Reliability of a Novel Hematological Malignancy Specific Patient-Reported Outcome Measure: HM-PRO

BACKGROUND

Patients' experience of symptoms often goes undetected during consultation in an outpatient clinic, and the use of a patient-reported outcome measure (PRO) in such a setting could be useful to aid treatment decision-making. A new PRO measure, the HM-PRO (Hematological Malignancy Specific Patient-Reported Outcome Measure) has been recently developed to evaluate hematological malignancy (HM) patients' health-related quality of life (HRQoL) and their symptom experience in daily clinical practice as well as in research. The objectives of the study were to assess: the internal consistency of the scores for Part A (impact) and its four domains (physical behavior; social well-being; emotional behavior; and eating and drinking habits) and Part B (signs and symptoms); and the test-retest reliability of the individual items of the newly developed hematological malignancy specific composite measure, the HM-PRO.

METHODS

This was a prospective longitudinal observational study where 150 patients with different HMs and different stage of disease (male n = 98 (65.3%); mean age 64.9 ± 14.4 years, range 17.9-89.2 years; mean time since diagnosis 3.7 ± 4.9 years, range 0.04-25.8 years) completed the HM-PRO at baseline (assessment 1 at t1) and after 7 days (assessment 2 at t2). Data analysis was performed using IBMSPSS 23 statistical software.

RESULTS

The Cronbach's alpha estimates of the HM-PRO for both assessment points (t1 and t2) were above 0.9 for Part A, and above 0.8 for Part B, showing strong stability of the measurement. The level of agreement for the reproducibility between the two assessments, using intra-class correlation coefficients (ICC), was very strong with Part A: ICC = 0.93 (95% CI = 0.90-0.95), and Part B: ICC = 0.91 (0.88-0.93). The ICC for the four domains of Part A ranged from 0.85-0.91. The ICC was greater than 0.8 for overall score of Part A and Part B for all the 10 diagnoses, confirming strong reliability.

CONCLUSION

This study clearly indicates that the HM-PRO possesses strong test-retest reliability for both Part A and Part B. The Cronbach's alpha confirmed acceptable internal consistency. The extensive reliability testing described in this study supports the generic nature of the HM-PRO for use in hematological malignancies in both routine clinical practice, to aid treatment decisions, as well as in research.

Quality-of-life issues and symptoms reported by patients living with haematological malignancy: a qualitative study

Background

Our aim was to identify health-related quality-of-life (HRQoL) issues and symptoms in patients with haematological malignancies (HMs) and develop a conceptual framework to reflect the inter-relation between them.

Methods

A total of 129 patients with HMs were interviewed in a UK multicentre qualitative study. All interviews were audio recorded, transcribed and analysed using NVivo-11.

Results

Overall, 34 issues were reported by patients and were grouped into two parts: quality of life (QoL) and symptoms. The most prevalent HRQoL issues were: eating and drinking habits; social life; physical activity; sleep; and psychological well-being. Furthermore, most prevalent disease-related symptoms were: tiredness; feeling unwell; breathlessness; lack of energy; and back pain. The most prevalent treatment side effects were: tiredness; feeling sick; disturbance in sense of taste; and breathlessness.

Conclusions

Both HMs and their treatments have a significant impact on patients' HRQoL, in particular on issues such as job-role change, body image and impact on finances.

Hematological Malignancy Specific Patient-Reported Outcome Measure (HM-PRO): Construct Validity Study

BACKGROUND

Validity is the ability of an instrument to measure what it claims to measure. It means the degree to which the empirical evidence supports the trustworthiness of interpretations based on the calculated scores. The hematological malignancy (HM) specific patient reported outcome measure (HM-PRO), is a newly developed instrument for use in daily clinical practice as well as in research. This study, provides the evidence for construct validity of the HM-PRO, specifically focusing on the convergent and divergent validity compared to the other established instruments used in hematology.

METHODS

This validation study adopted a prospective cross-sectional design where a heterogeneous group of patients diagnosed with different HMs and different disease state were recruited. A total of 905 patients were recruited from seven secondary care hospitals in the UK and online through five patient organizations. Patients were asked to complete the HM-PRO and other cancer specific PRO's, FACT-G and EORTC QLQ C-30. Data analysis was performed using IBM SPSS 23 statistical software.

