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Gharzai LA, Mierzwa ML, Peipert JD, Kirtane K, Casper K, Yadav P, Rothrock N, Cella D, Shaunfield S. Monitoring Adverse Effects of Radiation Therapy in Patients With Head and Neck Cancer: The FACT-HN-RAD Patient-Reported Outcome Measure. JAMA Otolaryngol Head Neck Surg 2023; 149:884-890. [PMID: 37589994 PMCID: PMC10436187 DOI: 10.1001/jamaoto.2023.2177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/15/2023] [Indexed: 08/18/2023]
Abstract
Importance Patients undergoing radiation therapy (RT) for head and neck squamous cell carcinoma (HNSCC) experience a range of debilitating adverse effects (AEs). Patient-reported outcome (PRO) measures to quantify these AEs are a necessary and important component of health care; however, currently available PRO options often measure only disease-related symptoms or AEs of non-RT treatments. Objective To develop a brief PRO measure of the most common AEs associated with RT for HNSCC. Design, Setting, and Participants This was a qualitative study that followed the US Food and Drug Administration guidelines to develop a brief measure of patient-reported RT-related AEs (the Functional Assessment of Cancer Therapy-Head and Neck Radiotherapy [FACT-HN-RAD] measure). The study included (1) a literature review of clinical trials; (2) secondary analysis of retrospective concept elicitation interviews (CEIs); (3) electronic surveys of practicing radiation oncologists; (4) mapping of existing items to inform the development of the draft version of the measure; and (5) validation of content and face validity via patient cognitive interviews. Analysis was performed of CEI data and interviews with practicing radiation oncologists. Data analysis was conducted from July 1, 2022, to April 21, 2023. Exposures Surveys and qualitative interviews. Main Outcomes and Measures The most common patient-reported RT-related AEs among patients with HNSCC. Results Of 19 CEI participants, 14 (mean [range] age, 67 [49-86] years; 12 [86%] men and 2 [14%] women) described RT-related AEs and were included in the secondary analysis. Eleven (79%) patients reported difficulty swallowing; 8 (57%), oral pain; 7 (50%), dry mouth; 7 (50%), weight loss; 6 (43%), skin burning; 5 (36%), loss of taste; 5 (36%), voice changes (36%); and 5 (36%), fatigue. Nine radiation oncologists (mean [range] time in practice, 8 [1-42] years; 5 [56%] men and 4 [44%] women) reported the most common AEs: 9 (100%) reported dysgeusia; 7 (78%), xerostomia; 7 (78%), mucositis or oral pain; 8 (89%), dysphagia or odynophagia; 6 (67%), dermatitis; and 3 (33%), fatigue. Together these data informed the development of an 8-item AE-focused measure of pain, dysphagia, xerostomia, dysgeusia, voice changes, dermatitis, fatigue, and weight loss. Cognitive interviews with 10 patients (mean [range] age, 61 [29-84] years; 8 [80%] men and 2 [20%] women) demonstrated strong face validity; all (100%) reported that the measure reflected their experience with RT and stated that the length of the questionnaire was "just right." Conclusions and Relevance The 8-item FACT-HN-RAD measure captures the most common patient- and physician-reported AEs related to RT for HNSCC. This measure offers a means to serially monitor patient-reported treatment-related AEs and recovery over time in both clinical and research settings. Future work will evaluate the psychometric validity of the measure.
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Affiliation(s)
- Laila A. Gharzai
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | | | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Kedar Kirtane
- Department of Medical Oncology, Moffitt Cancer Center, Tampa, Florida
| | - Keith Casper
- Department of Otolaryngology, University of Michigan, Ann Arbor
| | - Poonam Yadav
- Department of Radiation Oncology, Northwestern University, Chicago, Illinois
| | - Nan Rothrock
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - David Cella
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
| | - Sara Shaunfield
- Department of Medical Social Sciences, Northwestern University, Chicago, Illinois
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Hanmer J, Jensen RE, Rothrock N. A reporting checklist for HealthMeasures' patient-reported outcomes: ASCQ-Me, Neuro-QoL, NIH Toolbox, and PROMIS. J Patient Rep Outcomes 2020; 4:21. [PMID: 32215788 PMCID: PMC7096598 DOI: 10.1186/s41687-020-0176-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/24/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND ASCQ-Me®, Neuro-QoL™, NIH Toolbox®, and PROMIS®, which are health-related quality of life measures collectively known as HealthMeasures, have experienced rapid uptake in the scientific community with over 1700 peer-reviewed publications through 2018. Because of their proliferation across multiple research disciplines, there has been significant heterogeneity in the description and reporting of these measures. Here, we provide a publication checklist to promote standardization and comparability across different reports. This checklist can be used across all HealthMeasures systems. Checklist Development: Authors drafted a draft checklist, circulated among the HealthMeasures Steering Committee and PROMIS Health Organization until the members reached consensus. Checklist: The final checklist has 21 entries in 4 categories: measure details, administration, scoring, and reporting. Most entries (11) specify necessary measure-specific details including version number and administration language(s). Administration (4 entries) reminds authors to include details such as use of proxy respondents and the assessment platform. Scoring (3 entries) is necessary to ensure replication and cross-study comparisons. Reporting (3 entries) reminds authors to always report scores on the T-score metric. CONCLUSION Consistent documentation is necessary to ensure transparent and reproducible methods and support the accumulation of evidence across studies. This checklist promotes standardization and completeness in documentation for ASCQ-Me, Neuro-QoL, PROMIS, and NIH Toolbox measures.
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Affiliation(s)
- Janel Hanmer
- Department of Medicine, University of Pittsburgh, 230 McKee Place Suite 600, Pittsburgh, PA 15213 USA
| | - Roxanne E. Jensen
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 609 Medical Center Dr, Rockville, MD 20850 USA
| | - Nan Rothrock
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave, Suite 2100, Chicago, IL 60611 USA
| | - on behalf of the HealthMeasures Team
- Department of Medicine, University of Pittsburgh, 230 McKee Place Suite 600, Pittsburgh, PA 15213 USA
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 609 Medical Center Dr, Rockville, MD 20850 USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 N. Michigan Ave, Suite 2100, Chicago, IL 60611 USA
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Heatwole C, Bode R, Johnson NE, Dekdebrun J, Dilek N, Eichinger K, Hilbert JE, Logigian E, Luebbe E, Martens W, Mcdermott MP, Pandya S, Puwanant A, Rothrock N, Thornton C, Vickrey BG, Victorson D, Moxley RT. Myotonic dystrophy health index: Correlations with clinical tests and patient function. Muscle Nerve 2015; 53:183-90. [PMID: 26044513 DOI: 10.1002/mus.24725] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [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: 09/29/2014] [Revised: 05/21/2015] [Accepted: 05/29/2015] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The Myotonic Dystrophy Health Index (MDHI) is a disease-specific patient-reported outcome measure. Here, we examine the associations between the MDHI and other measures of disease burden in a cohort of individuals with myotonic dystrophy type-1 (DM1). METHODS We conducted a cross-sectional study of 70 patients with DM1. We examined the associations between MDHI total and subscale scores and scores from other clinical tests. Participants completed assessments of strength, myotonia, motor and respiratory function, ambulation, and body composition. Participants also provided blood samples, underwent physician evaluations, and completed other patient-reported outcome measures. RESULTS MDHI total and subscale scores were strongly associated with muscle strength, myotonia, motor function, and other clinical measures. CONCLUSIONS Patient-reported health status, as measured by the MDHI, is associated with alternative measures of clinical health. These results support the use of the MDHI as a valid tool to measure disease burden in DM1 patients.
