Assessing measurement invariance of a health-related quality-of-life questionnaire in radiotherapy patients

Objective: If the assumption of measurement invariance is not tested, we cannot be sure whether differences observed are due to true differences in health-related quality-of-life (HRQoL), or are measurement artifacts. We aim to investigate this assumption in a sample of heterogeneous cancer patients, focusing on whether age, sex, previous treatment for cancer, and information regarding treatment preferences result in biased HRQoL scores. Methods: 155 cancer patients who were about to begin their first session of radiotherapy were included. HRQoL was measured using the EORTC QLQ-C30. Structural equation modeling was applied to assess whether there was a violation of the assumption of invariance. Results: A satisfactory single construct (Functioning HRQoL) measurement model was found and two violations of invariance were identified. Irrespective of patients’ Functioning HRQoL, older patients reported worse physical functioning and patients who had received treatment prior to radiotherapy reported worse emotional functioning than we would otherwise expect. Conclusions: In the present study, accounting for measurement bias lead to a substantial improvement in the overall fit of the model. By ignoring the bias, we would have concluded that the model fit was unsatisfactory. The findings underline the importance of investigating measurement invariance in scales designed for heterogeneous samples

Globale effectvoorspellings- en beoordelingsmethoden: voorspelling en beoordeling van milieu-effecten ten behoeve van een MER ten dienste van een mogelijke toekomstige wijziging of herziening van het bestaande Structuurschema Drink- en Industriewatervoorziening

Wetensch. publicatieInstitute of Environmental Science

Denial and social and emotional outcomes in lung cancer patients: The protective effect of denial

Denial is a well-known phenomenon in clinical oncology practice. Yet whether the impact of denial on patient well-being is beneficial or harmful remains unknown. The purpose of the current study is to investigate the relationship between denial and social and emotional outcomes in a large sample of lung cancer patients over an extended time period. Denial and social and emotional outcomes were measured in 195 newly diagnosed lung cancer patients. Four assessments were conducted over 8 months. The level of denial was measured using the Denial of Cancer Interview. Patient-reported social and emotional outcomes were measured using the EORTC-QLQ-30 and the HADS. Patients with a moderate or increasing level of denial over time reported better social outcomes (role functioning: p = 0.0036, social functioning: p = 0.027) and less anxiety (p = 0.0001) and depression (p = 0.0019) than patients with a low level of denial. The overall quality of life was better among lung cancer patients who displayed either moderate or increasing levels of denial compared with those who displayed low levels of denial (p < 0.0001). A certain level of denial in lung cancer patients can have a protective effect on social and emotional outcomes. Clinicians should take this into account when providing information about the illness and its prognosis. (C) 2010 Elsevier Ireland Ltd. All rights reserved.Development and application of statistical models for medical scientific researc

Denial and physical outcomes in lung cancer patients, a longitudinal study

Although denial in cancer patients is often seen in clinical practice, studies relating denial to physical outcomes are lacking. The present study aims to investigate patterns of denial among lung cancer patients and connect these to their physical outcomes. Denial was measured longitudinally in 195 consecutive newly diagnosed lung cancer patients. Four assessments were conducted over an 8-month period. Patient-reported physical outcomes were measured with a generic and disease-specific quality of life measure. Medical data were provided by the patients' chest physicians. Three patterns of denial over time were identified in lung cancer patients: patients displayed either low, moderate or increasing denial. Male lung cancer patients were found to deny at a moderate level more often. A moderate or increasing level of denial was consistently related to improved patient-rated physical outcomes. Lung cancer patients displaying more denial reported a better overall perception of health and better physical functioning. They complained less about fatigue, nausea and vomiting, appetite loss, dysphagia and pain in arm and shoulder than low deniers. Other symptoms did not differ among denial classes. Denial in lung cancer patients may well be an adaptive mechanism and have to be respected in clinical practice. (C) 2009 Elsevier Ireland Ltd. All rights reserved.Development and application of statistical models for medical scientific researc

Validity of utilities of patients with esophageal cancer.

Contains fulltext : 48250.pdf (publisher's version ) (Closed access)OBJECTIVES: The convergent validity between utility assessment methods was assessed. METHODS: Investigated were patients with esophageal cancer treated surgically with curative intent. Patients were interviewed in a period from 3 to 12 months after surgical resection. Patients evaluated their actual health and seven other states. Visual analogue scale (VAS) and standard gamble (SG) utilities were obtained for the health states in an interview. Patients also indicated whether or not they preferred death to living in a health state (worse than dead [WTD] preferences). RESULTS: Fifty patients completed the interview. Convergent validity was excellent at the aggregate and individual level. However, the relation between VAS and SG differed strongly across individuals. On a scale from 0 (dead) to 100 (perfect health), SG scores were lower for patients with WTD preferences (mean difference d = 35; p = .002); however, VAS scores did not vary by WTD preferences. CONCLUSIONS: In general, there is good agreement between VAS and SG measures, although patients disagree about how the VAS and SG are related. The standard gamble varied by WTD preferences, however, the VAS did not

Bone marrow necrosis following treatment for chronic myeloid leukaemia with STI-571

Imatinib mesylate has recently been licensed for the treatment of selected patients with chronic myelogenous leukemia (CML). 1We report a case of bone marrow necrosis secondary to imatinib mesylate therapy in a patient with accelerated-phase CM

Developing a digital training tool to support oncologists in the skill of information-provision: A user centred approach

Background: For patients with cancer, being well informed by their oncologist about treatment options and the implications thereof is highly relevant. Communication skills training (CST) programs have shown to be effective in improving clinicians' communication skills, yet CSTs are time-consuming, inconvenient to schedule, and costly. Online education enables new ways of accessible learning in a safe and personalised environment. Aim and methods: We describe the design of a digital CST-tool for information provision skills that meets oncologists' learning needs. We used the CeHRes Roadmap for user-centred design as a guiding framework. Phase 1 (Contextual Inquiry) involved consultation of the literature and a focus group interview study to uncover the learning needs and training preferences of clinicians' regarding a digital training for the skill of information-provision. In phase 2 (Value Specification), two multidisciplinary expert panels specified the learning content and format of a digital training. Phase 3 (Design) encompassed an iterative development process, including two user group assessment sessions and 5 individual user sessions in which prototypes were tested. All sessions were recorded and independently analyzed by two researchers. Results: Based on literature and consultation of the users in the inquiry phase of the development process, and on expert opinion in the value specification phase, relevant (sub) skills and user requirements were defined to consider for the digital training format. It was decided to develop a conventional e-learning and a chatbot. Personalization and interactivity were integrated in the prototypes by including features that allow for e.g., choosing text, video or animation; to upload video-recorded consultations to receive peer-feedback; and to consult a communication expert. Results revealed that, overall, participants expressed a willingness to use a digital training tool to acquire information-provision skills. Individual user testing (including junior clinicians), indicated a preference for the chatbot over the e-learning. Conclusion: We offer a description of extensive development work which was conducted in collaboration with multiple health care professionals to iteratively develop two innovative prototypes of digital tools that would appropriately engage oncologists in learning effective information giving skills. The resulting prototypes were well appreciated and thus provide a solid basis for further development and testing