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Psychometric properties of a single-item visual analog scale measuring goals of care in patients with advanced cancer

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Abstract

Purpose

The purpose of this study was to examine the psychometric properties of a single-item visual analog scale (VAS) to measure goals of care in patients with advanced cancer.

Methods

Data were obtained from 378 patients with diagnoses of advanced lung, gastrointestinal, or pancreatic cancer. Goal of care was measured at baseline and every 3 months until patient death or completion of the 15-month study period. A single-item VAS ranging from 0 (quality of life is all that matters) to 100 (length of life is all that matters) was used to measure patients’ goals of care for all study subjects; a subsample of subjects also completed the Quality of Life-Length of Life scale which asked patients to select categories of preferences. Test–retest reliability (intra-class correlation) and construct validity (known-groups, convergent, divergent) were evaluated.

Results

At 9 and 12 months, the test–retest reliability for patients with stable symptoms (n = 107) was established with the ICC(1,3) = 0.81, p < .001. Known-groups (r = 0.99, p < .001), convergent (r = 0.78, p < .001), and divergent (r = .06, p = 0.24) validity all demonstrated evidence of good construct validity.

Conclusions

Preliminary psychometric testing for a single-item VAS that measures goals of care in a sample of patients with advanced cancer met standard requirements for reliability and validity. While further testing with a larger sample size is recommended, the tool’s use in the clinical area to assess cancer patients’ goals of care is appropriate. Such a tool could facilitate goals of care discussions in the clinical area.

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References

  1. Bischoff, K., O’Riordan, D. L., Marks, A. K., Sudore, R., & Pantilat, S. Z. (2018). Care planning for inpatients referred for palliative care consultation. Journal of the American Medical Association,178(1), 48–54.

    Google Scholar 

  2. Kaplan, S. H., Greenfield, S., & Ware, J. E. (1989). Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care,27(3 Suppl), S110–S127.

    Article  CAS  Google Scholar 

  3. Roter, D. L., Hall, J. A., Kern, D. E., Barker, L. R., Cole, K. A., & Roca, R. P. (1995). Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomize clinical trial. Archives of Internal Medicine,155(17), 1877–1884.

    Article  CAS  Google Scholar 

  4. Bertakis, K. D., Roter, D., & Putnam, S. M. (1991). The relationship of physician medical interview style to patient satisfaction. Journal of Family Practice,32(2), 175–181.

    CAS  PubMed  Google Scholar 

  5. Wright, A. A., Zhang, B., Ray, A., Mack, J. W., Trice, E., Balboni, T., et al. (2008). Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. Journal of the American Medical Association,300(14), 1665–1673.

    Article  CAS  Google Scholar 

  6. You, J. J., Fowler, R. A., Heyland, D. K., & Canadian Researchers at the End of Life Network (CARENET). (2014). Just ask: discussing goals of care with patients in hospital with serious illness. Canadian Medical Association Journal,186(6), 425–432.

    Article  Google Scholar 

  7. Balogh, E. P., Ganz, P. A., Murphy, S. B., Nass, S. J., Ferrell, B. R., & Stovall, E. (2011). Patient-centered cancer treatment planning: Improving the quality of oncology care. Summary of an Institute of Medicine workshop. The Oncologist,16(12), 1800–1805.

    Article  Google Scholar 

  8. Douglas, S. L., Lipson, A. R., & Daly, B. J. (2018). Analyzing goals of care in advanced cancer patients and their family caregivers: Evidence-based research. POJ Nursing Practice and Research,2(1), 1–4.

    Article  Google Scholar 

  9. Derry, H. M., Reid, M. C., & Prigerson, H. G. (2019). Advanced cancer patients' understanding of prognostic information: Applying insights from psychological research. Cancer Medicine,8(9), 4081–4088.

    PubMed  PubMed Central  Google Scholar 

  10. LeBlanc, T.W., Tulsky, J. (2018). Discussing goals of care. Block, S.D., ed. Resource document. UpToDate Inc. Retrieved September 9, 2019, from https://www.uptodate.com/contents/discussing-goals-of-care?search=Discussing%20goals%20of%20care&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.