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Affiliation(s)
- Chad Heatwole
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Rita Bode
- Psychometric Consultant, Chicago, Illinois, USA
| | | | - Jeanne Dekdebrun
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Nuran Dilek
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Katy Eichinger
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - James E Hilbert
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Eric Logigian
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Elizabeth Luebbe
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - William Martens
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Michael P Mcdermott
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA.,The University of Rochester Medical Center, Department of Biostatistics and Computational Biology, Rochester, New York, USA
| | - Shree Pandya
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Araya Puwanant
- The University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nan Rothrock
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles Thornton
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
| | - Barbara G Vickrey
- David Geffen School of Medicine, UCLA Medical Center, Los Angeles, California, USA.,Greater Los Angeles VA HealthCare System, Los Angeles, California, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard T Moxley
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
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Heatwole C, Johnson N, Bode R, Dekdebrun J, Dilek N, Hilbert JE, Luebbe E, Martens W, McDermott MP, Quinn C, Rothrock N, Thornton C, Vickrey BG, Victorson D, Moxley RT. Patient-Reported Impact of Symptoms in Myotonic Dystrophy Type 2 (PRISM-2). Neurology 2015; 85:2136-46. [PMID: 26581301 DOI: 10.1212/wnl.0000000000002225] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 08/24/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the frequency and relative importance of the most life-affecting symptoms in myotonic dystrophy type 2 (DM2) and to identify the factors that have the strongest association with these symptoms. METHODS We conducted a cross-sectional study of adult patients with DM2 from a National Registry of DM2 Patients to assess the prevalence and relative importance of 310 symptoms and 21 symptomatic themes. Participant responses were compared by age categories, sex, educational attainment, employment status, and duration of symptoms. RESULTS The symptomatic themes with the highest prevalence in DM2 were the inability to do activities (94.4%), limitations with mobility or walking (89.2%), hip, thigh, or knee weakness (89.2%), fatigue (89.2%), and myotonia (82.6%). Participants identified the inability to do activities and fatigue as the symptomatic themes that have the greatest overall effect on their lives. Unemployment, a longer duration of symptoms, and less education were associated with a higher average prevalence of all symptomatic themes (p < 0.01). Unemployment, a longer duration of symptoms, sex, and increased age were associated with a higher average effect of all symptomatic themes among patients with DM2 (p < 0.01). CONCLUSIONS The lives of patients with DM2 are affected by a variety of symptoms. These symptoms have different levels of significance and prevalence in this population and vary across DM2 subgroups in different demographic categories.
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Affiliation(s)
- Chad Heatwole
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA.
| | - Nicholas Johnson
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Rita Bode
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Jeanne Dekdebrun
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Nuran Dilek
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - James E Hilbert
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Elizabeth Luebbe
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - William Martens
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Michael P McDermott
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Christine Quinn
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Nan Rothrock
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Charles Thornton
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Barbara G Vickrey
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - David Victorson
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
| | - Richard T Moxley
- From the Departments of Neurology (C.H., J.D., N.D., J.E.H., E.L., W.M., M.P.M., C.T., R.T.M.) and Biostatistics and Computational Biology (M.P.M.), and James P. Wilmot Cancer Institute (C.Q.), University of Rochester Medical Center, Rochester, NY; University of Utah (N.J.), Salt Lake City; Northwestern University Feinberg School of Medicine (R.B., N.R., D.V.), Chicago, IL; David Geffen School of Medicine (B.G.V.), UCLA Medical Center, Los Angeles; and Greater Los Angeles VA HealthCare System (B.G.V.), CA
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Wagner LI, Schink J, Bass M, Patel S, Diaz MV, Rothrock N, Pearman T, Gershon R, Penedo FJ, Rosen S, Cella D. Bringing PROMIS to practice: brief and precise symptom screening in ambulatory cancer care. Cancer 2014; 121:927-34. [PMID: 25376427 DOI: 10.1002/cncr.29104] [Citation(s) in RCA: 160] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/07/2014] [Accepted: 08/11/2014] [Indexed: 11/08/2022]
Abstract
BACKGROUND Supportive oncology practice can be enhanced by the integration of a brief and validated electronic patient-reported outcome assessment into the electronic health record (EHR) and clinical workflow. METHODS Six hundred thirty-six women receiving gynecologic oncology outpatient care received instructions to complete clinical assessments through Epic MyChart, an EHR patient communication portal. Patient Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) were administered to assess fatigue, pain interference, physical function, depression, and anxiety. Checklists identified psychosocial concerns, informational and nutritional needs, and risk factors for inadequate nutrition. Assessment results, including PROMIS T scores with documented severity thresholds, were immediately populated in the EHR. Clinicians were notified of clinically elevated symptoms through EHR messages. EHR integration was designed to provide automated triage to social work providers for psychosocial concerns, to health educators for information, and to dietitians for nutrition-related concerns. RESULTS Four thousand forty-two MyChart messages sent, and 3203 (79%) were reviewed by patients. The assessment was started by 1493 patients (37%), and once they started, 93% (1386 patients) completed the assessment. According to first assessments only, 49.8% of the patients who reviewed the MyChart message completed the assessment. Mean PROMIS CAT T scores indicated a lower level of physical function and elevated anxiety in comparison with the general population. Fatigue, pain, and depression scores were comparable to those of the general population. Impaired physical functioning was the most common basis for clinical alerts and occurred in 4% of the patients. CONCLUSIONS PROMIS CATs were used to measure common cancer symptoms in routine oncology outpatient care. Immediate EHR integration facilitated the use of symptom reporting as the basis for referral to psychosocial and supportive care.
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Affiliation(s)
- Lynne I Wagner
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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Heatwole C, Bode R, Johnson N, Dekdebrun J, Dilek N, Heatwole M, Hilbert JE, Luebbe E, Martens W, Mcdermott MP, Rothrock N, Thornton C, Vickrey BG, Victorson D, Moxley R. Myotonic Dystrophy Health Index: initial evaluation of a disease-specific outcome measure. Muscle Nerve 2014; 49:906-14. [PMID: 24142420 DOI: 10.1002/mus.24097] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 09/23/2013] [Accepted: 10/08/2013] [Indexed: 01/09/2023]
Abstract
INTRODUCTION In preparation for clinical trials we examine the validity, reliability, and patient understanding of the Myotonic Dystrophy Health Index (MDHI). METHODS Initially we partnered with 278 myotonic dystrophy type-1 (DM1) patients and identified the most relevant questions for the MDHI. Next, we used factor analysis, patient interviews, and test-retest reliability assessments to refine and evaluate the instrument. Lastly, we determined the capability of the MDHI to differentiate between known groups of DM1 participants. RESULTS Questions in the final MDHI represent 17 areas of DM1 health. The internal consistency was acceptable in all subscales. The MDHI had a high test-retest reliability (ICC = 0.95) and differentiated between DM1 patient groups with different disease severities. CONCLUSIONS Initial evaluation of the MDHI provides evidence that it is valid and reliable as an outcome measure for assessing patient-reported health. These results suggest that important aspects of DM1 health may be measured effectively using the MDHI.
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Affiliation(s)
- Chad Heatwole
- The University of Rochester Medical Center, Department of Neurology, 601 Elmwood Avenue, Box 673, Rochester, New York, 14642, USA
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Yount SE, Rothrock N, Bass M, Beaumont JL, Pach D, Lad T, Patel J, Corona M, Weiland R, Del Ciello K, Cella D. A randomized trial of weekly symptom telemonitoring in advanced lung cancer. J Pain Symptom Manage 2014; 47:973-89. [PMID: 24210705 PMCID: PMC4013267 DOI: 10.1016/j.jpainsymman.2013.07.013] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [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: 03/22/2013] [Revised: 07/19/2013] [Accepted: 07/23/2013] [Indexed: 12/17/2022]
Abstract
CONTEXT Lung cancer patients experience multiple, simultaneous symptoms related to their disease and treatment that impair functioning and health-related quality of life (HRQL). Computer technology can reduce barriers to nonsystematic, infrequent symptom assessment and potentially contribute to improved patient care. OBJECTIVES To evaluate the efficacy of technology-based symptom monitoring and reporting in reducing symptom burden in patients with advanced lung cancer. METHODS This was a prospective, multisite, randomized controlled trial. Two hundred fifty-three patients were enrolled at three sites and randomized to monitoring and reporting (MR) or monitoring alone (MA). Patients completed questionnaires at baseline, 3, 6, 9, and 12 weeks and symptom surveys via interactive voice response weekly for 12 weeks. MR patients' clinically significant symptom scores generated an e-mail alert to the site nurse for management. The primary endpoint was overall symptom burden; secondary endpoints included HRQL, treatment satisfaction, symptom management barriers, and self-efficacy. RESULTS This randomized controlled trial failed to demonstrate efficacy of symptom monitoring and reporting in reducing symptom burden compared with monitoring alone in lung cancer. HRQL declined over 12 weeks in both groups (P < 0.006 to P < 0.025); at week 12, treatment satisfaction was higher in MA than MR patients (P < 0.012, P < 0.027). Adherence to weekly calls was good (82%) and patient satisfaction was high. CONCLUSION Feasibility of using a technology-based system for systematic symptom monitoring in advanced lung cancer patients was demonstrated. Future research should focus on identifying patients most likely to benefit and other patient, provider, and health system factors likely to contribute to the system's success.
