th Floor, Boston, MA 02210 USA
| | | | - Fiona Taylor
- Adelphi Values, 290 Congress Street, 6th Floor, Boston, MA 02210 USA
| | - Jay A. Barth
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
| | - Andrew E. Mulberg
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
| | - Vivian Kessler
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
| | - Nina Skuban
- grid.427771.00000 0004 0619 7027Amicus Therapeutics, Inc., Cranbury, NJ USA
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Mesa RA, Su Y, Woolfson A, Prchal JT, Turnbull K, Jabbour E, Scherber R, Shields AL, Krohe M, Ojo F, Pompilus F, Cappelleri JC, Harrison C. Development of a symptom assessment in patients with myelofibrosis: qualitative study findings. Health Qual Life Outcomes 2019; 17:61. [PMID: 30975150 PMCID: PMC6460742 DOI: 10.1186/s12955-019-1121-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/14/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The goal of the research reported here was to understand the patient experience of living with myelofibrosis (MF) and establish content validity of the Modified Myeloproliferative Neoplasm Symptom Assessment Diary (MPN-SD). METHODS Qualitative interviews were performed in patients with MF, including both concept elicitation and cognitive debriefing. Patients with MF were asked to spontaneously report on their signs, symptoms, and impacts of MF, as well as their understanding of the MPN-SD content, and use of the tool on an electronic platform. A supplementary literature review and meetings with MF experts were also performed. RESULTS Twenty-three patients with MF participated in qualitative interviews. Signs and symptoms most commonly reported by ruxolitinib-experienced patients (n = 16) were: fatigue and/or tiredness (n = 16, 100%), shortness of breath (n = 11, 69%), pain below the ribs on the left side and/or stomach pain and/or abdominal pain (n = 9, 56%), and enlarged spleen (n = 9, 56%) and for ruxolitinib-naïve patients (n = 7) were: fatigue and/or tiredness (n = 6, 86%), pain below the ribs on the left side (n = 6, 86%), enlarged spleen (n = 4, 57%), full quickly/filling up quickly (n = 4, 57%), night sweats and/or general sweats (n = 4, 57%), and itching (n = 4, 57%). Patients demonstrated that they were able to read, understand, and provide meaningful responses to the MPN-SD. The final version of the MPN-SD includes the 10 most commonly reported concepts from the MF patient interviews. CONCLUSIONS The findings demonstrate the comprehensiveness of the MPN-SD in assessing MF symptoms in both ruxolitinib-experienced and ruxolitinib-naïve patients, while remaining easy for patients to understand and complete.
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Affiliation(s)
- Ruben A Mesa
- University of Texas Health San Antonio Cancer Care Center, 7979 Wurzbach Rd, San Antonio, TX, 78229, USA
| | - Yun Su
- Pfizer Inc., 235 E 42nd St., New York, NY, 10017, USA
| | | | - Josef T Prchal
- University of Utah School of Medicine, 201 Presidents Cir., Salt Lake City, UT, 84112, USA
| | | | - Elias Jabbour
- MD Anderson Cancer Center, 1230 Holcombe Blvd., Houston, TX, 77030, USA
| | - Robyn Scherber
- Mayo Clinic Cancer Center, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Alan L Shields
- Adelphi Values, 290 Congress St. 7th Floor, Boston, MA, 02210, USA
| | - Meaghan Krohe
- Adelphi Values, 290 Congress St. 7th Floor, Boston, MA, 02210, USA.
| | - Funke Ojo
- Adelphi Values, 290 Congress St. 7th Floor, Boston, MA, 02210, USA
| | - Farrah Pompilus
- Adelphi Values, 290 Congress St. 7th Floor, Boston, MA, 02210, USA
| | | | - Claire Harrison
- Guy's and St. Thomas' NHS Foundation Trust, St. Thomas Hospital, Westminster Bridge Rd. Lambeth, London, SE1 7EH, UK
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Turner-Bowker DM, Lamoureux RE, Stokes J, Litcher-Kelly L, Galipeau N, Yaworsky A, Solomon J, Shields AL. Informing a priori Sample Size Estimation in Qualitative Concept Elicitation Interview Studies for Clinical Outcome Assessment Instrument Development. Value Health 2018; 21:839-842. [PMID: 30005756 DOI: 10.1016/j.jval.2017.11.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 10/25/2017] [Accepted: 11/30/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Evidence-based recommendations for the a priori estimation of sample size are needed for qualitative concept elicitation (CE) interview studies in clinical outcome assessment (COA) instrument development. Saturation is described as the point at which no new data is expected to emerge from the conduct of additional qualitative interviews. STUDY DESIGN A retrospective evaluation of 26 CE interview studies conducted with patients between 2006 and 2013 was completed to assess the point at which saturation of concept was achieved in each study. METHODS For each of the 26 interview studies, saturation of symptom concepts was assessed by dividing the sample into quartiles and then comparing the number of responses elicited from the first 25% of participants to the next 25% of participants, from the first 50% of participants to the next 25% of participants, and then from the first 75% of participants to the last 25% of participants. The number of interviews required to achieve saturation was documented for each study and then summarized across studies. RESULTS Findings indicate that 84% of symptom concepts emerged by the 10th interview, 92% emerged by the 15th interview, 97% emerged by the 20th interview, and 99% by the 25th interview. CONCLUSIONS Results provide practical guidance for estimating the number of interviews that may be needed to achieve saturation in a qualitative CE interview study for COA instrument development; address an important gap in qualitative research for the development of COAs in the context of medical product development; and offer useful information for study design and implementation.
