Equivalence of Electronic and Paper-and-Pencil Administration of Patient-Reported Outcome Measures: A Meta-Analytic Review

AbstractObjectivesPatient-reported outcomes (PROs; self-report assessments) are increasingly important in evaluating medical care and treatment efficacy. Electronic administration of PROs via computer is becoming widespread. This article reviews the literature addressing whether computer-administered tests are equivalent to their paper-and-pencil forms.MethodsMeta-analysis was used to synthesize 65 studies that directly assessed the equivalence of computer versus paper versions of PROs used in clinical trials. A total of 46 unique studies, evaluating 278 scales, provided sufficient detail to allow quantitative analysis.ResultsAmong 233 direct comparisons, the average mean difference between modes averaged 0.2% of the scale range (e.g., 0.02 points on a 10-point scale), and 93% were within ±5% of the scale range. Among 207 correlation coefficients between paper and computer instruments (typically intraclass correlation coefficients), the average weighted correlation was 0.90; 94% of correlations were at least 0.75. Because the cross-mode correlation (paper vs. computer) is also a test–retest correlation, with potential variation because of retest, we compared it to the within-mode (paper vs. paper) test–retest correlation. In four comparisons that evaluated both, the average cross-mode paper-to-computer correlation was almost identical to the within-mode correlation for readministration of a paper measure (0.88 vs. 0.91).ConclusionsExtensive evidence indicates that paper- and computer-administered PROs are equivalent

Psychometric properties and factor structure of the computerized PTSD scale -multimedia version among adult samples reporting trauma

This study investigated the psychometric properties of the Computerized PTSD Scale-Multimedia Version (CPS-M: Richard, Mayo, Bohn, Haynes, & lll Kolman, 1997), a self-administered adaptation of the Clinician-Administered PTSD Scale (CAPS: Blake, Weathers, Nagy, Kaloupek, Klauminzer, Charney, & Keane, 1990). The sample included 161 participants from both a veteran\u27s hospital and from a large urban outpatient HMO system who reported a history of trauma. Indices of internal consistency reliability (i.e., inter-item correlations, item-scale correlations, coefficient alpha) and temporal stability fell in satisfactory ranges. To assess convergent and discriminant validity, correlations were calculated between the CPSM and the following instruments: Purdue PTSD Scale, Beck Depression Inventory II (BDI-II), Hospital Anxiety and Depression Scale (HADS), Yale-Brown Obsessive Compulsive Scale (YBOCS), and Antisocial Behavior Inventory (ASBI). As hypothesized, the CMS-M was most strongly correlated with another measure of PTSD (r = .90) followed by the BDI-II (r = .85), HADS (r = .79), YBOCS (r = .71), and ASBI (r = .25). Confirmatory factor analysis procedures were used to assess fit of a set of nested measurement models. The fit of four different measurement models was tested. An oblique four-factor, first order model composed of reexperiencing (Bl-B5), avoidance (Cl-C2), dysphoria (C3-C7 & Dl-D3), and hyperarousal (D4- D5) provided the best fit to the data

Comparison of the effectiveness of traditional nursing medication administration with the Color Coding Kids system in a sample of undergraduate nursing students

The problem of medication errors in hospitals and the vulnerability of pediatric patients to adverse drug events (ADE) was investigated and well substantiated. The estimated additional cost of inpatient care for ADE’s in the hospital setting alone was conservatively estimated at an annual rate per incident of 400,000 preventable events each incurring an extra cost of approximately $5,857. The purpose of the researcher was to compare the effectiveness of traditional nursing medication administration with the Color Coding Kids (CCK) system (developed by Broselow and Luten for standardizing dosages) to reduce pediatric medication errors. A simulated pediatric rapid response scenario was used in a randomized clinical study to measure the effects of the CCK system to the traditional method of treatment using last semester nursing students. Safe medication administration, workflow turnaround time and hand-off communication were variables studied. A multivariate analysis of variance was used to reveal a significant difference between the groups on safe medication administration. No significant difference between the groups on time and communication was found. The researcher provides substantial evidence that the CCK system of medication administration is a promising technological breakthrough in the prevention of pediatric medication errors

A validity study of the reasons for life scale with emerging adult college students