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Affiliation(s)
| | | | | | | | - Deborah Pach
- Rush University Medical Center, Chicago, Illinois, USA
| | - Thomas Lad
- John H. Stroger Jr. Hospital of Cook County, Chicago, Illinois, USA
| | - Jyoti Patel
- Northwestern Medical Faculty Foundation, Chicago, Illinois, USA
| | | | | | | | - David Cella
- Northwestern University, Chicago, Illinois, USA
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Abstract
Patient-reported outcomes (PRO) are questionnaire measures of patients’ symptoms, functioning, and health-related quality of life. They are designed to provide important clinical information that generally cannot be captured with objective medical testing. In 2004, the National Institutes of Health launched a research initiative to improve the clinical research enterprise by developing state-of-the-art PROs. The NIH Patient-Reported Outcomes Measurement System (PROMIS) and Assessment Center are the products of that initiative. Adult, pediatric, and parent-proxy item banks have been developed by using contemporary psychometric methods, yielding rapid, accurate measurements. PROMIS currently provides tools for assessing physical, mental, and social health using short-form and computer-adaptive testing methods. The PROMIS tools are being adopted for use in clinical trials and translational research. They are also being introduced in clinical medicine to assess a broad range of disease outcomes. Recent legislative developments in the United States support greater efforts to include patients’ reports of health experience in order to evaluate treatment outcomes, engage in shared decision-making, and prioritize the focus of treatment. PROs have garnered increased attention by the Food and Drug Administration (FDA) for evaluating drugs and medical devices. Recent calls for comparative effectiveness research favor inclusion of PROs. PROs could also potentially improve quality of care and disease outcomes, provide patient-centered assessment for comparative effectiveness research, and enable a common metric for tracking outcomes across providers and medical systems.
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Hays RD, Spritzer KL, Amtmann D, Lai JS, Dewitt EM, Rothrock N, Dewalt DA, Riley WT, Fries JF, Krishnan E. Upper-extremity and mobility subdomains from the Patient-Reported Outcomes Measurement Information System (PROMIS) adult physical functioning item bank. Arch Phys Med Rehabil 2013; 94:2291-6. [PMID: 23751290 DOI: 10.1016/j.apmr.2013.05.014] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2013] [Revised: 05/15/2013] [Accepted: 05/18/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To create upper-extremity and mobility subdomain scores from the Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning adult item bank. DESIGN Expert reviews were used to identify upper-extremity and mobility items from the PROMIS item bank. Psychometric analyses were conducted to assess empirical support for scoring upper-extremity and mobility subdomains. SETTING Data were collected from the U.S. general population and multiple disease groups via self-administered surveys. PARTICIPANTS The sample (N=21,773) included 21,133 English-speaking adults who participated in the PROMIS wave 1 data collection and 640 Spanish-speaking Latino adults recruited separately. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES We used English- and Spanish-language data and existing PROMIS item parameters for the physical functioning item bank to estimate upper-extremity and mobility scores. In addition, we fit graded response models to calibrate the upper-extremity items and mobility items separately, compare separate to combined calibrations, and produce subdomain scores. RESULTS After eliminating items because of local dependency, 16 items remained to assess upper extremity and 17 items to assess mobility. The estimated correlation between upper extremity and mobility was .59 using existing PROMIS physical functioning item parameters (r=.60 using parameters calibrated separately for upper-extremity and mobility items). CONCLUSIONS Upper-extremity and mobility subdomains shared about 35% of the variance in common, and produced comparable scores whether calibrated separately or together. The identification of the subset of items tapping these 2 aspects of physical functioning and scored using the existing PROMIS parameters provides the option of scoring these subdomains in addition to the overall physical functioning score.
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Affiliation(s)
- Ron D Hays
- UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine, Los Angeles, CA; RAND, Santa Monica, CA.
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Templin TN, Hays RD, Gershon RC, Rothrock N, Jones RN, Teresi JA, Stewart A, Weech-Maldonado R, Wallace S. Introduction to patient-reported outcome item banks: issues in minority aging research. Expert Rev Pharmacoecon Outcomes Res 2013; 13:183-6. [PMID: 23570428 PMCID: PMC4004066 DOI: 10.1586/erp.13.10] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pre-Conference Workshop in conjunction with the Annual Meeting of the Geriatrics Society of America San Diego Convention Center, San Diego, CA, USA, 14 November 2012 In 2004, the NIH awarded contracts to initiate the development of high-quality psychological and neuropsychological outcome measures for the improved assessment of health-related outcomes. The workshop introduced these measurement development initiatives, the measures created and the NIH-supported resource (Assessment Center) for internet or tablet-based test administration and scoring. Presentations covered item response theory and assessment of test bias, construction of item banks and computerized adaptive testing, and the different ways in which qualitative analyses contribute to the definition of construct domains and the refinement of outcome constructs. The panel discussion included questions about representativeness of samples and the assessment of cultural bias.
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Affiliation(s)
- Thomas N Templin
- Thomas N Templin, Office of Health Research, College of Nursing, Wayne State University, 5557 Cass Avenue, Room 321, Detroit, MI, 48083, USA
| | - Ron D Hays
- Ron D Hays, Department of Medicine, 911 Broxton Avenue, Room 110, University of California Los Angeles, Los Angeles, CA, 90024-2801, USA, RAND, Santa Monica, CA., ;
| | - Richard C Gershon
- Richard C Gershon, Medical Social Sciences, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA,
| | - Nan Rothrock
- Nan Rothrock, Medical Social Sciences, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, USA,
| | - Richard N Jones
- Richard N Jones, Institute for Aging Research, Hebrew Senior Life, 1200 Centre Street, Boston, MA 02131, USA, Phone: 617-971-5323,
| | - Jeanne A Teresi
- Jeanne A Teresi, Columbia University Stroud Center and Research Division, Hebrew Home at Riverdale, 5901 Palisade Avenue, Riverdale, New York, 10471, USA, ;
| | - Anita Stewart
- Anita Stewart, University of California, San Francisco, School of Nursing, Institute for Health & Aging, 3333 California Street, LHts-340, San Francisco, CA, 94143, USA,
| | - Robert Weech-Maldonado
- Robert Weech-Maldonado, Department of Health Services Administration, School of Health Professions, University of Alabama at Birmingham, 520 WEBB Building, 1530 Third Avenue South, Birmingham, Alabama, 35294, USA,
| | - Steve Wallace
- Steve Wallace, University of California, Los Angeles, Center for Health Policy Research, 10960 Wilshire Blvd., Suite 1550, Los Angeles, CA 90024, USA,
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11
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Heatwole C, Bode R, Johnson N, Quinn C, Martens W, McDermott MP, Rothrock N, Thornton C, Vickrey B, Victorson D, Moxley R. Patient-reported impact of symptoms in myotonic dystrophy type 1 (PRISM-1). Neurology 2012; 79:348-57. [PMID: 22786587 PMCID: PMC3400095 DOI: 10.1212/wnl.0b013e318260cbe6] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Accepted: 03/19/2012] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the most critical symptoms in a national myotonic dystrophy type 1 (DM1) population and to identify the modifying factors that have the greatest effect on the severity of these symptoms. METHODS We performed a cross-sectional study of 278 adult patients with DM1 from the national registry of patients with DM1 between April and August 2010. We assessed the prevalence and relative significance of 221 critical DM1 symptoms and 14 disease themes. These symptoms and themes were chosen for evaluation based on prior interviews with patients with DM1. Responses were categorized by age, CTG repeat length, gender, and duration of symptoms. RESULTS Participants with DM1 provided symptom rating survey responses to address the relative frequency and importance of each DM1 symptom. The symptomatic themes with the highest prevalence in DM1 were problems with hands or arms (93.5%), fatigue (90.8%), myotonia (90.3%), and impaired sleep or daytime sleepiness (87.9%). Participants identified fatigue and limitations in mobility as the symptomatic themes that have the greatest effect on their lives. We found an association between age and the average prevalence of all themes (p < 0.01) and between CTG repeat length and the average effect of all symptomatic themes on participant lives (p < 0.01). CONCLUSIONS There are a wide range of symptoms that significantly affect the lives of patients with DM1. These symptoms, some previously underrecognized, have varying levels of importance in the DM1 population and are nonlinearly dependent on patient age and CTG repeat length.