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Affiliation(s)
| | | | | | | | | | | | - Jeffrey Solomon
- Independent research and evaluation consultant, Boston, MA, USA
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Kimball AB, Sundaram M, Shields AL, Hudgens S, Okun M, Foley C, Ganguli A. Adalimumab alleviates skin pain in patients with moderate-to-severe hidradenitis suppurativa: Secondary efficacy results from the PIONEER I and PIONEER II randomized controlled trials. J Am Acad Dermatol 2018; 79:1141-1143. [PMID: 29787843 DOI: 10.1016/j.jaad.2018.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
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Taylor F, Reasner DS, Carson RT, Deal LS, Foley C, Iovin R, Lundy JJ, Pompilus F, Shields AL, Silberg DG. Development of a Symptom-Based Patient-Reported Outcome Instrument for Functional Dyspepsia: A Preliminary Conceptual Model and an Evaluation of the Adequacy of Existing Instruments. Patient 2018; 9:409-18. [PMID: 27020447 PMCID: PMC5021747 DOI: 10.1007/s40271-016-0164-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The aim was to document, from the perspective of the empirical literature, the primary symptoms of functional dyspepsia (FD), evaluate the extent to which existing questionnaires target those symptoms, and, finally, identify any missing evidence that would impact the questionnaires' use in regulated clinical trials to assess treatment efficacy claims intended for product labeling. METHODS A literature review was conducted to identify the primary symptoms of FD and existing symptom-based FD patient-reported outcome (PRO) instruments. Following a database search, abstracts were screened and articles were retrieved for review. The primary symptoms of FD were organized into a conceptual model and the PRO instruments were evaluated for conceptual coverage as well as compared against evidentiary requirements presented in the FDA's PRO Guidance for Industry. RESULTS Fifty-six articles and 16 instruments assessing FD symptoms were reviewed. Concepts listed in the Rome III criteria for FD (n = 7), those assessed by existing FD instruments (n = 34), and symptoms reported by patients in published qualitative research (n = 6) were summarized in the FD conceptual model. Except for vomiting, all of the identified symptoms from the published qualitative research reports were also specified in the Rome III criteria. Only three of the 16 instruments, the Dyspepsia Symptom Severity Index (DSSI), Nepean Dyspepsia Index (NDI), and Short-Form Nepean Dyspepsia Index (SF-NDI), measure all seven FD symptoms defined by the Rome III criteria. Among these three, each utilizes a 2-week recall period and 5-point Likert-type scale, and had evidence of patient involvement in development. Despite their coverage, when these instruments were evaluated in light of regulatory expectations, several issues jeopardized their potential qualification for substantiation of a labeling claim. CONCLUSIONS No existing PRO instruments that measured all seven symptoms adhered to the regulatory principles necessary to support product labeling. As such, the development of a new FD symptom PRO instrument is supported.
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Affiliation(s)
| | - David S Reasner
- Study Endpoints, Ironwood Pharmaceuticals, Inc., 301 Binney Street, Cambridge, MA, 02142, USA.
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15
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Jacobson TA, Edelman SV, Galipeau N, Shields AL, Mallya UG, Koren A, Davidson MH. Development and Content Validity of the Statin Experience Assessment Questionnaire (SEAQ)©. Patient 2018; 10:321-334. [PMID: 27981439 PMCID: PMC5422451 DOI: 10.1007/s40271-016-0211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION The National Lipid Association Statin Intolerance (SI) Panel recognized the need for better understanding of the patient SI experience. OBJECTIVE The objective of this research was to develop a patient-reported outcome (PRO) questionnaire to assess a patient's experience with SI. METHODS Questionnaire development was informed via a series of research activities: literature review, concept elicitation, item generation, and content evaluation. Following the literature review and concept elicitation, a draft questionnaire was constructed and subsequently modified based on feedback from therapeutic area experts and patients via cognitive debriefing interviews. RESULTS Muscle-related symptoms were the most commonly reported symptoms associated with SI in the literature review (35 of 41 articles reviewed [85%]) and in semi-structured interviews with experts (n = 5 [100%]) and patients (n = 17 of 20 [85.0%]). Physical and other impacts of SI symptoms on daily activities were also frequently reported. A 17-item draft questionnaire was created, and cognitive debriefing with experts (n = 5) and patients (n = 15) was conducted. Overall, the items, response options, and instructions were comprehensible and positively reviewed; minor changes resulted in the 15-item Statin Experience Assessment Questionnaire (SEAQ)©. Using a 30-day recall period, the SEAQ© assesses the severity and impact of six SI symptoms (muscle ache, muscle pain, muscle cramps, muscle weakness, tiredness, and joint pain) on an 11-point numeric scale. Statin discontinuation and likelihood of discontinuation due to symptoms are assessed and scored on a yes/no and five-point verbal response scale, respectively. CONCLUSION The SEAQ
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Affiliation(s)
- Terry A Jacobson
- Emory University School of Medicine, Lipid Clinic and Cardiovascular Risk Reduction Program, Department of Medicine, 49 Jesse Hill Jr Drive SE, Atlanta, GA, 30303, USA.
| | - Steven V Edelman
- University of California San Diego School of Medicine, Veterans Affairs Medical Center, 3350 La Jolla Village Drive (111G), San Diego, CA, 92161, USA
| | - Nina Galipeau
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Alan L Shields
- Adelphi Values, 290 Congress Street, 7th Floor, Boston, MA, 02210, USA
| | - Usha G Mallya
- Sanofi US, 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Andrew Koren
- Sanofi US, 55 Corporate Drive, Bridgewater, NJ, 08807, USA
| | - Michael H Davidson
- University of Chicago Pritzker School of Medicine, 150 E. Huron, Suite 900, Chicago, IL, 60611, USA
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Taylor F, Higgins S, Carson RT, Eremenco S, Foley C, Lacy BE, Parkman HP, Reasner DS, Shields AL, Tack J, Talley NJ. Development of a Symptom-Focused Patient-Reported Outcome Measure for Functional Dyspepsia: The Functional Dyspepsia Symptom Diary (FDSD). Am J Gastroenterol 2018; 113:39-48. [PMID: 28925989 PMCID: PMC5770596 DOI: 10.1038/ajg.2017.265] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/01/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The Functional Dyspepsia Symptom Diary (FDSD) was developed to address the lack of symptom-focused, patient-reported outcome (PRO) measures designed for use in functional dyspepsia (FD) patients and meeting Food and Drug Administration recommendations for PRO instrument development. METHODS Concept elicitation interviews were conducted with FD participants to identify symptoms important and relevant to FD patients. A preliminary version of the FDSD was constructed, then completed by FD participants on an electronic device in cognitive interviews to evaluate the readability, comprehensibility, relevance, and comprehensiveness of the FDSD, and to preliminarily evaluate its measurement properties. RESULTS During concept elicitation interviews, 45 participants spontaneously reported 19 symptom concepts. Of those, seven symptoms were selected for assessment by the eight-item FDSD. Cognitive interviews with 57 participants confirmed that participants were able to comprehend and provide meaningful responses to the FDSD, and that the handheld electronic FDSD format was suitable for use in the target population. Scores of the FDSD were well-distributed among response options, item discrimination indices suggested that the FDSD items differentiate among patients with varying degrees of FD severity, and inter-item correlations suggested that no items of the FDSD were capturing redundant information. Internal consistency estimates (0.87) and construct-related validity estimates using known-groups methods were within acceptable ranges. CONCLUSIONS The FDSD is a content-valid PRO measure, with preliminary psychometric evidence providing support for the FDSD's items and total score. Further psychometric evaluations are recommended to more fully test the FDSD's score performance and other measurement properties in the target patient population.
