Morten Aa Petersen1, Neil K Aaronson2, Juan I Arraras3, Wei-Chu Chie4, Thierry Conroy5, Anna Costantini6, Linda Dirven7, Peter Fayers8, Eva-Maria Gamper9, Johannes M Giesinger9, Esther J J Habets10, Eva Hammerlid11, Jorunn Helbostad12, Marianne J Hjermstad13, Bernhard Holzner9, Colin Johnson14, Georg Kemmler9, Madeleine T King15, Stein Kaasa16, Jon H Loge17, Jaap C Reijneveld18, Susanne Singer19, Martin J B Taphoorn7, Lise H Thamsborg20, Krzysztof A Tomaszewski21, Galina Velikova22, Irma M Verdonck-de Leeuw23, Teresa Young24, Mogens Groenvold25. 1. The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: Morten.Aagaard.Petersen@regionh.dk. 2. Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 3. Medical Oncology Department, Hospital of Navarre, Pamplona, Spain. 4. Institute of Epidemiology and Preventive Medicine, Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan. 5. Medical Oncology Department, Institut de cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France. 6. Psychoncology Unit, Sant'Andrea Hospital, Faculty of Medicine, Psychology Sapienza University, Rome, Italy. 7. Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK The Hague, The Netherlands; Department of Neurology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. 8. Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK. 9. Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Innsbruck Medical University, Innsbruck, Austria. 10. Department of Neurology, Haaglanden Medical Center, PO Box 432, 2501 CK The Hague, The Netherlands. 11. Department of Otolaryngology Head and Neck Surgery, Sahlgrenska University Hospital, Göteborg University, Göteborg, Sweden. 12. Department of Neuroscience, Norwegian University of Science and Technology, St. Olav University Hospital, Trondheim, Norway. 13. European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 14. Surgical Unit, Faculty of Medicine, University of Southampton, Southampton, UK. 15. School of Psychology and Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 16. Oslo University Hospital, University of Oslo, Norway and European Palliative Care Research Centre (PRC), Norwegian University of Science and Technology, Oslo, Norway. 17. Palliative Medicine Unit, University Hospital of Trondheim, Trondheim, Norway. 18. Department of Neurology, Brain Tumor Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands; Department of Neurology, Brain Tumor Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. 19. Division of Epidemiology and Health Services Research, Institute of Medical Biostatistics, Epidemiology and Informatics, University Medical Centre, Mainz, Germany. 20. The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark. 21. Health Outcomes Research Unit, Department of Gerontology, Geriatrics, and Social Work, Faculty of Education, Ignatianum Academy, Krakow, Poland. 22. Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK. 23. Department of Otolaryngology - Head & Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands. 24. East & North Hertfordshire NHS Trust Incorporating Mount Vernon Cancer Centre, Northwood, Middlesex, UK. 25. The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark; Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
Abstract
BACKGROUND: To optimise measurement precision, relevance to patients and flexibility, patient-reported outcome measures (PROMs) should ideally be adapted to the individual patient/study while retaining direct comparability of scores across patients/studies. This is achievable using item banks and computerised adaptive tests (CATs). The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) is one of the most widely used PROMs in cancer research and clinical practice. Here we provide an overview of the research program to develop CAT versions of the QLQ-C30's 14 functional and symptom domains. METHODS: The EORTC Quality of Life Group's strategy for developing CAT item banks consists of: literature search to identify potential candidate items; formulation of new items compatible with the QLQ-C30 item style; expert evaluations and patient interviews; field-testing and psychometric analyses, including factor analysis, item response theory calibration and simulation of measurement properties. In addition, software for setting up, running and scoring CAT has been developed. RESULTS: Across eight rounds of data collections, 9782 patients were recruited from 12 countries for the field-testing. The four phases of development resulted in a total of 260 unique items across the 14 domains. Each item bank consists of 7-34 items. Psychometric evaluations indicated higher measurement precision and increased statistical power of the CAT measures compared to the QLQ-C30 scales. Using CAT, sample size requirements may be reduced by approximately 20-35% on average without loss of power. CONCLUSIONS: The EORTC CAT Core represents a more precise, powerful and flexible measurement system than the QLQ-C30. It is currently being validated in a large independent, international sample of cancer patients.
BACKGROUND: To optimise measurement precision, relevance to patients and flexibility, patient-reported outcome measures (PROMs) should ideally be adapted to the individual patient/study while retaining direct comparability of scores across patients/studies. This is achievable using item banks and computerised adaptive tests (CATs). The European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) is one of the most widely used PROMs in cancer research and clinical practice. Here we provide an overview of the research program to develop CAT versions of the QLQ-C30's 14 functional and symptom domains. METHODS: The EORTC Quality of Life Group's strategy for developing CAT item banks consists of: literature search to identify potential candidate items; formulation of new items compatible with the QLQ-C30 item style; expert evaluations and patient interviews; field-testing and psychometric analyses, including factor analysis, item response theory calibration and simulation of measurement properties. In addition, software for setting up, running and scoring CAT has been developed. RESULTS: Across eight rounds of data collections, 9782 patients were recruited from 12 countries for the field-testing. The four phases of development resulted in a total of 260 unique items across the 14 domains. Each item bank consists of 7-34 items. Psychometric evaluations indicated higher measurement precision and increased statistical power of the CAT measures compared to the QLQ-C30 scales. Using CAT, sample size requirements may be reduced by approximately 20-35% on average without loss of power. CONCLUSIONS: The EORTC CAT Core represents a more precise, powerful and flexible measurement system than the QLQ-C30. It is currently being validated in a large independent, international sample of cancerpatients.
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