swedish learning 21; seattle; swedish
Purpose: To develop an item response theory (IRT)-calibrated patient-reported outcome measure (PRO) that assesses cancer patient physical function, fatigue and social participation.
Problem Statement: The subspecialty of cancer rehabilitation medicine (CRM) has to date lacked a psychometrically validated patient-reported outcome measure that assesses patients’ physical function, fatigue, and social participation. A significant proportion of the 16.9 million US cancer survivors will experience, or have already experienced, impairments that compromise function, a predictable consequence of their disease and treatment. While each disease site and line of treatment may be associated with unique impairments, there are some that cut across several cancers within the diagnostic spectrum, while others are common in most. Examples include neuropathic pain, peripheral neuropathy, myalgia, arthralgia, deconditioning, altered biomechanics, lymphedema, cognitive impairment, insomnia, and bladder/bowel dysfunction. It is therefore critical to develop psychometrically sound outcome instruments that accurately measure rehabilitative outcomes across an episode of clinical care.
Background: Although the field of cancer rehabilitation is growing, its ability to meet clinical demands lags current and projected needs. There are many probable causes, but one that is potentially addressable in the near term is the lack of a scalable means of assessing physical and social function to align care with patients’ symptoms and goals. In 2015, the Cancer Rehabilitation Medicine Metrics Consortium (CRMMC) was formed to address this need. This study field tested a 21-item patient reported outcome tool previously created by CRMMC.
Methods: The 21 candidate items in addition to anchoring items were administered to participants at each of the 6 participating CRMMC institutions. Demographic and clinical information was abstracted from participant’s EHR. Data was anonymized and captured via REDCap. Data analysis methods included descriptive statistics for demographic and clinical data; IRT information curves and density plots for candidate items; and regression models to assess discrimination across anchoring variables and stepwise increases across ordered response options. Poorly performing, redundant or low information-containing items were discarded. A scoring algorithm was created.
Results: A total of 616 patients completed 21 items in the initial item pool. Nine items were removed because of comparatively lower information that they provide according to IRT item calibrations, low item-total correlations, or bimodal distributions. The remaining items generated a 12-item short form. Regression analyses determined that the items were responsive to and representative of the patient population across trait ranges and multiple domains/subdomains of function.
Conclusion/Discussion: This psychometric investigation supports use of the 12-item PROMIS Cancer Function Brief 3D Profile for evaluating function in outpatient cancer rehabilitation patients.
Significance: To our knowledge, the PROMIS Cancer Function Brief 3D Profile is the first specialized SF created from PROMIS item banks to meet the unique assessment and clinical decision-making needs of rehabilitation providers who treat cancer patients. We believe that the development of the PROMIS Cancer Function Brief 3D Profile is important, as it has high information density and requires minimal time for patients to complete. It’s been integrated into Epic QNRs and is being piloted in the SCI’s cancer rehabilitation medicine clinic.
Smith, Sean R.; Vargo, Mary; Zucker, David S; Shahpar, Samman; Gerber, Lynn; Henderson, Maryanne; Jay, Gina; Lee, Minji; and Cheville, Andrea, "Psychometric Characteristics and Validity of the PROMIS Cancer Function Brief 3D Profile" (2022). All Podium Presentations. 4.