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Affiliation(s)
- Fiona Taylor
- Adelphi Values, Patient-Centered Outcomes, Boston, Massachusetts, USA,Adelphi Values, Patient-Centered Outcomes, 290 Congress Street, 7th Floor, Boston, Massachusetts 02210, USA. E-mail:
| | - Sophie Higgins
- Adelphi Values, Patient-Centered Outcomes, Boston, Massachusetts, USA
| | | | | | - Catherine Foley
- Adelphi Values, Patient-Centered Outcomes, Boston, Massachusetts, USA
| | - Brian E Lacy
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Henry P Parkman
- Temple University School of Medicine, Philadelphia, Pennsylvania, USA
| | - David S Reasner
- Ironwood Pharmaceuticals, Inc., Cambridge, Massachusetts, USA
| | - Alan L Shields
- Adelphi Values, Patient-Centered Outcomes, Boston, Massachusetts, USA
| | - Jan Tack
- University of Leuven, Leuven, Belgium
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17
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Banderas B, Skup M, Shields AL, Stokes J, Foley C, Ganguli A. Psychometric evaluation of the Rheumatoid Arthritis Symptom Questionnaire (RASQ) in an observational study. Curr Med Res Opin 2017; 33:2121-2128. [PMID: 28885061 DOI: 10.1080/03007995.2017.1378173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To describe the psychometric performance of the scores produced by the Rheumatoid Arthritis Symptom Questionnaire (RASQ), a new patient-reported outcome (PRO) questionnaire developed to assess the signs and symptoms of rheumatoid arthritis (RA). METHODS Adult subjects with clinically confirmed RA completed a set of questionnaires (including the RASQ) at an initial study visit (Day 1), and then completed the RASQ and the Patient Global Impression of Change (PGI-C) on their own on Day 8. Demographic and health data were summarized using descriptive statistics, and psychometric analyses were conducted, including: acceptability, item and scale distribution, reliability (internal consistency and test-re-test reliability), and construct-related validity (convergent validity and known-groups methods). RESULTS In total, 200 subjects (females = 61.5%; white = 72.0%; and age [mean] = 60.7 years) with RA were recruited across the US and included in the analysis. There were no missing data recorded for the RASQ, and scores were well distributed for both timepoints. The RASQ Total Symptom Score surpassed the threshold (α ≥ 0.70) for internal consistency at Day 1 (α = 0.967) and test-re-test score reliability (intra-class correlation coefficient [ICC] > 0.70) (ICC = 0.960). Convergent validity analyses demonstrated that the RASQ items and Total Symptom Score had high correlations (convergent validity) with other PRO questionnaires. Known-groups methods demonstrated that the RASQ (Total Symptom Score and all single items) can differentiate between clinically distinct groups. CONCLUSIONS The RASQ is capable of producing psychometrically sound scores when administered to adults with RA.
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Banderas B, Skup M, Shields AL, Mazar I, Ganguli A. Development of the Rheumatoid Arthritis Symptom Questionnaire (RASQ): a patient reported outcome scale for measuring symptoms of rheumatoid arthritis. Curr Med Res Opin 2017; 33:1643-1651. [PMID: 28574727 DOI: 10.1080/03007995.2017.1338562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA), a chronic, progressive inflammatory, autoimmune disease, can substantially reduce health-related quality of life (HRQoL) and lead to severe disability and early mortality. Patient-reported outcome (PRO) instruments are used to assess the patient experience of RA symptoms and impacts, and can capture RA treatment effects. To address limitations in existing PRO instruments, this research aimed to establish the content validity of a new instrument, the Rheumatoid Arthritis Symptom Questionnaire (RASQ), to assess the signs and symptoms of RA. METHOD The most important and relevant sign and symptom concepts for RA patients were identified through a targeted review of the published literature, expert opinion, and concept elicitation patient interviews. Cognitive interviews were conducted with patients to test the comprehensibility and comprehensiveness of the RASQ. RESULTS Seven symptoms emerged consistently across the conceptual research: joint pain, joint swelling, joint stiffness, joint tenderness, joint warmth, muscle pain, and tiredness. Draft item content was developed to assess these symptoms, in addition to a single impact item, resulting in three RASQ versions: two utilizing a 7 day recall period (one assessing symptoms at their worst, the other on average) and a third using a 24 hour recall period assessing symptoms at their worst. Cognitive interview results demonstrated patient understanding and ability to use the instrument. CONCLUSIONS Content validity of the RASQ was established in accordance with instrument development guidelines. The RASQ fills a measurement gap by assessing the RA signs and symptoms most important to patients. Research evaluating the RASQ's psychometric properties is underway.
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Kimball AB, Sundaram M, Banderas B, Foley C, Shields AL. Development and initial psychometric evaluation of patient-reported outcome questionnaires to evaluate the symptoms and impact of hidradenitis suppurativa. J DERMATOL TREAT 2017; 29:152-164. [DOI: 10.1080/09546634.2017.1341614] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Armstrong AW, Banderas B, Foley C, Stokes J, Sundaram M, Shields AL. Development and psychometric evaluation of the self-assessment of psoriasis symptoms (SAPS) – clinical trial and the SAPS – real world patient-reported outcomes. J DERMATOL TREAT 2017; 28:505-514. [DOI: 10.1080/09546634.2017.1290206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- April W. Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Catherine Foley
- Adelphi Values USA, Patient-Centered Outcomes, Boston, MA, USA
| | - Jonathan Stokes
- Adelphi Values USA, Patient-Centered Outcomes, Boston, MA, USA
| | - Murali Sundaram
- AbbVie, Health Economics and Outcomes Research, North Chicago, IL, USA
| | - Alan L. Shields
- Adelphi Values USA, Patient-Centered Outcomes, Boston, MA, USA
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Turner-Bowker DM, Hao Y, Foley C, Galipeau N, Mazar I, Krohe M, Globe D, Shields AL. The use of patient-reported outcomes in advanced breast cancer clinical trials: a review of the published literature. Curr Med Res Opin 2016; 32:1709-17. [PMID: 27331272 DOI: 10.1080/03007995.2016.1205005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE As a means to measure quantifiable signs, symptoms, and impacts of a disease or its treatment, patient-reported outcome (PRO) instruments can be applied to numerous settings, including use in drug development to support labeling claims. This research summarizes the use of PROs in trials for 16 commonly used regulatory approved treatments for advanced or metastatic breast cancer. METHODS For each treatment (n = 16), a literature search was conducted in MEDLINE, Embase, and PsycINFO. The primary criterion for selection was the report of studies that used PROs to evaluate treatment benefit and/or toxicity in advanced or metastatic breast cancer. From this, a sub-set of articles for each treatment were selected for full-text review where PRO-related information was extracted and summarized. RESULTS The searches yielded 1727 publications. Following abstract review, 1702 were excluded because they failed to meet criteria, or were duplicates or less relevant for PRO information reported. Thus, 25 articles were reviewed in detail for this evaluation. Eleven PRO instruments were identified from these publications. The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - Core (EORTC QLQ-C30) was utilized the most frequently (n = 13, 52.0%). Most publications reported PROs positioned as secondary endpoints (n = 20, 80.0%); described some of the statistical analyses applied to PRO data (n = 21, 84.0%); and specified PRO results (n = 23, 92.0%). CONCLUSIONS While several of the publications provided some information on how PROs were utilized, many did not describe details for PRO administration, scoring, analyses, and results interpretation. While it is encouraging that PROs are often used in clinical trials for patients with metastatic breast cancer, they are not commonly used to support endpoints that establish the basis for label claims. Because they yield direct insight into the patient experience of a condition, PROs may be used to provide a more comprehensive perspective of the benefits and risks from treatment.