Thesis (Ph.D.) University of Alaska Fairbanks, 2014This study examined the validity of the Reasons for Life Scale (RFLS) with emerging adult college students. The RFLS measures "reasons for life." It was developed for use with Alaska Native youth as a way to assess potential risk of suicide without directly questioning about suicidal ideation or history of suicide attempts. This study sought to adapt the RFLS for use with emerging adult (age 18-25) college students, and to examine its factor structure and convergent validity with this population. First, a focus group was conducted to assist in rewording two Alaska Native-specific items from the RFLS for non-Natives. Then, with the additional items from the focus group, the revised version of the RFLS (RFLS-R) and other suicide-related measures were administered to a sample of 116 emerging adult college students. Exploratory factor analysis indicated a unidimensional factor structure for the RFLS-R with this sample. The RFLS-R showed a significant and strong correlation with the Reasons for Living Inventory (RLI; r = .70), which, like the RFLS-R, measures reasons for living but makes direct reference to suicide. There also were significant moderate negative correlations with the Suicidal Behavior Questionnaire - Revised (SBQ-R; r = -.36) and the Adult Suicidal Ideation Questionnaire (ASIQ; r = -.29). There was a significant moderate correlation between the RFLSR and a measure of socially desirable responding, the Balanced Inventory of Desirable Responding (BIDR; r = .31), with similar correlations found between the BIDR and other suicide-related measures included in this study. The results suggest that socially desirable responding did not strongly affect participants' responding or explain the associations found among the measures. The high correlation with the RLI suggests that the RFLS-R measures a similar construct, providing evidence of convergent validity; however, the RLI was more highly correlated with measures of suicidality than the RFLS-R -- suggesting that while the RFLS was moderately associated with measures of suicidality, it is a weaker predictor of suicide risk than the RLI. Although the RFLS-R was not as highly correlated with measures of suicidality as the RLI, which directly mentions suicide, the RFLS-R is the only known suicide measure that completely avoids items and instructions that mention suicide, therefore it may be useful in contexts where directly discussing suicide is not acceptable or appropriate.Introduction -- Chapter 1 Literature Review -- 1.1 Suicide -- 1.11 Suicide in Alaska -- 1.12 Suicidality among emerging adult college students -- 1.13 Resilience and suicide risk -- 1.2 Reasons for Living Inventory -- 1.21 Brief Reasons for Living Inventory -- 1.22 College and adolescent versions of the RLI -- 1.221 Brief Reasons for Living Inventory for Adolescents -- 1.222 Reasons for Living Inventory for Adolescents -- 1.223 College Student Reasons for Living Inventory -- 1.224 Reasons for Living Inventory for Young Adults -- 1.23 Cultural Factors and the RLI -- 1.3 Reasons for Life Scale -- 1.4 Current Study -- Chapter 2 Study 1: Method -- 2.1 Participants -- 2.2 Procedure -- 2.3 Results -- Appendices -- Chapter 3 Study 2: Method -- 3.1 Participants -- 3.2 Procedure -- 3.3 Measures -- 3.31 Reasons for living -- 3.32 Reasons for life -- 3.33 Socially desirable response patterns -- 3.34 Suicidal ideation -- 3.35 Suicidal behavior -- 3.4 Statistical analyses -- 3.41 Data preparation -- 3.42 Factor structure of the RFLS-R -- 3.43 Sample size with EFA -- 3.44 Convergent validity -- 3.45 Mediation analyses -- Appendices -- Chapter 4 Results -- 4.1 Internal Structure of the RFLS-R -- 4.11 Sample suitability for factor analysis -- 4.12 Exploratory factor analysis -- 4.2 Convergent Validity -- 4.3 Mediation Analyses -- Chapter 5 Discussion -- 5.1 Functioning of Reworded RFLS Items -- 5.2 Factor Structure of the RFLS-R -- 5.3 Convergent Validity of the Reasons for Life Scale: Revised (RFLS-R) -- 5.31 Relationship with reasons for living -- 5.32 Relationship with suicide measures -- 5.33 Impact of socially desirable responding -- 5.4 Conclusions and Limitations -- References

Einstellung gegenüber Computern und Akzeptanz computerisierter Untersuchungen bei stationär behandelten psychiatrischen Patienten