RESULTS

A total of 486 males (53.7%) and 419 females (46.3%), with a mean age of 64.3 (± 12.4) years and mean time since diagnosis of 4.6 ( ± 5.2) were recruited. The total score of Part A of the HM-PRO highly correlated with the five functional scales of the EORTC QLQ-C30 (Physical = -0.71, Role = -0.72, Emotional = -0.64, Cognitive = -0.58, Social = -0.74-p < 0.001). With respect to correlation with FACT-G, the total score of Part A of the HM-PRO highly correlated with Physical (-0.74), Emotional (-0.57), Functional (-0.66) domains and overall score of FACT-G (-0.74). Similarly, the total score of Part B of the HM-PRO highly correlated with three symptoms scales of EORTC QLQ-C30 (Fatigue scale = -0.74, Nausea and Vomiting = -0.52, Pain = -0.59-p < 0.001) and individual symptom items (Dyspnea = 0.51, Insomnia= 0.43, Appetite loss = 0.54-p < 0.001).

CONCLUSION

The construct validity evidence presented in this research is a testimony to the HM-PRO's ability to measure HRQoL issues which it intends to measure. This is of utmost importance when a PRO is used in routine clinical practice so that the interpretation of the scores or response to an individual item is understood by the clinicians/nurses as intended by the patients.

Development of a Novel Hematological Malignancy Specific Patient-Reported Outcome Measure (HM-PRO): Content Validity

BACKGROUND

The quality of life of patients at all stages of hematological malignancy is greatly affected by the disease and its treatment. There is a wide range of health-related quality of life (HRQoL) issues important to these patients. Any new instrument developed to measure HRQoL of such patients should be content valid, i.e., the items should be comprehensively relevant to the patients and their health condition. The aim of the present study was to examine content validity of a hematological malignancy specific patient reported outcome measure (HM-PRO) developed for use in routine clinical practice.

METHODS

Following literature review and semi-structured interviews, the generated themes and sub-themes were discussed to develop the prototype version of the HM-PRO. A 4-step approach was used for content validation: initial testing and cognitive interviewing; item rating; content validity panel meeting; final field testing and cognitive interviewing. Additional questions related to patients' perception of recall period and preferred sentence structure (i.e., question or statement) of the items were also asked during cognitive interviews.

RESULTS

The content analysis of 129 transcribed semi-structured interviews resulted in the prototype version of the instrument consisting of 58 items grouped into two parts: Part A (impact/HRQoL - 34 items) and Part B (signs and symptoms - 24 items). The initial testing showed intra-class correlation coefficient (ICC) of >0.8 for both Part A and Part B. Item rating for language clarity, completeness, relevance, and response scale by experts and patients showed content validity index for scales average >0.8 for both Part A and Part B, except 0.64 for relevance for Part A by the patient panel. The final testing of the revised version of the instrument showed the Cronbach's alpha value of 0.91 for Part A and 0.76 for Part B, suggesting high internal consistency, and ICC of 0.91 for Part A and 0.76 for Part B. The recall period of "today" for Part-A and "last 3 days" for Part-B were the patients' preferred "recall period." Furthermore, the patients expressed preference to the HM-PRO items as statements.

CONCLUSION

The findings of this study confirm that the HM-PRO possesses a strong content validity, includes all the issues important to patients and is easy to read, understand and respond to spontaneously.

Paper and electronic versions of HM-PRO, a novel patient-reported outcome measure for hematology: an equivalence study

Aim: To determine measurement equivalence of paper and electronic application of the hematological malignancy-patient-reported outcome (HM-PRO), a specific measure for the evaluation of patient-reported outcomes in HMs. Patients & methods: Following International Society of Pharmacoeconomics and Outcomes Research ePRO Good Research Practice Task Force guidelines, a total of 193 adult patients with different HMs were recruited into a multicenter prospective study. The paper and the electronic version of the instrument were completed in the outpatient clinics in a randomized crossover design with a 30 min time interval to minimize the learning effect. Those who completed the paper version first, completed the electronic version after 30 min and vice versa. Instrument version and order effects were tested on total score of the two parts of the HM-PRO (Part A: quality of life and Part B: signs & symptoms) in a two-way ANOVA with patients as random effects. Intraclass correlation coefficients (95% CI) and Spearman's rank correlation coefficients were used to evaluate test–retest reliability and reproducibility. The effects of instrument version and order were tested on total score of the two parts of HM-PRO. Results: The questionnaire version and administration order effects were not significant at the 5% level. There were no interactions found between these two factors for HM-PRO (Part A [quality of life]; p = 0.95); and (part B [signs and symptoms]; p = 0.72]. Spearman's rank correlation coefficients were greater than 0.9, and intraclass correlation coefficients ranged from 0.94 to 0.98; furthermore, the scores were not statistically different between the two versions, showing acceptable reliability indexes. Noteworthy, the difference between the completion time for both paper (mean = 6:38 min) and electronic version (mean = 7:29 min) was not statistically significant (n = 100; p = 0.11). Patients did not report any difficulty in completing the electronic version during cognitive interviews and were able to understand and respond spontaneously. Conclusion: Measurement equivalence has been demonstrated for the paper and electronic application of the HM-PRO.