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Affiliation(s)
| | - Yanni Hao
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
| | | | | | | | | | - Denise Globe
- b Novartis Pharmaceuticals Corporation , East Hanover , NJ , USA
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Krohe M, Hao Y, Lamoureux RE, Galipeau N, Globe D, Foley C, Mazar I, Solomon J, Shields AL. Patient-Reported Outcomes in Metastatic Breast Cancer: A Review of Industry-Sponsored Clinical Trials. Breast Cancer (Auckl) 2016; 10:93-102. [PMID: 27441001 PMCID: PMC4946584 DOI: 10.4137/bcbcr.s39385] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 05/01/2016] [Accepted: 05/05/2016] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Patient-reported outcome (PRO) measures serve to capture vital patient information not otherwise obtained by primary study endpoints. This paper examines how PROs are utilized as endpoints in industry-sponsored metastatic breast cancer clinical trials. METHODS A search was conducted in the clinicaltrials.gov web site for trials involving common treatments for metastatic breast cancer. Thirty-eight clinical trials were identified which included a PRO endpoint in the study, and data were extracted and summarized. RESULTS Overall, 17 unique PRO questionnaires and 14 concepts of measurement were identified as secondary or exploratory endpoints. The Functional Assessment of Cancer Therapy-Breast was the most frequently utilized questionnaire, commonly implemented to assess quality of life. The EORTC QLQ-C30 was also frequently used to measure quality of life or pain. CONCLUSION This review shares insights into the role of PROs in trials for metastatic breast cancer from which treatment developers and other stakeholders can enhance successful implementation of the patient voice into future trials.
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Affiliation(s)
| | - Yanni Hao
- Novartis Oncology, East Hanover, NJ, USA
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Shields AL, Hao Y, Krohe M, Yaworsky A, Mazar I, Foley C, Mehmed F, Globe D. Patient-Reported Outcomes in Oncology Drug Labeling in the United States: A Framework for Navigating Early Challenges. Am Health Drug Benefits 2016; 9:188-97. [PMID: 27688832 PMCID: PMC5004817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/18/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Despite an increased use of patient-reported outcomes (PROs) in oncology clinical trials, integrating the patient perspective into drug approval decisions and documentation has been challenging. OBJECTIVES To review important regulatory and measurement terminology, and to provide oncology outcomes researchers and those involved with building oncology programs with tools to plan PRO data collection, particularly in relation to drug efficacy claims for drug labeling in the United States. DISCUSSION When contemplating a PRO measurement strategy for oncology clinical trials, outcomes researchers are challenged in several ways. First, given multiple stakeholders, researchers must communicate with their scientific, commercial, and regulatory colleagues using often misunderstood terms, such as "label," "claim," "end point," "outcome," and "concept." Second, because stakeholders do not always have access to data from early-stage clinical trials and do not contribute to the target drug's profile in early development, researchers are often unable to address the most important question in building a measurement strategy: What do we want to say about our drug? To overcome these challenges, researchers can systematically develop an end point model to facilitate communication among drug development stakeholders using a common language and to link the building blocks of a PRO measurement strategy, including claims, concepts, questionnaires, and end points. We developed a model that characterizes a disease by its proximal signs and/or symptoms and increasingly distal health outcomes to provide researchers potential measurement concepts that can be instrumental in selecting PRO questionnaires for use in studies. CONCLUSION PRO data collected in clinical trials should be used in drug development to evaluate the drug's efficacy; it is encouraging that US regulators are willing to work with drug sponsors to overcome the challenges associated with the development, implementation, and interpretation of PROs. The tools discussed in this article can facilitate the planning process for oncology researchers, as well as assist in communicating with US regulators.
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Affiliation(s)
| | - Yanni Hao
- Director, Health Economics & Outcomes Research, Novartis Pharmaceuticals Oncology, East Hanover, NJ
| | | | | | - Iyar Mazar
- Senior Research Associate, Adelphi Values USA
| | | | - Faisal Mehmed
- Vice President, Clinical Development & Medical Affairs, Novartis Pharmaceuticals Oncology
| | - Denise Globe
- Executive Director and Head of Health Economics & Outcomes Research, Novartis Pharmaceuticals Oncology
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Hao Y, Krohe M, Yaworsky A, L Shields A, Mazar I, Foley C, Globe D. Clinical Trial Patient-reported Outcomes Data: Going Beyond the Label in Oncology. Clin Ther 2016; 38:811-20. [PMID: 27036873 DOI: 10.1016/j.clinthera.2016.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/24/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Patient-reported outcome (PRO) data are increasingly being implemented in oncology clinical trial research to evaluate treatment benefit, such as disease-related symptoms, treatment-related adverse events, and health-related quality of life impacts. However, only a small amount of PRO data collected is used to support labeling claims, leaving a substantial amount of data that could be shared by sponsors to further convey treatment benefit from the patient perspective. METHODS This paper describes how pharmaceutical sponsors can realize the value of PRO data derived from oncology trials with regard to the following stakeholders: payers, health care providers (HCPs), and patient advocacy groups. Further, ideas are presented for integrating PRO data and implementing PRO assessments within oncology, by stakeholder type. Finally, a summary is provided to describe how PRO data can benefit the patient by facilitating better, more symptom-focused care and enhancing treatment decisions. FINDINGS With the goal of motivating further use of PRO assessments in oncology, we present examples of how payers utilize PRO data to inform reimbursement decisions (eg, PRO data inform decisions made by Germany׳s Institute for Quality and Efficiency in Health Care and the United Kingdom׳s National Institute for Health and Care Excellence); how communication of results with patient advocacy groups can lead to a better understanding of what is important to patients; and how HCPs can use PRO instruments to inform patient treatment decisions through real-world application. IMPLICATIONS Integrating PRO data can enhance health care by allowing the patient's voice to carry beyond regulatory decisions and into those made by payers and HCPs, which are crucial to quality care and assessing the value of care. Utilizing PRO assessments and communicating results to key stakeholders in the oncology space can allow sponsors to report treatment benefit and, more importantly, can provide valuable insight into the patient treatment experience.