Die Nutzung von Computern hat in unserer Gesellschaft während der letzten Jahre stark zugenommen und eine Umkehrung dieses Trends ist derzeit nicht denkbar. Auch in zunehmend mehr Feldern der Medizin wird Computertechnik genutzt, wobei nicht nur die im medizinischen Sektor Beschäftigten, sondern auch die Patienten immer häufiger mit dem Computer als diagnostischem Hilfsmittel konfrontiert werden. Es erscheint naheliegend, daß psychiatrisch kranke Menschen besonders sensibel hierauf reagieren könnten. Menschen richten ihr Handeln an individuellen Leitschienen aus, sie handeln auf der Grundlage von Einstellungen (englisch: attitude). Akzeptanz beschreibt hingegen einen kurzfristigen Prozeß, die Bereitschaft, etwas Neues anzunehmen. Die vorliegende Arbeit beschäftigt sich mit der Frage, welche Rolle die Einstellung zu Computern (‚computer attitude‘) und die Akzeptanz von Computeruntersuchungen bei deren Anwendung an psychiatrischer Patienten spielen. Sie untersucht, ob und wie sich Einstellung und Akzeptanz messen lassen und wodurch sie beeinflusst werden. 160 stationär behandelte psychiatrische Patienten der Klinik für Psychiatrie und Psychotherapie I der J.W. Goethe-Universität beantworteten einen Fragebogen zur Messung der Einstellung gegenüber Computern (GCAS). Ein Teil (N=78) dieser 160 Patienten absolvierte zusätzlich eine umfangreiche Test- und Fragebogenbatterie am Computer und mit herkömmlichen ‚Papierund-Bleistift‘-Verfahren, in deren Verlauf die Akzeptanz der Untersuchung erfaßt wurde. Die Untersuchungszeitpunkte lagen jeweils in enger zeitlicher Nähe zur Aufnahme und zur Entlassung aus der stationären Behandlung. Wiederum ein Teil (N=22) dieser 78 Patienten hatte zwischen Erst- und Zweituntersuchung Gelegenheit, den Computer in einer spielerisch gestalteten Weise als Freizeitinstrument zu nutzen. Die Auswertungen berücksichtigten die Zugehörigkeit zu drei diagnostischen Subgruppen (‚psychotische Störung‘, ‚affektive Störung‘ und ‚andere Störungen‘). Zunächst wurden die Testgütekriterien der selbst entwickelten Instrumente geprüft. Es zeigte sich eine generell positive Einstellung der untersuchten Patienten gegenüber dem Computer (GCAS-Score > 48 bei 76,9% der Patienten). Bezüglich der diagnostischen Subgruppen zeigten sich keine signifikanten Unterschiede. Männliche (Z=2,4; p=0,02), jüngere (R=-0,22; p=0,002) und besser gebildete Patienten (R=0,34; p=0,00001) hatten jedoch eine bessere Einstellung gegenüber Computern. Es fanden sich Unterschiede in der Akzeptanz der Computeruntersuchung in Abhängigkeit von diagnostischer Subgruppe und Einstellung zu Computern. Die spielerische Kurzintervention erwies sich als nicht geeignet die Einstellung gegenüber Computern signifikant zu verändern. In der vorliegenden Arbeit wird gezeigt, welchen Einfluß Einstellungen und Akzeptanz auf die Interaktion von Patient und Computer haben. Die Kenntnis dieses Einflusses ist für die Bewertung der am Computer erzielten Testergebnisse eine wesentliche Information.The use of computers has increased heavily in our society in recent years and a reversal of this trend is not currently conceivable. Computer technology is also being used in increasing numbers of medical fields, in which context it is not only the people employed in the medical sector but also patients who are being faced with computers as diagnostic aids with increasing frequency. It would seem obvious that people with psychiatric illnesses react to this development with particular sensitivity. People’s actions are guided by individual guiding principles, they act on the basis of attitudes. Acceptance, by contrast, describes a short-term process, the willingness to accept something new. The present dissertation deals with the question of the role played by attitudes towards computers and the acceptance of computer diagnosis when computers are used with psychiatric patients. It investigates whether and how attitude and acceptance can be measured and by what factors they are influenced. 160 psychiatric in-patients at the Clinic for Psychiatry and Psychotherapy I of the J. W. Goethe University answered a questionnaire measuring attitudes to computers (GCAS). One segment (N=78) of these 160 patients additionally undertook a comprehensive battery of tests and questionnaires both on the computer and using traditional “paper and pencil”, as part of which acceptance was also recorded. The times when the survey was conducted lay respectively in close proximity to the times when patients were admitted to and discharged from in-patient treatment. A further segment (N=22) of these 78 patients were given the opportunity between the first and second diagnosis to use a computer set up for gaming as a leisure instrument. The analyses took account of membership of three diagnostic sub-groups (‘psychotic disorder’, ‘affective disorder’ and ‘other disorders’). To begin with, the test quality criteria of the instruments developed by the author were tested. There was a generally positive attitude among the patients in the study towards computers (GCAS score > 48 with 76.9% of patients). There were no significant differences between the diagnostic sub-groups. But male (Z=2.4; p=0.02), younger (R=-0.22; p=0.002) and better educated patients (R=0.34; p=0.00001) had a more positive attitude towards computers. There were differences in the acceptance of computer diagnosis depending on the diagnostic sub-group and attitude to computers. The brief gaming interval did not turn out to be suitable to change the attitude towards computers significantly. The present dissertation clearly shows the influence of attitude and acceptance on the interaction between patient and computer. Knowledge of this influence represents significant information when analysing the results achieved at the computer