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Cella D, Lai JS, Nowinski CJ, Victorson D, Peterman A, Miller D, Bethoux F, Heinemann A, Rubin S, Cavazos JE, Reder AT, Sufit R, Simuni T, Holmes GL, Siderowf A, Wojna V, Bode R, McKinney N, Podrabsky T, Wortman K, Choi S, Gershon R, Rothrock N, Moy C. Neuro-QOL: brief measures of health-related quality of life for clinical research in neurology. Neurology 2012; 78:1860-7. [PMID: 22573626 DOI: 10.1212/wnl.0b013e318258f744] [Citation(s) in RCA: 424] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To address the need for brief, reliable, valid, and standardized quality of life (QOL) assessment applicable across neurologic conditions. METHODS Drawing from larger calibrated item banks, we developed short measures (8-9 items each) of 13 different QOL domains across physical, mental, and social health and evaluated their validity and reliability. Three samples were utilized during short form development: general population (Internet-based, n = 2,113); clinical panel (Internet-based, n = 553); and clinical outpatient (clinic-based, n = 581). All short forms are expressed as T scores with a mean of 50 and SD of 10. RESULTS Internal consistency (Cronbach α) of the 13 short forms ranged from 0.85 to 0.97. Correlations between short form and full-length item bank scores ranged from 0.88 to 0.99 (0.82-0.96 after removing common items from banks). Online respondents were asked whether they had any of 19 different chronic health conditions, and whether or not those reported conditions interfered with ability to function normally. All short forms, across physical, mental, and social health, were able to separate people who reported no health condition from those who reported 1-2 or 3 or more. In addition, scores on all 13 domains were worse for people who acknowledged being limited by the health conditions they reported, compared to those who reported conditions but were not limited by them. CONCLUSION These 13 brief measures of self-reported QOL are reliable and show preliminary evidence of concurrent validity inasmuch as they differentiate people based upon number of reported health conditions and whether those reported conditions impede normal function.
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Affiliation(s)
- D Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
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13
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Heatwole C, Bode R, Martens W, McDermott M, Moxley R, Quinn C, Tawil A, Rothrock N, Vickrey B, Victorson D, Johnson N. Results from a National Cross-Sectional Study of Disease-Burden in Facioscapulohumeral Muscular Dystrophy (FSHD) (S15.004). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s15.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Khanna D, Maranian P, Rothrock N, Cella D, Gershon R, Khanna PP, Spiegel B, Furst DE, Clements PJ, Bechtel A, Hays RD. Feasibility and construct validity of PROMIS and "legacy" instruments in an academic scleroderma clinic. Value Health 2012; 15:128-134. [PMID: 22264980 PMCID: PMC3457915 DOI: 10.1016/j.jval.2011.08.006] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 07/17/2011] [Accepted: 08/08/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) roadmap initiative is a cooperative group program of research designed to develop, evaluate, and standardize item banks to measure patient-reported outcomes relevant across medical conditions. The objective of the current study was to assess feasibility and evaluation of the construct validity of PROMIS item banks versus legacy measures in an observational study in systemic sclerosis (SSc). We hypothesized that the PROMIS item banks can be administered in a clinical setting if there is adequate staff support without disrupting the flow of clinic. METHODS Patients with SSc in a single academic center completed computerized adaptive test (CAT) administered PROMIS item banks during the clinic visit and legacy measures (using paper and pencil). The construct validity of PROMIS items was evaluated by examining correlations with corresponding legacy measures using multitrait-multimethod analysis. RESULTS Participants consisted of 143 SSc patients with an average age of 51.5 years; 71% were female and 68% were white. The average number of items completed for each CAT-administered item bank ranged from 5 to 8 (69 CAT items per patient), and the average time to complete each CAT-administered item bank ranged from 48 seconds to 1.9 minutes per patient (average time = 11.9 minutes/per patient for 11 banks). All correlations between PROMIS domains and respective legacy measures were large and in the hypothesized direction (ranged from 0.61 to 0.82). CONCLUSION Our study supports the construct validity of the CAT-administered PROMIS item banks and shows that they can be administered successfully in a clinic with support staff. Future studies should assess the feasibility of PROMIS item banks in a busy clinical practice.
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Affiliation(s)
- Dinesh Khanna
- Division of Rheumatology, University of Michigan, Ann Arbor, MI 48106, USA.
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Rubinstein WS, Acheson LS, O'Neill SM, Ruffin MT, Wang C, Beaumont JL, Rothrock N. Clinical utility of family history for cancer screening and referral in primary care: a report from the Family Healthware Impact Trial. Genet Med 2011; 13:956-65. [PMID: 22075527 PMCID: PMC3425444 DOI: 10.1097/gim.0b013e3182241d88] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess the effectiveness of computerized familial risk assessment and tailored messages for identifying individuals for targeted cancer prevention strategies and motivating behavior change. METHODS We conducted a randomized clinical trial in primary care patients aged 35-65 years using Family Healthware, a self-administered, internet-based tool that collects family history for six common diseases including breast cancer, colon cancer, and ovarian cancer, stratifies risk into three tiers, and provides tailored prevention messages. Cancer screening adherence and consultation were measured at baseline and 6-month follow-up. RESULTS Of 3283 participants, 34% were at strong or moderate risk of at least one of the cancers. Family Healthware identified additional participants for whom earlier screening (colon cancer, 4.4%; breast cancer, women ages: 35-39 years, 9%) or genetic assessment (colon cancer, 2.5%; breast cancer, 10%; and ovarian cancer, 4%) may be indicated. Fewer than half were already adherent with risk-based screening. Screening adherence improved for all risk categories with no difference between intervention and control groups. Consultation with specialists did not differ between groups. CONCLUSION Family Healthware identified patients for intensified cancer prevention. Engagement of clinicians and patients, integration with clinical decision support, and inclusion of nonfamilial risk factors may be necessary to achieve the full potential of computerized risk assessment.
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Affiliation(s)
- Wendy S Rubinstein
- Department of Medicine, Division of Genetics, NorthShore University HealthSystem, Evanston, Illinois 60201, USA.
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Rubinstein WS, O'neill SM, Rothrock N, Starzyk EJ, Beaumont JL, Acheson LS, Wang C, Gramling R, Galliher JM, Ruffin MT. Components of family history associated with women's disease perceptions for cancer: a report from the Family Healthware™ Impact Trial. Genet Med 2011; 13:52-62. [PMID: 21150785 PMCID: PMC3927459 DOI: 10.1097/gim.0b013e3181fbe485] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the specific components of family history and personal characteristics related to disease perceptions about breast, colon, and ovarian cancers. METHODS Baseline, cross-sectional data on 2,505 healthy women aged 35-65 years enrolled from 41 primary care practices in the cluster-randomized Family Healthware™ Impact Trial, assessed for detailed family history and perceived risk, perceived severity, worry, and perceived control over getting six common diseases including breast, colon, and ovarian cancers. RESULTS Participants provided family history information on 41,841 total relatives. We found evidence of underreporting of paternal family history and lower perceived breast cancer risk with cancer in the paternal versus maternal lineage. We observed cancer-specific perceived risks and worry for individual family history elements and also found novel "spillover" effects where a family history of one cancer was associated with altered disease perceptions of another. Having a mother with early-onset breast or ovarian cancer was strongly associated with perceived risk of breast cancer. Age, parenthood, and affected lineage were associated with disease perceptions and ran counter to empiric risks. CONCLUSIONS Understanding patients' formulation of risk for multiple diseases is important for public health initiatives that seek to inform risk appraisal, influence disease perceptions, or match preventive interventions to existing risk perceptions.