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Affiliation(s)
- Yanni Hao
- Novartis Pharmaceuticals Oncology, USA, East Hanover, NJ
| | | | | | | | - Iyar Mazar
- Adelphi Values USA, Boston, Massachusetts
| | | | - Denise Globe
- Novartis Pharmaceuticals Oncology, USA, East Hanover, NJ
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Sen R, Shields AL, Atsuda K. Patient Preference for Once-Weekly Dosing in Type 2 Diabetes Mellitus in Japan. J Health Econ Outcomes Res 2016; 4:55-66. [PMID: 37663012 PMCID: PMC10471358 DOI: 10.36469/9826] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Background: Among several factors that impair adherence to available therapies in type 2 diabetes mellitus (T2DM) is the complexity of the dosing regimen. Moreover, the value of a once-weekly (QW) administration of oral medications for T2DM compared to once, twice, or thrice daily (QD, BID, TID) regimens is unclear. This study aims to identify subgroups and patient characteristics correlated with a preference for QW dosing compared to daily dosing using survey-based methods. Methods: This was a cross-sectional online survey study among patients with T2DM in Japan. Patients with T2DM were categorized into one of the three groups: (1) patients on treatment with oral hypoglycemic agent(s) only, (2) patients on combination treatment with oral hypoglycemic agent(s) and insulin, and (3) patients diagnosed with or suspected to have T2DM with no current or past experience with T2DM drug treatment (treatment naïve). Preliminary logistic regressions and classification and regression tree analysis (QW/QD dosing preferences as the dependent variable) were conducted to identify key predictors of dosing preference, followed by an evaluation of frequencies and trends in dosing preferences by the identified factors (subgroups). Results: Current treatment regimen, age, and work status were identified as the major demographic factors that were most predictive of QW preference. While, overall, 55.5% preferred QD and 33.3% preferred QW, the preference toward QW is higher in a specific cohort of patients that is treatment naïve (i.e., patients diagnosed with T2DM and/on diet/exercise therapy with no current or past experience with T2DM drug treatment) than who are on treatment, younger (age ≤64 years old), working full-time than part-time, and/or currently taking 0 or 1 drugs or more than 6 drugs (68.67% versus 30.12%). The most commonly cited reasons for QW preference were (1) "less burdensome because they didn't have to take it every day" (47.8%), (2) "less psychological burden" (14.6%), and (3) "forget to take it less often"(12.5%). Conclusion: Patients with T2DM vary in terms of preference for dosing regimens. Daily dosing was preferred over QW dosing in the overall population, however, preference for QW was higher in younger, full-time working, treatment naïve subjects, who are/or currently taking 0 or 1 drugs or more than 6 drugs.
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Eek D, Krohe M, Mazar I, Horsfield A, Pompilus F, Friebe R, Shields AL. Patient-reported preferences for oral versus intravenous administration for the treatment of cancer: a review of the literature. Patient Prefer Adherence 2016; 10:1609-21. [PMID: 27601886 PMCID: PMC5003561 DOI: 10.2147/ppa.s106629] [Citation(s) in RCA: 128] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE The emergence of various modes of administration for cancer treatment, including oral administration, brings into focus the importance of patient preference for administration. The purpose of this research was to evaluate the administration preferences of cancer patients, specifically between oral and intravenous (IV) treatment, as well as the factors contributing to preference. METHODS A literature search was conducted in OvidSP to identify research in which the preferences of cancer patients for oral or IV treatment have been evaluated. Data were analyzed in two stages: 1) those articles that directly compared preference between modes of administration were tallied to determine explicit preference for oral or IV treatment; and 2) all attributes associated with patient preference were documented. RESULTS Of the 48 abstracts identified as part of the initial OvidSP search, eight articles were selected for full-text review. One article was removed following full-text review, and seven additional articles were identified through a gray literature search, yielding a total of 14 articles for evaluation. In Stage 1, 13 of the 14 articles compared preference, of which eleven articles (84.6%) reported that patients preferred oral treatment over IV, while two (15.4%) stated that cancer patients preferred IV treatment over oral. In Stage 2, the most frequently reported attributes contributing to preference included convenience, ability to receive treatment at home, treatment schedule, and side effects. DISCUSSION Evidence suggests that oncology patients prefer oral treatment to IV. Rationale for preference was due to a number of factors, including convenience, perception of efficacy, and past experience. Further evaluation should be conducted, given the limited data on patient preference in oncology.
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Affiliation(s)
| | - Meaghan Krohe
- Adelphi Values, Boston, MA, USA
- Correspondence: Meaghan Krohe, Adelphi Values, 7th Floor, 290 Congress St, Boston, MA 02210, USA, Tel +1 617 720 0001, Fax +1 617 720 0004, Email
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Stokes J, Evans CJ, Pompilus F, Shields AL, Summers KH. Development of a Questionnaire to Assess the Impact of Chronic Low Back Pain for Use in Regulated Clinical Trials. Patient 2013; 6:291-305. [DOI: 10.1007/s40271-013-0026-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Strober BE, Nyirady J, Mallya UG, Guettner A, Papavassilis C, Gottlieb AB, Elewski BE, Turner-Bowker DM, Shields AL, Gwaltney CJ, Lebwohl M. Item-level psychometric properties for a new patient-reported psoriasis symptom diary. Value Health 2013; 16:1014-1022. [PMID: 24041351 DOI: 10.1016/j.jval.2013.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVES This research evaluated the psychometric properties of a new Psoriasis Symptom Diary, identified diary responder definitions for use in determining whether a patient has experienced clinically meaningful change, and refined diary item content for use in future clinical trials. METHODS The Psoriasis Symptom Diary was administered in a phase 2 clinical trial of AIN457 to US adult outpatients (N = 172) with physician-diagnosed moderate to severe chronic plaque-type psoriasis. Participant compliance with daily diary administration and item score variability, reliability, construct and discriminant validity, sensitivity to change, and interpretation were all evaluated. RESULTS Participants completed 94% of scheduled diary assessments across 12 study weeks. Diary items were generally normally distributed, and no floor or ceiling effects were observed. Item reliability (reproducibility) was acceptable (intraclass correlation coefficients > 0.80), with an exception for one item (skin color). At week 12, items significantly related to criterion measures as predicted (Psoriasis Area and Severity Index r = 0.27-0.57; Investigator's Global Assessment r = 0.25-0.59), with the exception of items that measured skin color and difficulty using hands. Most items generated change scores that were synchronous to changes as measured by the Psoriasis Area and Severity Index, Investigator's Global Assessment, Dermatology Life Quality Index (r > 0.37), as well as the Patient Global Impression of Change. Responders experienced a 2- to 3-point and 3- to 5-point change in item scores for minimal and large improvements, respectively. Four items that did not perform well were dropped from the diary. CONCLUSIONS The 16-item Psoriasis Symptom Diary demonstrated favorable psychometric properties and is a brief, useful tool for measuring patient-based symptoms and the impact of chronic plaque psoriasis.