  11. Meropol, N. J., Weinfurt, K. P., Burnett, C. B., Balshem, A., Benson, A. B., Castel, L., et al. (2003). Perceptions of patients and physicians regarding phase I cancer clinical trials: implications for physician-patient communication. Journal of Clinical Oncology,21(13), 2589–2596.

    Article  Google Scholar 

  12. Sanders, J. J., Curtis, J. R., & Tulsky, J. A. (2018). Achieving goal-concordant care: A conceptual model and approach to measuring serious illness communication and its impact. Journal of Palliative Medicine,21(S2), S17–S27.

    Article  Google Scholar 

  13. Bijur, P. E., Silver, W., & Gallagher, J. (2001). Reliability of the visual analog scale for measurement of acute pain. Academic Emergency Medicine,8(12), 1153–1157.

    Article  CAS  Google Scholar 

  14. Back, A. L. (2017). What enables oncologists to discuss goals of care with their patients? practical ways toward a culture of kindness, transparency, and responsibility. Journal of Oncology Practice,13(9), 591–593.

    Article  Google Scholar 

  15. Rhee, H., Belyea, M., & Mammen, J. (2017). Visual analogue scale (VAS) as a monitoring tool for daily changes in asthma symptoms in adolescents: A prospective study. Allergy, Asthma & Clinical Immunology,13, 24–31.

    Article  Google Scholar 

  16. Haley, K. L., Womack, J. L., Harmon, T. G., & Williams, S. W. (2015). Visual analog rating of mood by people with aphasia. Topics in Stroke Rehabilitation,22(4), 239–245.

    Article  Google Scholar 

  17. Heller, G. Z., Manuguerra, M., & Chow, R. (2016). How to analyze the visual analogue scale: myths, truths and clinical relevance. Scandinavian Journal of Pain,13, 67–75.

    Article  Google Scholar 

  18. de Boer, A. G., van Lanschot, J. J., Stalmeier, P. F., van Sandick, J. W., Hulscher, J. B., de Haes, J. C., et al. (2004). Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Quality of Life Research,13(2), 311–320.

    Article  Google Scholar 

  19. Stanek, S. (2017). Goals of care: a concept clarification. Journal of Advanced Nursing,73(6), 1302–1314.

    Article  Google Scholar 

  20. Meropol, N. J., Egleston, B. L., Buzaglo, J. S., Benson, B., Cegala, D. J., Diefenbach, M. A., et al. (2008). Cancer patient preferences for quality and length of life. Cancer,113(12), 3459–3466.

    Article  Google Scholar 

  21. Weinfurt, K. P., Castel, L. D., Li, Y., Sulmasy, D. P., Balshem, A. M., Benson, A. B., et al. (2003). The correlation between patient characteristics and expectations of benefit from phase I clinical trials. Cancer,98(1), 166–175.

    Article  Google Scholar 

  22. Winter, L., & Parks, S. M. (2008). Family discord and proxy decision makers' end-of-life treatment decisions. Journal of Palliative Medicine,11(8), 1109–1114.

    Article  Google Scholar 

  23. Winter, L. (2013). Patient values and preferences for end of life treatments: Are values better predictors than a living will? Journal of Palliative Medicine,16(4), 362–368.

    Article  Google Scholar 

  24. Hui, D., & Bruera, E. (2017). The edmonton symptom assessment system 25 years later: Past, present and future developments. Journal of Pain and Symptom Management,53(3), 630–643.

    Article  Google Scholar 

  25. Carvaja, A., Centeno, C., Watson, R., & Bruera, E. (2011). A comprehensive study of psychometric properties of the Edmonton Symptom Assessment System (ESAS) in Spanish advanced cancer patients. European Journal of Cancer,47(12), 1863–1872.

    Article  Google Scholar 

  26. Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia: Wolters Kluwer Health.

    Google Scholar 

  27. Amit, M., Hutcheson, K., Zaveri, J., Lewin, J., Kupferman, M. E., Hessel, A. C., et al. (2019). Patient-reported outcomes of symptom burden in patients receiving surgical or nonsurgical treatment for low-intermediate risk oropharyngeal squamous cell carcinoma: a comparative analysis of a prospective registry. Oral Oncology,91, 13–20.