A Decision Tree Approach To The Assessment Of Posttraumatic Stress Disorder

Structured diagnostic interviews are widely considered to be the optimal method of assessing symptoms of posttraumatic stress; however few clinicians report using structured assessments to guide clinical practice. One key impediment to the use of structured assessments in clinical practice is the amount of time required for test administration and interpretation. Thus, the present research conducted an initial feasibility study using a normative sample of college-aged adults (n = 88) to develop an assessment protocol based on the clinician administered PTSD scale (caps). Decision tree analysis was utilized to identify a subset of predictor variables within the 17 caps symptom criteria variables that were most predictive of a diagnosis of posttraumatic stress disorder (PTSD). The algorithm-driven sequence of questions reduced the number of items administered by more than 75% and classified the validation sample at 100.0% accuracy for those without a diagnosis of PTSD and 85.7% accuracy for those with a diagnosis of PTSD. The present study also demonstrated the feasibility of computer administration of the algorithm-based sequence in a normative sample of college-aged adults (n = 197). The algorithm-based, computer-administered sequence had high sensitivity and specificity and excellent diagnostic agreement with the computer-administered full caps sequence. These results demonstrated the feasibility of developing a protocol to assess PTSD in a way that imposes little assessment burden while still providing a reliable diagnosis

Quality of life assessment in women with breast cancer: benefits, acceptability and utilization

In 2006, breast cancer was the third leading cause of death in American women; however, more women survive breast cancer than any other type of cancer. As the disease progresses, it is important to know how one's health-related quality of life (QOL) is affected for those who receive treatment, those who survive, and those who remain disease-free. The purpose of this study was to summarize the benefits, challenges, and barriers of QOL measurement for female breast cancer patients. A PubMed literature search was conducted using the terms "quality of life" and "breast cancer." The search was then refined with terms related to QOL assessment instruments. The research team reviewed over 100 of the 2,090 articles identified

Diagnostic efficiency of the computerized PTSD scale – multimedia version (CPS-M) in assessing posttraumatic stress disorder

The most commonly used interview for posttraumatic stress disorder (PTSD) is the Clinician-Administered PTSD Scale (CAPS), a semi-structured interview patterned after the DSM-IV criteria (Blake et al., 1990). The Computerized PTSD Scale – Multimedia Version (CPS-M: Richard, Mayo, Bohn, Haynes, & Kolman, 1997) is a computerized interview that is modeled after the CAPS. This study examined how well the CPS-M agreed with the CAPS diagnostically in a clinical sample. Ninety veterans completed the test protocol consisting of paper-and-pencil measures, the CPS-M, and the CAPS interview. Correlations between the CAPS and CPS-M were high at the item, subscale, and full-scale levels. Confidence interval analysis revealed that the CPS-M scales were not significantly different from their CAPS counterparts but failed to establish equivalence. Alpha scores for the scales indicated good internal consistency on both the CAPS and CPS-M. Difference scores between the two instruments were normally distributed, and scale effect sizes were negligible. ROC curve analysis for the CPS-M revealed high diagnostic accuracy. These results present a strong case for more widespread use of the CPS-M in the assessment of PTSD

Standardization and normative data of the Greek version of the temperament and character inventory (TCI)

BACKGROUND: Robert Cloninger’s psychobiological model of temperament and character is a dimensional approach to personality assessment and gave birth to the temperament and character inventory (TCI). The aim of the present report is to examine the psychometric properties of the Greek version of the TCI, and to replicate its postulated structure and provide preliminary normative data for the Greek population. METHODS: The study sample included 734 subjects from the general Greek population (436 females; 59.4 % and 298 males; 40.6 %). Their mean age was 40.80 ± 11.48 years (range 25–67 years). The mean age for females was 39.43 ± 10.87 years (range 25–65 years), while the mean age for males was 42.82 ± 12.06 years (range 25–67 years). Descriptive statistics tables concerning age, gender and occupational status distribution in the sample were created. The analysis included the calculation of Cronbach’s alpha, factor analysis with promax rotation and the calculation of Pearson correlation coefficients between the subscales scores. Analysis of Covariance with age as covariate and t test and Cohen’s d as post hoc tests was used to search for differences in subscales scores between males and females. RESULTS: The overall psychometric properties of the Greek version of the TCI proved to be satisfactory, with acceptable consistencies of the subscales. The factor analysis of temperament identified four factors which together explained 58.56 % of total variance, while the factor analysis of the three-factor solution of the character explained 52.24 % of total variance. The TCI scales correlate significantly but weakly between each other and with age. DISCUSSION: The Greek version of the TCI exhibits psychometric properties similar to its original English counterpart and to other national translations and it is suitable for use in research and clinical practice