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Affiliation(s)
- Bruce E Strober
- Department of Dermatology, University of Connecticut, Farmington, CN, USA
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Mesa RA, Gotlib J, Gupta V, Catalano JV, Deininger MW, Shields AL, Miller CB, Silver RT, Talpaz M, Winton EF, Harvey JH, Hare T, Erickson-Viitanen S, Sun W, Sandor V, Levy RS, Kantarjian HM, Verstovsek S. Effect of ruxolitinib therapy on myelofibrosis-related symptoms and other patient-reported outcomes in COMFORT-I: a randomized, double-blind, placebo-controlled trial. J Clin Oncol 2013; 31:1285-92. [PMID: 23423753 DOI: 10.1200/jco.2012.44.4489] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To assess the effects of ruxolitinib on symptom burden and quality of life (QoL) and to evaluate the ability of the modified Myelofibrosis Symptom Assessment Form (MFSAF) v2.0 to measure meaningful changes in myelofibrosis-related symptoms in patients with myelofibrosis. PATIENTS AND METHODS COMFORT-I (Controlled Myelofibrosis Study With Oral JAK Inhibitor Treatment-I) is a double-blind, placebo-controlled phase III study evaluating ruxolitinib in patients with intermediate-2 or high-risk myelofibrosis. Exploratory analyses were conducted on the following patient-reported outcomes (PROs) assessments: modified MFSAF v2.0 (individual symptoms and Total Symptom Score [TSS]), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), Patient Reported Outcomes Measurement Information System (PROMIS) Fatigue Scale, and Patient Global Impression of Change (PGIC). RESULTS Patients receiving ruxolitinib experienced improvements in individual myelofibrosis-related symptoms, although patients receiving placebo experienced worsening (P < .001). The majority (91%) of ruxolitinib-treated patients designated as ≥ 50% TSS responders (≥ 50% TSS improvement) self-reported their condition as either "Much improved" or "Very much improved" on the PGIC. These patients achieved significant improvements in the EORTC QLQ-C30 functional domains and Global Health Status/QoL versus patients receiving placebo, who experienced worsening on these measures (P ≤ .0135). Ruxolitinib-treated patients with a lesser degree of symptom improvement (< 50% TSS responders) also achieved improvements over placebo on these measures. The degree of spleen volume reduction with ruxolitinib correlated with improvements in TSS, PGIC, PROMIS Fatigue Scale, and EORTC Global Health Status/QoL. Ruxolitinib-treated patients who achieved a ≥ 35% reduction in spleen volume experienced the greatest improvements in these PROs. CONCLUSION Ruxolitinib-treated patients achieved clinically meaningful improvements in myelofibrosis-related symptoms and QoL, but patients receiving placebo reported worsening of symptoms and other PROs.
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Affiliation(s)
- Ruben A Mesa
- Division of Hematology-Oncology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA.
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Philp I, Brainin M, Walker MF, Ward AB, Gillard P, Shields AL, Norrving B. Development of a poststroke checklist to standardize follow-up care for stroke survivors. J Stroke Cerebrovasc Dis 2012; 22:e173-80. [PMID: 23265778 DOI: 10.1016/j.jstrokecerebrovasdis.2012.10.016] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 10/24/2012] [Accepted: 10/31/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Long-term care for stroke survivors is fragmented and lacks an evidence-based, easy-to-use tool to identify persistent long-term problems among stroke survivors and streamline referral for treatment. We sought to develop a poststroke checklist (PSC) to help health care professionals identify poststroke problems amenable to treatment and subsequent referral. METHODS An instrument development team, supported by measurement experts, international stroke experts, and poststroke care stakeholders, was created to develop a long-term PSC. A list of long-term poststroke problem areas was generated by an international, multidisciplinary group of stroke experts, the Global Stroke Community Advisory Panel. Using Delphi methods, a consensus was reached on which problem areas on the list were most important and relevant to include in a PSC. The instrument development team concurrently created the actual checklist, which provided example language about how to ask about poststroke problem areas and linked patient responses to a specific referral process. RESULTS Eleven long-term poststroke problem areas were rated highly and consistently among stroke experts participating in the Delphi process (n = 12): secondary prevention, activities of daily living, mobility, spasticity, pain, incontinence, communication, mood, cognition, life after stroke, and relationship with caregiver. These problem areas were included in the long-term PSC. CONCLUSIONS The PSC was developed to be a brief and easy-to-use tool, intended to facilitate a standardized approach for health care providers to identify long-term problems in stroke survivors and to facilitate appropriate referrals for treatment.
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Affiliation(s)
- Ian Philp
- South Warwickshire Foundation National Health Service Trust, Warwick, United Kingdom.
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Mathew TA, Shields AL, Imasheva A, Shin SS, Furin JJ, Mishustin SP, Peremitin GG, Strelis AK, Yanova GV, Greenfield SF. Knowledge, attitudes, and practices of physicians in Tomsk Oblast tuberculosis services regarding alcohol use among tuberculosis patients in Tomsk, Russia. Cult Med Psychiatry 2009; 33:523-37. [PMID: 19768525 PMCID: PMC3042364 DOI: 10.1007/s11013-009-9148-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In recent years, the Russian Federation has seen a dramatic rise in morbidity and mortality from tuberculosis (TB), attributed in part to an increase in alcohol use disorders (AUDs), which are associated with worse TB treatment outcomes. This study describes the knowledge, attitudes and practices of physicians who treat TB patients in Tomsk, Russia. We conducted semistructured interviews with 16 TB physicians and 1 addiction specialist. Interviews were audiorecorded, transcribed, translated and systematically analyzed. We identified four key domains: definitions of alcohol use and abuse and physicians' knowledge, attitudes and practices regarding these problems. Physicians described patients as largely precontemplative and reluctant to seek treatment. Physicians recognized their limited knowledge in diagnosing and treating AUDs but expressed interest in acquiring these skills. Few options are currently available for treatment of AUDs in TB patients in Tomsk. These findings suggest that Tomsk physicians are aware of the need to engage AUDs in TB patients but identify a knowledge gap that restricts their ability to do so. Training TB physicians to use simple screening instruments and deliver evidence-based alcohol interventions improves TB outcomes among patients with co-occurring AUDs.