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Affiliation(s)
- Wendy S Rubinstein
- Center for Medical Genetics, NorthShore University HealthSystem, 1000 Central Street, Suite 620, Evanston, IL 60201, USA.
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Riley WT, Rothrock N, Bruce B, Christodolou C, Cook K, Hahn EA, Cella D. Patient-reported outcomes measurement information system (PROMIS) domain names and definitions revisions: further evaluation of content validity in IRT-derived item banks. Qual Life Res 2010; 19:1311-21. [PMID: 20593306 PMCID: PMC3670674 DOI: 10.1007/s11136-010-9694-5] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2010] [Indexed: 12/19/2022]
Abstract
PURPOSE Content validity of patient-reported outcomes (PROs) is evaluated primarily during item development, but subsequent psychometric analyses, particularly for item response theory (IRT)-derived scales, often result in considerable item pruning and potential loss of content. After selecting items for the PROMIS banks based on psychometric and content considerations, we invited external content expert reviews of the degree to which the initial domain names and definitions represented the calibrated item bank content. METHODS A minimum of four content experts reviewed each item bank and recommended a domain name and definition based on item content. Domain names and definitions then were revealed to the experts who rated how well these names and definitions fit the bank content and provided recommendations for definition revisions. RESULTS These reviews indicated that the PROMIS domain names and definitions remained generally representative of bank content following item pruning, but modifications to two domain names and minor to moderate revisions of all domain definitions were needed to optimize fit with the item bank content. CONCLUSIONS This reevaluation of domain names and definitions following psychometric item pruning, although not previously documented in the literature, appears to be an important procedure for refining conceptual frameworks and further supporting content validity.
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Affiliation(s)
- William T Riley
- National Heart Lung and Blood Institute, 6701 Rockledge Dr., MSC 7936, Bethesda, MD 20892, USA.
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Abstract
Two inflammatory autoimmune diseases, systemic lupus erythematosus and rheumatoid arthritis, are characterized by fatigue. Patient reports support the significant negative impact of the symptom on functioning and well-being. The prevalence, trajectory, mechanism, and correlates of fatigue in each disease are reviewed. Some disease-focused treatments have demonstrated a reduction in fatigue. However, until recently, clinical trials have not routinely assessed fatigue. Analyses and interpretation of data have been hindered by variability in the reliability and validity of fatigue measures. Empirically based fatigue treatment guidelines are needed in both conditions.
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Affiliation(s)
- Rosalind Ramsey-Goldman
- Department of Medicine, 240 E. Huron, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA.
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Hahn EA, Devellis RF, Bode RK, Garcia SF, Castel LD, Eisen SV, Bosworth HB, Heinemann AW, Rothrock N, Cella D. Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing. Qual Life Res 2010. [PMID: 20419503 DOI: 10.1007/s11136-010-9654-0.measuring] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a social health measurement framework, to test items in diverse populations and to develop item response theory (IRT) item banks. METHODS A literature review guided framework development of Social Function and Social Relationships sub-domains. Items were revised based on patient feedback, and Social Function items were field-tested. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter IRT modeling and evaluation of differential item functioning (DIF). RESULTS The analytic sample included 956 general population respondents who answered 56 Ability to Participate and 56 Satisfaction with Participation items. EFA and CFA identified three Ability to Participate sub-domains. However, because of positive and negative wording, and content redundancy, many items did not fit the IRT model, so item banks do not yet exist. EFA, CFA and IRT identified two preliminary Satisfaction item banks. One item exhibited trivial age DIF. CONCLUSION After extensive item preparation and review, EFA-, CFA- and IRT-guided item banks help provide increased measurement precision and flexibility. Two Satisfaction short forms are available for use in research and clinical practice. This initial validation study resulted in revised item pools that are currently undergoing testing in new clinical samples and populations.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 710 N. Lake Shore Dr., Room 725, Chicago, IL 60611, USA.
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Hahn EA, Devellis RF, Bode RK, Garcia SF, Castel LD, Eisen SV, Bosworth HB, Heinemann AW, Rothrock N, Cella D. Measuring social health in the patient-reported outcomes measurement information system (PROMIS): item bank development and testing. Qual Life Res 2010; 19:1035-44. [PMID: 20419503 PMCID: PMC3138729 DOI: 10.1007/s11136-010-9654-0] [Citation(s) in RCA: 232] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE To develop a social health measurement framework, to test items in diverse populations and to develop item response theory (IRT) item banks. METHODS A literature review guided framework development of Social Function and Social Relationships sub-domains. Items were revised based on patient feedback, and Social Function items were field-tested. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), two-parameter IRT modeling and evaluation of differential item functioning (DIF). RESULTS The analytic sample included 956 general population respondents who answered 56 Ability to Participate and 56 Satisfaction with Participation items. EFA and CFA identified three Ability to Participate sub-domains. However, because of positive and negative wording, and content redundancy, many items did not fit the IRT model, so item banks do not yet exist. EFA, CFA and IRT identified two preliminary Satisfaction item banks. One item exhibited trivial age DIF. CONCLUSION After extensive item preparation and review, EFA-, CFA- and IRT-guided item banks help provide increased measurement precision and flexibility. Two Satisfaction short forms are available for use in research and clinical practice. This initial validation study resulted in revised item pools that are currently undergoing testing in new clinical samples and populations.
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Affiliation(s)
- Elizabeth A Hahn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 710 N. Lake Shore Dr., Room 725, Chicago, IL 60611, USA.
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Cella D, Riley W, Stone A, Rothrock N, Reeve B, Yount S, Amtmann D, Bode R, Buysse D, Choi S, Cook K, Devellis R, DeWalt D, Fries JF, Gershon R, Hahn EA, Lai JS, Pilkonis P, Revicki D, Rose M, Weinfurt K, Hays R. The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. J Clin Epidemiol 2010; 63:1179-94. [PMID: 20685078 DOI: 10.1016/j.jclinepi.2010.04.011] [Citation(s) in RCA: 3108] [Impact Index Per Article: 222.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Revised: 03/31/2010] [Accepted: 04/08/2010] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Patient-reported outcomes (PROs) are essential when evaluating many new treatments in health care; yet, current measures have been limited by a lack of precision, standardization, and comparability of scores across studies and diseases. The Patient-Reported Outcomes Measurement Information System (PROMIS) provides item banks that offer the potential for efficient (minimizes item number without compromising reliability), flexible (enables optional use of interchangeable items), and precise (has minimal error in estimate) measurement of commonly studied PROs. We report results from the first large-scale testing of PROMIS items. STUDY DESIGN AND SETTING Fourteen item pools were tested in the U.S. general population and clinical groups using an online panel and clinic recruitment. A scale-setting subsample was created reflecting demographics proportional to the 2000 U.S. census. RESULTS Using item-response theory (graded response model), 11 item banks were calibrated on a sample of 21,133, measuring components of self-reported physical, mental, and social health, along with a 10-item Global Health Scale. Short forms from each bank were developed and compared with the overall bank and with other well-validated and widely accepted ("legacy") measures. All item banks demonstrated good reliability across most of the score distributions. Construct validity was supported by moderate to strong correlations with legacy measures. CONCLUSION PROMIS item banks and their short forms provide evidence that they are reliable and precise measures of generic symptoms and functional reports comparable to legacy instruments. Further testing will continue to validate and test PROMIS items and banks in diverse clinical populations.