Computer networking for scientists

Scientific research has always relied on communication for gathering and providing access to data; for exchanging information; for holding discussions, meetings, and seminars; for collaborating with widely dispersed researchers; and for disseminating results. The pace and complexity of modern research, especially collaborations of researchers in different institutions, has dramatically increased scientists' communications needs. Scientists now need immediate access to data and information, to colleagues and collaborators, and to advanced computing and information services. Furthermore, to be really useful, communication facilities must be integrated with the scientist's normal day-to-day working environment. Scientists depend on computing and communications tools and are handicapped without them.

Analysis of the roles of bluetongue virus outer capsid proteins VP2 and VP5 in determination of virus serotype

Analyses of reassortant and parental strains of BTV serotypes 3 and 10, in serum neutralization tests, confirmed the major role of outer capsid protein VP2 in determination of virus serotype and its involvement in serum neutralization. However, a reassortant BTV strain (R70), containing protein VP5 derived from BTV 3 and VP2 derived from BTV 10, cross-neutralized with both parental virus strains (BTV 3 and BTV 10). It is concluded that VP5 also plays some part in serotype determination of these virus isolates, as analyzed by serum-neutralization, but its role may be less significant than that of VP2.

The vector potential of British Culicoides species for bluetongue virus

Two species of British Culicoides, C. nubeculosus and C. impunctatus were found to support bluetongue virus (BTV) multiplication after ingestion of the virus. Both species were infected by membrane feeding and C. nubeculosus also became infected after feeding on viraemic sheep. This species was shown to transfer the virus across a membrane after 8 days incubation at 25 degrees C and could therefore presumably act as a BTV vector. Six other British species of Culicoides supported BTV multiplication after intrathoracic inoculation of the virus.

Variation in the responses of Culicoides variipennis (Diptera, Ceratopogonidae) to oral infection with bluetongue virus

The infection rate of an established colony of Culicoides variipennis to oral infection with bluetongue virus (BTV) type 4 was found to be highly variable and ranged from 0 to 51.6 per cent. This type of wide variation has previously only been reported to occur between individual populations of a species and not between samples from a single population. This must be taken into account when such colonies are used as reference standards for interpretation of field and laboratory data, particularly relating to studies of vector efficiency. Study of the response of individual susceptible C. variipennis to BTV infection demonstrated considerable variation in the level of virus multiplication that individual females are able to support. Virus concentrations varied from less than 1.1 to 5.1 log10 TCID50/fly up to 10 days post infection. 43.6 per cent of females contained less than 2.5 log10 TCID50 virus. It is suggested that such insects would have a mesenteron escape barrier to infection and would be incapable of transmitting BTV. The implications of these results for vector research are discussed.

Isolation of bluetongue and related viruses from Culicoides spp. in the Sudan

Infection of domestic ruminants with bluetongue virus (BTV) is widespread in the Sudan but there are no records of vector species of Culicoides in that country. Therefore, light-trap collections of Culicoides for virus isolation procedures were made in the Khartoum and Um Benein areas of the Sudan during September-October 1982. Two virus isolates were made from pools of unengorged, female Culicoides. An isolate from a pool of C. kingi (schultzei gp) is a member of the Epizootic Haemorrhagic Disease (EHD) serogroup. The other isolate from a pool of C. imicola, a known BTV vector in other parts of Africa, is type-5 BTV. In laboratory experiments, the North American vector of BTV, C. variipennis, supported replication of both Sudanese isolates to a high titre and transmission occurred after 10 days' incubation. This paper records the first isolation in the Sudan of arboviruses from Culicoides, with the identification of a BTV serotype and the presence of a member of the EHD (genus orbivirus, family Reoviridae) serogroup.

Infection of Israeli culicoides with African horse sickness, blue tongue and akabane viruses

Type 9 African horse sickness virus and type 4 bluetongue virus multiplied to a high titre in an Israeli strain of Culicoides puncticollis after intrathoracic inoculation. Akabane virus persisted for at least 10 days in this midge after intrathoracic inoculation but with little evidence of virus multiplication. All 3 viruses failed to multiply in C. puncticollis after ingestion by the oral route and all were inactivated by 4 days post infection. Five other species of Israeli Culicoides supported multiplication of bluetongue virus after intrathoracic inoculation.