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Affiliation(s)
- Trini A. Mathew
- Division of Infectious Diseases, University of Mississippi Medical Center, 2500 North State Street, Jackson, Mississippi 39216, United States of America
| | - Alan L. Shields
- Department of Psychology, East Tennessee State University, Box 70649, Johnson City, Tennessee 37614, United States of America
| | - Aizhan Imasheva
- 1230 13th Street, Apt 918, NW, Washington, District of Columbia 20005, United States of America
| | - Sonya S. Shin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, 651 Huntington Avenue, Boston, Massachusetts 02115, United States of America
| | - Jennifer J. Furin
- Division of Social Medicine and Health Inequalities, Brigham and Women's Hospital, 651 Huntington Avenue, Boston, Massachusetts 02115, United States of America
| | - Sergey P. Mishustin
- Tomsk Oblast Tuberculosis Services, R. Luxembourg 17, Tomsk, Tomsk Oblast, 634009, Russian Federation
| | - Gennady G. Peremitin
- Tomsk Oblast Tuberculosis Services, R. Luxembourg 17, Tomsk, Tomsk Oblast, 634009, Russian Federation
| | - Aivar K. Strelis
- Tuberculosis and Pulmonology Department, Siberian State Medical University, Moskovky trakt 2, Tomsk, Tomsk Oblast, 634050, Russian Federation
| | - Galina V. Yanova
- Tomsk Oblast Clinical Tuberculosis Hospital, Ul. Novaya 1, Timiryazevo, Tomsk, Tomsk Oblast, 634510, Russian Federation
| | - Shelly F. Greenfield
- Harvard Medical School, Alcohol and Drug Abuse Treatment Program, McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478, United States of America
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Abstract
The Substance Abuse Subtle Screening Inventory (SASSI) is a 10 scale indirect screening instrument used to detect substance use disorders. The current meta-analytic study described reliability reporting practices across 48 studies involving the SASSI. Reliability generalization methods were then employed to evaluate typical score reliability for the screening measure. Results showed approximately 73% of studies did not report reliability estimates. Analysis of data from the remaining studies revealed adequate reliability for the total scale (alpha = .87) and face valid scales (FVA alpha = .88 and FVOD alpha = .92), but substantially lower reliability estimates for the indirect scales (range of alpha = .23-.65). The study's findings underscore the need for improved reliability reporting for the SASSI and suggest cautious use of the measure, especially its indirect scales, as an indicator of problematic substance use/abuse in clinical settings.
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Affiliation(s)
- Christopher S Miller
- VA Puget Sound Health Care System, Center for Polytrauma Care and Spinal Cord Injury Unit, 1600 South Columbian Way, Seattle, WA 98101, USA.
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Mathew TA, Yanov SA, Mazitov R, Mishustin SP, Strelis AK, Yanova GV, Golubchikova VT, Taran DV, Golubkov A, Shields AL, Greenfield SF, Shin SS. Integration of alcohol use disorders identification and management in the tuberculosis programme in Tomsk Oblast, Russia. Eur J Public Health 2008; 19:16-8. [PMID: 19112073 DOI: 10.1093/eurpub/ckn093] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Alcohol use disorders (AUDs) among tuberculosis (TB) patients are associated with nonadherence and poor treatment outcomes. We developed a multidisciplinary model to manage AUDs among TB patients in Tomsk, Russia. First, we assessed current standards of care through stakeholder meetings and ethnographic work. The Alcohol Use Disorders Identification Test (AUDIT) was incorporated into routine assessment of all patients starting TB treatment. We established treatment algorithms based on AUDIT scores. We then hired specialists and addressed licensing requirements to provide on-site addictions care. Our experience offers a successful model in the management of co-occurring AUDs among patients with chronic medical problems.
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Affiliation(s)
- Trini A Mathew
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216, USA
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Shields AL, Campfield DC, Miller CS, Howell RT, Wallace K, Weiss RD. Score Reliability of Adolescent Alcohol Screening Measures: A Meta-Analytic Inquiry. Journal of Child & Adolescent Substance Abuse 2008. [DOI: 10.1080/15470650802292855] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Alan L. Shields
- a Department of Psychology , East Tennessee State University , Johnson City, TN
- b McLean Hospital, Harvard Medical School , Belmont, MA
- c PRO Consulting , Pittsburgh, PA
| | | | | | | | - Kimberly Wallace
- d Department of Psychology , University of Montana , Missoula, MT
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Gwaltney CJ, Shields AL, Shiffman S. Equivalence of electronic and paper-and-pencil administration of patient-reported outcome measures: a meta-analytic review. Value Health 2008; 11:322-333. [PMID: 18380645 DOI: 10.1111/j.1524-4733.2007.00231.x] [Citation(s) in RCA: 442] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Patient-reported outcomes (PROs; self-report assessments) are increasingly important in evaluating medical care and treatment efficacy. Electronic administration of PROs via computer is becoming widespread. This article reviews the literature addressing whether computer-administered tests are equivalent to their paper-and-pencil forms. METHODS Meta-analysis was used to synthesize 65 studies that directly assessed the equivalence of computer versus paper versions of PROs used in clinical trials. A total of 46 unique studies, evaluating 278 scales, provided sufficient detail to allow quantitative analysis. RESULTS Among 233 direct comparisons, the average mean difference between modes averaged 0.2% of the scale range (e.g., 0.02 points on a 10-point scale), and 93% were within +/-5% of the scale range. Among 207 correlation coefficients between paper and computer instruments (typically intraclass correlation coefficients), the average weighted correlation was 0.90; 94% of correlations were at least 0.75. Because the cross-mode correlation (paper vs. computer) is also a test-retest correlation, with potential variation because of retest, we compared it to the within-mode (paper vs. paper) test-retest correlation. In four comparisons that evaluated both, the average cross-mode paper-to-computer correlation was almost identical to the within-mode correlation for readministration of a paper measure (0.88 vs. 0.91). CONCLUSIONS Extensive evidence indicates that paper- and computer-administered PROs are equivalent.
