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Development and validation of the nasopharyngeal cancer scale among the system of quality of life instruments for cancer patients (QLICP-NA V2.0): combined classical test theory and generalizability theory

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Abstract

Objectives

This research was designed to develop a nasopharyngeal cancer (NPC) scale based on quality of life (QOL) instruments for cancer patients (QLICP-NA). This scale was developed by using a modular approach and was evaluated by classical test and generalizability theories.

Methods

Programmed decision procedures and theories on instrument development were applied to create QLICP-NA V2.0. A total of 121 NPC inpatients were assessed using QLICP-NA V2.0 to measure their QOL data from hospital admission until discharge. Scale validity, reliability, and responsiveness were evaluated by correlation, factor, parallel, multi-trait scaling, and t test analyses, as well as by generalizability (G) and decision (D) studies of the generalizability theory.

Results

Results of multi-trait scaling, correlation, factor, and parallel analyses indicated that QLICP-NA V2.0 exhibited good construct validity. The significant difference of QOL between the treated and untreated NPC patients indicated a good clinical validity of the questionnaire. The internal consistency (α) and test–retest reliability coefficients (intra-class correlations) of each domain, as well as the overall scale, were all >0.70. Ceiling effects were not found in all domains and most facets, except for common side effects (24.8 %) in the domain of common symptoms and side effects, tumor early symptoms (27.3 %) and therapeutic side effects (23.2 %) in specific domain, whereas floor effects did not exist in each domain/facet. The overall changes in the physical and social domains were significantly different between pre- and post-treatments with a moderate effective size (standard response mean) ranging from 0.21 to 0.27 (p < 0.05), but these changes were not obvious in the other domains, as well as in the overall scale. Scale reliability was further confirmed by G coefficients and index of dependability, with more exact variance components based on generalizability theory.

Conclusions

QLICP-NA V2.0 exhibited reasonable degrees of validity, reliability, and responsiveness. However, this scale must be further improved before it can be used as a practical instrument to evaluate the QOL of NPC patients in China.

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Acknowledgments

The authors received the Grant support from the National Natural Science Foundation of China (81302510, 81273185).

Funding

This study was funded by the National Natural Science Foundation of China (Grant number: 81302510, 81273185).

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Author notes

    Authors and Affiliations

    1. Nutritional Department, The Affiliated Hospital of Guangdong Medical College, Zhanjiang, 524001, Guangdong, China

      Jiayuan Wu

    2. School of Pubic Health, Guangdong Medical College, Zhanjiang, 524023, Guangdong, China

      Liren Hu & Gaohua Zhang

    3. Department of Oncology, The Affiliated Hospital of Guangdong Medical College, Zhanjiang, 524001, Guangdong, China

      Qilian Liang

    4. School of Public Health, Kunming Medical University, Kunming, 650500, Yunnan, China

      Qiong Meng

    5. School of Humanities and Management, Research Center on Quality of Life and Applied Psychology, Guangdong Medical College, Dongguan, 523808, Guangdong, China

      Chonghua Wan

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    1. Jiayuan Wu
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    Correspondence to Qilian Liang or Chonghua Wan.

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    Jiayuan Wu declares that he has no conflict of interest. Liren Hu declares that he has no conflict of interest. Gaohua Zhang declares that he has no conflict of interest. Qilian Liang declares that he has no conflict of interest. Qiong Meng declares that he has no conflict of interest. Chonghua Wan declares that he has no conflict of interest.

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    All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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    Informed consent was obtained from all individual participants included in the study.

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    Jiayuan Wu and Liren Hu are as the first co-author with the same contributions.

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    Wu, J., Hu, L., Zhang, G. et al. Development and validation of the nasopharyngeal cancer scale among the system of quality of life instruments for cancer patients (QLICP-NA V2.0): combined classical test theory and generalizability theory. Qual Life Res 25, 2087–2100 (2016). https://doi.org/10.1007/s11136-016-1251-4

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