    Article  Google Scholar 

  28. Waltz, C. F., Strickland, O. L., & Lenz, E. R. (2005). Measurement in nursing and health research (3rd ed.). New York: Springer.

    Google Scholar 

  29. DeVon, H. A., Block, M. E., Moyle-Wright, P., Ernst, D. M., Hayden, S. J., Lazzara, D. J., et al. (2007). A psychometric toolbox for testing validity and reliability. Journal of Nursing Scholarship,39(2), 155–164.

    Article  Google Scholar 

  30. Mokkink, L. B., Terwee, C. B., Knol, D. L., Stratford, P. W., Alonso, J., Patrick, D. L., et al. (2010). The COSMIN checklist for evaluating the methodological quality of studies on measurement properties: A clarification of its content. BioMedCentral Medical Research Methodology,10, 22.

    Article  Google Scholar 

  31. Campbell, D. T., & Fiske, D. W. (1959). Convergent and discriminant validation by the multitrait-multimethod matrix. Psychological Bulletin,56(2), 81–105.

    Article  CAS  Google Scholar 

  32. Cohen, J. (1977). Statistical power analysis for the behavioral sciences (Rev. ed.). Hillsdale: Lawrence Erlbaum Associates, Inc.

    Google Scholar 

  33. Perron, B., & Gillespie, D. (2015). Key concepts in measurement. New York, NY: Oxford University Press.

    Book  Google Scholar 

  34. Sendlbeck, M., Araujo, E. G., Schett, G., & Englbrecht, M. (2015). Psychometric properties of three single-item pain scales in patients with rheumatoid arthritis seen during routine clinical care: A comparative perspective on construct validity, reproducibility and internal responsiveness. Rheumatic and Musculoskeletal Diseases Open,1, 1–9.

    Google Scholar 

  35. Yen, M., & Lo, L. H. (2002). Examining test-retest reliability: An intra-class correlation approach. Nursing Research,51(1), 59–62.

    Article  Google Scholar 

  36. Gang, C., Taylor, P. A., Haller, S., Kircanski, K., Stoddard, J., Pine, D. S., et al. (2018). Intraclass correlation: Improved modeling approaches and applications for neuroimaging. Human Brain Mapping,39(3), 1187–1206.

    Article  Google Scholar 

  37. Sandberg, A., Cider, Å., Jivegård, L., Nordanstig, J., Wittboldt, S., & Bäck, M. (2020). Test-retest reliability, agreement, and minimal detectable change in the 6-minute walk test in patients with intermittent claudication. Journal of Vascular Surgery,71(1), 197–203.

    Article  Google Scholar 

  38. Koo, T. K., & Li, M. Y. (2016). Cracking the code: providing insight into the fundamentals of research and evidence-based practice—A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine,15(2), 155–163.

    Article  Google Scholar 

  39. Trochim, W. M. K. (2005). The research methods knowledge base (2nd ed.). Cincinnati, OH: Atomic Dog Publishing.

    Google Scholar 

  40. Paiva, C. E., Barroso, E. M., Carneseca, E. C., Souza, C. P., dos Santos, F. T., Mendoza Lopez, R. V., et al. (2014). A critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: a systematic review. BioMedCentral Medical Research Methodology,14, 8–18.

    Article  Google Scholar 

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Acknowledgements

Supported by Grant No. NRO14856, National Institute of Health/National Institute of Nursing Research

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Authors and Affiliations

  1. Case Comprehensive Cancer Center, Case Western Reserve University, School of Nursing, 10900 Euclid Avenue, Cleveland, OH, 44104, USA

    Sara L. Douglas

  2. Case Western Reserve University, School of Nursing, 10900 Euclid Avenue, Cleveland, OH, 44104, USA

    Grant Pignatello, Sumin Park & Amy R. Lipson

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  1. Sara L. Douglas
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Correspondence to Sara L. Douglas.

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Douglas, S.L., Pignatello, G., Park, S. et al. Psychometric properties of a single-item visual analog scale measuring goals of care in patients with advanced cancer. Qual Life Res 29, 1999–2005 (2020). https://doi.org/10.1007/s11136-020-02458-w

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