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Affiliation(s)
- Chad J Gwaltney
- Brown University, Providence, RI, USA, and PRO Consulting, Pittsburgh, PA, USA.
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Abstract
OBJECTIVE To identify indoor tanning patterns with relevance for health screening and prevention efforts. DESIGN We collected data on indoor tanning patterns from January 17, 2006, through April 14, 2006. By cluster analysis, 4 patterns of indoor tanning were identified: special event, spontaneous or mood, mixed, and regular year-round tanning. These 4 types of indoor tanning were compared by demographic, behavioral, and psychosocial variables for clinically significant differences. SETTING Midsized (ie, approximately 12 000 students) southeastern university. PARTICIPANTS A total of 168 women who tanned indoors. MAIN OUTCOME MEASURES Self-reported attitudes, intentions and tanning behaviors, and tanning dependence. RESULTS Event tanners tanned the least, started tanning the latest, and scored lowest on measures of attitudes, social norms, and tanning dependence measures. Regular year-round tanners started the earliest, tanned at the highest levels, and scored the highest on the attitude, social norms, and tanning dependence measures. Spontaneous or mood tanners were similar to event tanners but with a mood component to their tanning. Mixed tanners, as the name implies, exhibited behavior that appeared to be a mixture of the regular and event tanning types. CONCLUSIONS The results of this study emphasize the fact that "one size fits all" does not apply when it comes to indoor tanning. Tanning behavioral types, which can be clinically assessed, can serve as a guide to physicians so that they can tailor their skin cancer prevention messages to be more effective.
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Affiliation(s)
- Joel Hillhouse
- Department of Public Health, PO Box 70674, East Tennessee State University, Johnson City, TN 37614, USA.
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Shields AL, Howell RT, Potter JS, Weiss RD. The Michigan Alcoholism Screening Test and its shortened form: a meta-analytic inquiry into score reliability. Subst Use Misuse 2007; 42:1783-800. [PMID: 17934995 DOI: 10.1080/10826080701212295] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Meta-analytic methods provide a framework around which an inquiry into MAST and SMAST score reliability was completed. Of the 470 measurement opportunities observed between 1971 and 2005, 62 (13.2%) were coupled with accurate reliability information. Weighted reliability estimates centered on .80 suggesting that the MAST and SMAST generally produce scores of similar and adequate reliability for most research purposes. However, the variability of internal consistency estimates shows that at times these tools will not produce reliable scores, particularly among female and nonclinical respondents. Multiple regression equations provide practical guidelines to improve reliability estimates for the future use of these instruments.
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Affiliation(s)
- Alan L Shields
- East Tennessee State University, Johnson City, Tennessee 37614-1702, USA.
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Abstract
The University of Rhode Island Change Assessment Scale (URICA) is a widely used measure of readiness to change. To evaluate the URICA's ability to discriminate among alcohol abusers with and without co-occurring major depression, the authors administered it to 193 outpatients court-referred for alcohol treatment. Estimates of internal consistency suggest that scoring the URICA using its traditional factors, as well as using the newer Readiness to Change index, produced variable yet adequately reliable scores. Further, the URICA detected statistically significant differences in motivation to change an alcohol problem between an alcohol use disorder group (AD; n = 131) and an alcohol use disorder with co-occurring depression group (AD/D; n = 62) with the AD/D group showing greater readiness to change. For the AD/D group, separate URICAs were given for alcohol use and depressed mood. Confirming previous findings, results suggest the URICA may lack sensitivity to discriminate among two simultaneously occurring psychological disorders.
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Affiliation(s)
- Alan L Shields
- Department of Psychology, East Tennessee State University, Johnson City 37614, USA.
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Abstract
The Alcohol Use Disorders Identification Test (AUDIT) was examined by employing confirmatory factor analytic techniques to data from two samples collected 1998-1999: college students (n = 465) and court-referred, substance use treatment outpatients (clinical sample; n = 135). Despite the fact that the AUDIT was originally designed as a three-factor measure (consumption, dependence, and consequences), previous studies have lent support to one- and two-factor models. The results of this study support a two-factor model (alcohol consumption and dependence/consequences) in both samples. As further evidence that the two-factor model is appropriate, a psychometric evaluation suggested that the AUDIT generated reliable scores in both groups when used as either a one- or two-factor measure, but not when three scores are derived in the student sample.
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Affiliation(s)
- Alan L Shields
- Alcohol and Drug Abuse Treatment Program, McLean Hospital, Belmont, MA 02478-9106, USA.
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Hufford MR, Witkiewitz K, Shields AL, Kodya S, Caruso JC. Relapse as a nonlinear dynamic system: application to patients with alcohol use disorders. J Abnorm Psychol 2003; 112:219-27. [PMID: 12784831 DOI: 10.1037/0021-843x.112.2.219] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Understanding the relapse process is one of the most important issues in addictive behaviors research. To date, most studies have taken a linear approach toward predicting relapse based on risk factors. Nonlinear dynamical systems theory can be used to describe processes that are not adequately modeled using a linear approach. In particular, the authors propose that catastrophe theory, a subset of nonlinear dynamical systems theory, can be used to describe the relapse process in addictive behaviors. Two small prospective studies using 6-month follow-ups of patients with alcohol use disorders (inpatient, n = 51; outpatient, n = 43) illustrate how cusp catastrophe theory may be used to predict relapse. Results from these preliminary studies indicate that a cusp catastrophe model has more predictive utility than traditional linear models.
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Hufford MR, Shields AL, Shiffman S, Paty J, Balabanis M. Reactivity to ecological momentary assessment: an example using undergraduate problem drinkers. Psychol Addict Behav 2002; 16:205-11. [PMID: 12236455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
A. A. Stone and S. Shiffman (1994) defined ecological momentary assessment (EMA) as monitoring or sampling strategies that assess phenomena at the moment they occur in natural settings, thus maximizing ecological validity while avoiding retrospective recall. To address the extent to which EMA affects the behaviors and cognitions under observation, the authors examined behavioral and motivational reactivity to EMA among male and female undergraduate problem drinkers (n = 33). Participants completed a 2-week monitoring protocol using palmtop computers as well as pre- and postmonitoring measures of their drinking behavior and motivation for change. The findings suggest that the magnitude of reactivity to EMA is small. Suggestions for future research are presented.
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Hufford MR, Shields AL, Shiffman S, Paty J, Balabanis M. Reactivity to ecological momentary assessment: An example using undergraduate problem drinkers. Psychology of Addictive Behaviors 2002. [DOI: 10.1037/0893-164x.16.3.205] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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