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Affiliation(s)
- David Cella
- Medical Social Sciences, Northwestern University, 710 North LakeShore Drive, Chicago, IL 60611, USA.
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Amtmann D, Cook KF, Jensen MP, Chen WH, Choi S, Revicki D, Cella D, Rothrock N, Keefe F, Callahan L. Development of a PROMIS item bank to measure pain interference. Pain 2010; 150:173-182. [PMID: 20554116 PMCID: PMC2916053 DOI: 10.1016/j.pain.2010.04.025] [Citation(s) in RCA: 721] [Impact Index Per Article: 51.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 02/27/2010] [Accepted: 04/20/2010] [Indexed: 01/22/2023]
Abstract
This paper describes the psychometric properties of the PROMIS-pain interference (PROMIS-PI) bank. An initial candidate item pool (n=644) was developed and evaluated based on the review of existing instruments, interviews with patients, and consultation with pain experts. From this pool, a candidate item bank of 56 items was selected and responses to the items were collected from large community and clinical samples. A total of 14,848 participants responded to all or a subset of candidate items. The responses were calibrated using an item response theory (IRT) model. A final 41-item bank was evaluated with respect to IRT assumptions, model fit, differential item function (DIF), precision, and construct and concurrent validity. Items of the revised bank had good fit to the IRT model (CFI and NNFI/TLI ranged from 0.974 to 0.997), and the data were strongly unidimensional (e.g., ratio of first and second eigenvalue=35). Nine items exhibited statistically significant DIF. However, adjusting for DIF had little practical impact on score estimates and the items were retained without modifying scoring. Scores provided substantial information across levels of pain; for scores in the T-score range 50-80, the reliability was equivalent to 0.96-0.99. Patterns of correlations with other health outcomes supported the construct validity of the item bank. The scores discriminated among persons with different numbers of chronic conditions, disabling conditions, levels of self-reported health, and pain intensity (p<0.0001). The results indicated that the PROMIS-PI items constitute a psychometrically sound bank. Computerized adaptive testing and short forms are available.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Karon F. Cook
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Wen-Hung Chen
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD
| | - Seung Choi
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dennis Revicki
- Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nan Rothrock
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Francis Keefe
- Departments of Psychiatry & Behavioral Sciences, Anesthesiology, Medicine and Psychology and Neuroscience: Social and Health Sciences, Duke University and Duke University Medical Center, Durham, NC
| | - Leigh Callahan
- Departments of Medicine, Orthopaedics, and Social Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC
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Amtmann D, Cook KF, Jensen MP, Chen WH, Choi S, Revicki D, Cella D, Rothrock N, Keefe F, Callahan L, Lai JS. Development of a PROMIS item bank to measure pain interference. Pain 2010. [PMID: 20554116 DOI: 10.1016/j.pain.2010.04.025[publishedonlinefirst:2010/06/18]] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
This paper describes the psychometric properties of the PROMIS-pain interference (PROMIS-PI) bank. An initial candidate item pool (n=644) was developed and evaluated based on the review of existing instruments, interviews with patients, and consultation with pain experts. From this pool, a candidate item bank of 56 items was selected and responses to the items were collected from large community and clinical samples. A total of 14,848 participants responded to all or a subset of candidate items. The responses were calibrated using an item response theory (IRT) model. A final 41-item bank was evaluated with respect to IRT assumptions, model fit, differential item function (DIF), precision, and construct and concurrent validity. Items of the revised bank had good fit to the IRT model (CFI and NNFI/TLI ranged from 0.974 to 0.997), and the data were strongly unidimensional (e.g., ratio of first and second eigenvalue=35). Nine items exhibited statistically significant DIF. However, adjusting for DIF had little practical impact on score estimates and the items were retained without modifying scoring. Scores provided substantial information across levels of pain; for scores in the T-score range 50-80, the reliability was equivalent to 0.96-0.99. Patterns of correlations with other health outcomes supported the construct validity of the item bank. The scores discriminated among persons with different numbers of chronic conditions, disabling conditions, levels of self-reported health, and pain intensity (p<0.0001). The results indicated that the PROMIS-PI items constitute a psychometrically sound bank. Computerized adaptive testing and short forms are available.
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Affiliation(s)
- Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Box 357920, Seattle, WA 98195-7920, USA Center for Health Outcomes Research, United BioSource Corporation, Bethesda, MD, USA Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA Departments of Psychiatry and Behavioral Sciences, Anesthesiology, Medicine and Psychology and Neuroscience: Social and Health Sciences, Duke University and Duke University Medical Center, Durham, NC, USA Departments of Medicine, Orthopaedics, and Social Medicine and Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
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24
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Hays RD, Bode R, Rothrock N, Riley W, Cella D, Gershon R. The impact of next and back buttons on time to complete and measurement reliability in computer-based surveys. Qual Life Res 2010; 19:1181-4. [PMID: 20552282 PMCID: PMC2940029 DOI: 10.1007/s11136-010-9682-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2010] [Indexed: 11/25/2022]
Abstract
Purpose To assess the impact of including next and back buttons on response burden and measurement reliability of computer-based surveys. Methods A sample of 807 participants (mean age of 53; 64% women, 83% non-Hispanic white; 81% some college or college graduates) from the YouGov Polimetrix panel was administered 56 items assessing performance of social/role activities and 56 items measuring satisfaction with social/role activities. Participants were randomly assigned to either (1) automatic advance to the next question with no opportunity to go back (auto/no back); (2) automatic advance to the next questions with an opportunity to go back (auto/back); (3) next button to go to the next question with no opportunity to go back (next/no back); or (4) next button to go to the next question with an opportunity to go back (next/back). Results We found no difference in missing data, internal consistency reliability, and domain scores by group. Time to complete the survey was about 50% longer when respondents were required to use a next button to go on. Conclusions Given the similarity in missing data, reliability and mean scale scores with or without use of the next button, we recommend automatic advancement to the next item with the option to go back to the previous item.
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Affiliation(s)
- Ron D Hays
- UCLA Department of Medicine, 911 Broxton Avenue, Room 110, Los Angeles, CA 90024-2801, USA.
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25
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Gershon RC, Rothrock N, Hanrahan R, Bass M, Cella D. The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research. J Appl Meas 2010; 11:304-14. [PMID: 20847477 PMCID: PMC3686485] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The Patient-Reported Outcomes Measurement Information System (PROMIS) was developed as one of the first projects funded by the NIH Roadmap for Medical Research Initiative to re-engineer the clinical research enterprise. The primary goal of PROMIS is to build item banks and short forms that measure key health outcome domains that are manifested in a variety of chronic diseases which could be used as a "common currency" across research projects. To date, item banks, short forms and computerized adaptive tests (CAT) have been developed for 13 domains with relevance to pediatric and adult subjects. To enable easy delivery of these new instruments, PROMIS built a web-based resource (Assessment Center) for administering CATs and other self-report data, tracking item and instrument development, monitoring accrual, managing data, and storing statistical analysis results. Assessment Center can also be used to deliver custom researcher developed content, and has numerous features that support both simple and complicated accrual designs (branching, multiple arms, multiple time points, etc.). This paper provides an overview of the development of the PROMIS item banks and details Assessment Center functionality.
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Affiliation(s)
- Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, Chicago, IL 60611, USA.
