Author:
Vickers Andrew J.,Assel Melissa,Hannon Michael,Desai Priyanka,Carlsson Sigrid V.,McCready Taylor,Cracchiolo Jennifer,Simon Brett
Abstract
Abstract
Background
Verbal rating scales (VRS) are widely used in patient-reported outcome (PRO) measures. At our institution, patients complete an online instrument using VRSs with a five-point brief response scale to assess symptoms as part of routine follow-up after ambulatory cancer surgery. We received feedback from patients that the brief VRS descriptors such as “mild” or “somewhat” were vague. We added explicit descriptors to our VRSs, for instance, “Mild: I can generally ignore my pain” for pain severity or “Somewhat: I can do some things okay, but most of my daily activities are harder because of fatigue” for fatigue interference. We then compared responses before and after this change was made.
Methods
The symptoms investigated were pain, fatigue and nausea. Our hypothesis was that the explicit descriptors would reduce overall variance. We therefore compared the coefficient of variation of scores and tested the association between symptoms scores and known predictors thereof. We also compared time to completion between questionnaires with and without the additional descriptors.
Results
A total of 17,500 patients undergoing 21,497 operations were assigned questionnaires in the period before the descriptors were added; allowing for a short transition period, 1,417 patients having 1436 operations were assigned questionnaires with the additional descriptors. Symptom scores were about 10% lower with the additional descriptors but the coefficient of variation was slightly higher. Moreover, the only statistically significant difference between groups for association with a known predictor favored the item without the additional language for nausea severity (p = 0.004). Total completion time was longer when the instrument included the additional descriptors, particularly the first and second time that the questionnaire was completed.
Conclusions
Adding descriptors to a VRS of post-operative symptoms did not improve scale properties in patients undergoing ambulatory cancer surgery. We have removed the additional descriptors from our tool. We recommend further comparative psychometric research using data from PROs collected as part of routine clinical care.
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,General Medicine
Reference18 articles.
1. Pusic AL, Temple LK, Carter J, Stabile CM, Assel MJ, Vickers AJ, et al. A randomized controlled trial evaluating electronic outpatient symptom monitoring after ambulatory cancer surgery. Ann Surg. 2021;274(3):441–8.
2. Basch E, Reeve BB, Mitchell SA, Clauser SB, Minasian LM, Dueck AC, et al. Development of the National Cancer Institute's patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE). J Natl Cancer Inst. 2014;106(9):dju244.
3. Ancker JS, Stabile C, Carter J, Chen LY, Stein D, Stetson PD, et al. Informing, reassuring, or alarming? Balancing patient needs in the development of a postsurgical symptom reporting system in cancer. AMIA Annu Symp Proc. 2018;2018:166–74.
4. Vickers AJ. Comparison of an ordinal and a continuous outcome measure of muscle soreness. Int J Technol Assess Health Care. 1999;15(4):709–16.
5. van Dijk JFM, Zaslansky R, van Boekel RLM, Cheuk-Alam JM, Baart SJ, Huygen F, et al. Postoperative pain and age: a retrospective cohort association study. Anesthesiology. 2021;135(6):1104–19.