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26
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O'Neill SM, Rubinstein WS, Wang C, Yoon PW, Acheson LS, Rothrock N, Starzyk EJ, Beaumont JL, Galliher JM, Ruffin MT. Familial risk for common diseases in primary care: the Family Healthware Impact Trial. Am J Prev Med 2009; 36:506-14. [PMID: 19460658 DOI: 10.1016/j.amepre.2009.03.002] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [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] [Received: 09/19/2008] [Revised: 02/09/2009] [Accepted: 03/10/2009] [Indexed: 10/20/2022]
Abstract
CONTEXT Family history is a risk factor for many common chronic diseases, yet it remains underutilized in primary care practice. BACKGROUND Family Healthware is a self-administered, web-based tool that assesses familial risk for CHD; stroke; diabetes; and colorectal, breast, and ovarian cancer, and provides a personalized prevention plan based on familial risk. The Family Healthware Impact Trial evaluated the tool. DESIGN In this cluster RCT, participants completed baseline and 6-month follow-up surveys. The intervention group used Family Healthware directly after the baseline survey. Controls used the tool after completing the follow-up survey. SETTING/PARTICIPANTS Patients aged 35-65 years with no known diagnosis of these six diseases were enrolled from 41 primary care practices. MAIN OUTCOME MEASURES The prevalence of family-history-based risk for coronary heart disease (CHD); stroke; diabetes; and colorectal, breast, and ovarian cancer was determined in a primary care population. RESULTS From 2005 to 2007, 3786 participants enrolled. Data analysis was undertaken from September 2007 to March 2008. Participants had a mean age of 50.6 years and were primarily white (91%) women (70%). Of the 3585 participants who completed the risk assessment tool, 82% had a strong or moderate familial risk for at least one of the diseases: CHD (strong=33%, moderate=26%); stroke (strong=15%, moderate=34%); diabetes (strong=11%, moderate=26%); colorectal cancer (strong=3%, moderate=11%); breast cancer (strong=10%, moderate=12%); and ovarian cancer (strong=4%, moderate=6%). Women had a significantly (p<0.04) higher familial risk than men for all diseases except colorectal and ovarian cancer. Overweight participants were significantly (p<or=0.02) more likely to have a strong family history for CHD, stroke, and diabetes. Older participants were significantly (p<or=0.02) more likely to report a strong family history for CHD and stroke as well as colorectal and breast cancer. CONCLUSIONS This self-administered, online tool delineated a substantial burden of family-history-based risk for these chronic diseases in an adult, primary care population. TRIAL REGISTRATION NCT00164658.
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Affiliation(s)
- Suzanne M O'Neill
- Center for Medical Genetics, NorthShore University HealthSystem (formerly Evanston Northwestern Healthcare), Evanston, Illinois, USA.
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Wang C, O'Neill SM, Rothrock N, Gramling R, Sen A, Acheson LS, Rubinstein WS, Nease DE, Ruffin MT. Comparison of risk perceptions and beliefs across common chronic diseases. Prev Med 2009; 48:197-202. [PMID: 19073208 PMCID: PMC2720609 DOI: 10.1016/j.ypmed.2008.11.008] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2008] [Revised: 11/07/2008] [Accepted: 11/09/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Few studies have compared perceptions of risk, worry, severity and control across multiple diseases. This paper examines how these perceptions vary for heart disease, diabetes, stroke, and colon, breast, and ovarian cancers. METHODS The data for this study came from the Family Healthware Impact Trial (FHITr), conducted in the United States from 2005 to 2007. Healthy adults (N=2362) from primary care practices recorded their perceptions at baseline for each disease. Analyses were conducted controlling for study site and personal risk factors. RESULTS Perceived risk was significantly higher for cancers than for other diseases. Men worried most about getting heart disease; women worried most about getting breast cancer, followed by heart disease. Diabetes was perceived to be the least severe condition. Heart disease was perceived to be the most controllable compared to cancers, which were perceived to be the least controllable. Women had higher perceived risk and worry ratings compared to men for several diseases. CONCLUSIONS These data highlight how individuals comparatively view chronic diseases. Addressing prior disease perceptions when communicating multiple disease risks may facilitate an accurate understanding of risk for diseases, and help individuals to effectively identify and engage in relevant behaviors to reduce their risk.
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Christodoulou C, Junghaenel DU, DeWalt DA, Rothrock N, Stone AA. Cognitive interviewing in the evaluation of fatigue items: results from the patient-reported outcomes measurement information system (PROMIS). Qual Life Res 2008; 17:1239-46. [PMID: 18850327 DOI: 10.1007/s11136-008-9402-x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2008] [Accepted: 09/18/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Cognitive Interviewing (CI) is a technique increasingly used to obtain respondent feedback on potential items during questionnaire development. No standard guidelines exist by which to incorporate CI feedback in deciding to retain, revise, or eliminate potential items. We used CI in developing fatigue items for the National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Roadmap initiative. Our aims were to describe the CI process, formally evaluate the utility of decisions made on the basis of CI, and offer suggestions for future research. METHODS Participants were 22 patients with a diverse range of chronic health conditions. During CI, each participant provided feedback on a series of items. We then reviewed the CI data and decided whether to retain, revise, or eliminate each potential item. Following this, we developed or adopted three quantitative methods to compare retained versus eliminated items. RESULTS Retained items raised fewer serious concerns, were less likely to be viewed as non-applicable, and were less likely to display problems with clarity or to make incorrect assumptions about respondents. CONCLUSIONS CI was useful in developing the PROMIS fatigue items and the methods used to judge CI for the present item set may be useful for future investigations.
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Cella D, Yount S, Rothrock N, Gershon R, Cook K, Reeve B, Ader D, Fries JF, Bruce B, Rose M. The Patient-Reported Outcomes Measurement Information System (PROMIS): progress of an NIH Roadmap cooperative group during its first two years. Med Care 2007; 45:S3-S11. [PMID: 17443116 PMCID: PMC2829758 DOI: 10.1097/01.mlr.0000258615.42478.55] [Citation(s) in RCA: 2008] [Impact Index Per Article: 118.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The National Institutes of Health (NIH) Patient-Reported Outcomes Measurement Information System (PROMIS) Roadmap initiative (www.nihpromis.org) is a 5-year cooperative group program of research designed to develop, validate, and standardize item banks to measure patient-reported outcomes (PROs) relevant across common medical conditions. In this article, we will summarize the organization and scientific activity of the PROMIS network during its first 2 years. DESIGN The network consists of 6 primary research sites (PRSs), a statistical coordinating center (SCC), and NIH research scientists. Governed by a steering committee, the network is organized into functional subcommittees and working groups. In the first year, we created an item library and activated 3 interacting protocols: Domain Mapping, Archival Data Analysis, and Qualitative Item Review (QIR). In the second year, we developed and initiated testing of item banks covering 5 broad domains of self-reported health. RESULTS The domain mapping process is built on the World Health Organization (WHO) framework of physical, mental, and social health. From this framework, pain, fatigue, emotional distress, physical functioning, social role participation, and global health perceptions were selected for the first wave of testing. Item response theory (IRT)-based analysis of 11 large datasets supplemented and informed item-level qualitative review of nearly 7000 items from available PRO measures in the item library. Items were selected for rewriting or creation with further detailed review before the first round of testing in the general population and target patient populations. CONCLUSIONS The NIH PROMIS network derived a consensus-based framework for self-reported health, systematically reviewed available instruments and datasets that address the initial PROMIS domains. Qualitative item research led to the first wave of network testing which began in the second year.
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Affiliation(s)
- David Cella
- Evanston Northwestern Healthcare, Evanston, Illinois 60201, USA.
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Abstract
One of the PROMIS (Patient-Reported Outcome Measurement Information System) network's primary goals is the development of a comprehensive item bank for patient-reported outcomes of chronic diseases. For its first set of item banks, PROMIS chose to focus on pain, fatigue, emotional distress, physical function, and social function. An essential step for the development of an item pool is the identification, evaluation, and revision of extant questionnaire items for the core item pool. In this work, we also describe the systematic process wherein items are classified for subsequent statistical processing by the PROMIS investigators. Six phases of item development are documented: identification of extant items, item classification and selection, item review and revision, focus group input on domain coverage, cognitive interviews with individual items, and final revision before field testing. Identification of items refers to the systematic search for existing items in currently available scales. Expert item review and revision was conducted by trained professionals who reviewed the wording of each item and revised as appropriate for conventions adopted by the PROMIS network. Focus groups were used to confirm domain definitions and to identify new areas of item development for future PROMIS item banks. Cognitive interviews were used to examine individual items. Items successfully screened through this process were sent to field testing and will be subjected to innovative scale construction procedures.
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Affiliation(s)
- Darren A DeWalt
- Division of General Internal Medicine and the Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina, USA.
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Abstract
PURPOSE Previous studies have documented elevations in indices of sympathetic activity in cats and humans with interstitial cystitis (IC). To examine potential autonomic dysregulation in IC we examined the effects of a laboratory mental stress challenge on blood pressure and heart rate (HR) in patients with IC and healthy controls. MATERIALS AND METHODS A total of 14 female patients with IC and 14 age matched controls participated in a laboratory session, including a 25-minute mental stress challenge. Systolic blood pressure (SBP), diastolic blood pressure (DBP) and HR were measured at intervals before, during and following the stressor. The level of chronic stress, symptom severity and pain at voiding were assessed. RESULTS Mean age was 49 years (range 32 to 66). The resting HR of patients with IC (82.02 bpm) was significantly higher than that of controls (63.31 bpm, p = 0.0001). There was also suggested evidence of elevated resting DBP in patients with IC (p = 0.07) but no significant difference in mean resting SBP. Autonomic arousal elicited by the laboratory stressor did not differ between the groups and subjects in each group perceived the task as equally stressful. Patients with IC had significantly elevated HR at each time point compared with controls (p <0.0001) with an average mean difference +/- SD between the groups of 19.5 +/- 4.0 (main effect for group p <0.0001). Although consistent increases in SBP and DBP were observed in patients after baseline, these differences were not significant. CONCLUSIONS Patients with IC had an increased HR at baseline and throughout a laboratory mental stress challenge compared to healthy age matched women. No differences in HR or blood pressure reactivity were observed between the 2 groups.
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Affiliation(s)
- Susan K Lutgendorf
- Department of Psychology, University of Iowa, Iowa City, Iowa 52242, USA.
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Martin R, Lemos C, Rothrock N, Bellman SB, Russell D, Tripp-Reimer T, Lounsbury P, Gordon E. Gender Disparities in Common Sense Models of Illness Among Myocardial Infarction Victims. Health Psychol 2004; 23:345-53. [PMID: 15264970 DOI: 10.1037/0278-6133.23.4.345] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Symptom attributions were contrasted between male and female myocardial infarction victims (N = 157) who were comparable on age, cardiac risk status, medical history, symptom presentation, and other variables. Women were less likely than men to attribute their prehospital symptoms to cardiac causes. In the context of hearing symptom attributions or advice from support persons, women were less likely than men to report receiving a cardiac attribution or advice to seek medical attention. Results have implications for how victim gender influences the lay interpretation of cardiac symptoms.
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Affiliation(s)
- René Martin
- College of Nursing, University of Iowa, Iowa City, IA 52242, USA.
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Lutgendorf SK, Anderson B, Rothrock N, Buller RE, Sood AK, Sorosky JI. Quality of life and mood in women receiving extensive chemotherapy for gynecologic cancer. Cancer 2000; 89:1402-11. [PMID: 11002237] [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: 02/17/2023]
Abstract
BACKGROUND Quality of life (QOL) and mood were investigated among women who had received intensive chemotherapy for at least 1 year for advanced gynecologic cancers. Relationships of coping styles to QOL and mood in these patients also were examined. METHODS Twenty-four patients who had been receiving chemotherapy continuously or intermittently for at least 1 year were recruited into the study. To control for the diagnosis of cancer and for prior hysterectomy, 24 age-matched early stage gynecologic cancer patients not receiving chemotherapy and assessed 1 year following diagnosis were examined as a comparison group. All subjects completed psychosocial assessments at a clinic visit. Medical information was retrospectively abstracted from patient charts. RESULTS Decrements in physical, emotional, and functional well-being were reported by extensively treated patients, whereas social well-being and satisfaction with the relationship between doctor and patient were close to the norms of the comparison group. Extensively treated patients reported more fatigue and less vigor, but their depression and anxiety did not differ from early stage patients. Almost all extensively treated patients reported that their treatment had been worthwhile. Patients using avoidant coping reported poorer physical and emotional well-being, along with greater anxiety, depression, fatigue, and total mood disturbance. Those using active coping reported better social well-being, better relationships with their doctors, and less overall distress. CONCLUSIONS This study indicates that gynecologic oncology patients extensively treated with chemotherapy experienced substantial decrements to quality of life, and yet treatment still was considered worthwhile by a majority of patients. Avoidant coping may be a particular risk factor for poor QOL and greater distress.
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Affiliation(s)
- S K Lutgendorf
- University of Iowa, Department of Psychology, Iowa City, Iowa 52242, USA.
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Abstract
OBJECTIVE Although stress is known to modulate the inflammatory response, there has been little experimental examination of the effects of stress and stress reduction on inflammation in humans. In particular, the effects of stress and relaxation on neurogenic inflammation have been minimally studied. This study examines the effects of three experimental manipulations: mental stress, relaxation, and control on the local inflammatory response evoked by the intradermal injection of capsaicin, the active ingredient in chili peppers. METHODS Fifty subjects (28 men and 22 women) were pretrained in relaxation using an imagery-based relaxation tape and then randomized to experimental condition. Subjects participated in an evening reactivity session including 20 minutes of a stress (Stroop test), relaxation (tape), or control (video) manipulation, followed by a capsaicin injection in the forearm. Digitized flare measurements were taken for 1 hour postcapsaicin, and measurements of cardiovascular variables, cortisol, adrenocorticotrophic hormone, and norepinephrine were taken at regular intervals. RESULTS The size of the maximum capsaicin-induced flare was significantly smaller in the relaxation condition than in the stress or control conditions, which did not differ from each other. Increases in norepinephrine, heart rate, and systolic blood pressure during the experimental task, but not after capsaicin, significantly predicted size of maximum flare and total area under the curve of flare measurements. CONCLUSIONS These findings suggest that stress reduction may affect local inflammatory processes. Results are consistent with sympathetic modulation of the effects of relaxation on the flare response.
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Affiliation(s)
- S Lutgendorf
- Department of Psychology, University of Iowa, Iowa City 52242, USA.
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36
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Heffner KP, Rosenberg H, Rothrock N, Kimber-Riggs K, Gould C. Recreational drug use concurrent with abuse or dependence on other psychoactive substances. J Subst Abuse Treat 1996; 13:499-504. [PMID: 9219148 DOI: 10.1016/s0740-5472(96)00190-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In an effort to identify instances of the non-problematic use of a drug concurrent with the problematic use of one or more other drugs, we used structured interviews to obtain comprehensive drug use histories from 48 clients admitted to an intensive outpatient program. We classified clients on the basis of whether they demonstrated evidence of concurrent problematic and non-problematic drug use (Index and Probable Index cases) or only problematic drug use patterns (Non-Index cases). Both Index and Non-Index drug use patterns were about equally common in our sample. Both Index and Probable Index cases used a variety of drugs in a non-problematic manner and were generally congruent in their self-labelling of their drug use relative to their DSM-IV status for each drug used. We discuss several limitations of the study, including our reliance on retrospective, self-report data; potential problems with generalization to other populations; and possible changes in drug use patterns over time.
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Abstract
OBJECTIVE The present study was conducted to provide a nationwide survey of acceptance of nonabstinence goals and related alcoholism treatment practices by Canadian alcoholism treatment services. METHOD A random sample of 335 Canadian alcoholism treatment service agencies were mailed a 4-page questionnaire designed to assess acceptance of moderate drinking as a drinking goal and related alcoholism treatment practices. RESULTS Acceptance varied by type of service, with considerably more acceptance by outpatient programs (62%) and mixed inpatient/outpatient programs (43%) than inpatient/detoxification/ correctional facilities (27%) and halfway houses (16%). Two-thirds of the respondents who reported moderate drinking as unacceptable in their own agencies categorically rejected moderation for all alcoholism clients. CONCLUSIONS Individuals seeking services in Canadian alcoholism treatment agencies are more likely to have a choice of drinking goals if they present to an outpatient program than a residential institution, and Canadian agencies appear more accepting of moderation goals than American programs, but less accepting than British and Norwegian service agencies.
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Affiliation(s)
- H Rosenberg
- Psychology Department, Bowling Green State University, Ohio 43403, USA
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