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. 2016 Oct;25(10):2403-2415.
doi: 10.1007/s11136-016-1354-y. Epub 2016 Jul 8.

New Measures to Capture End of Life Concerns in Huntington Disease: Meaning and Purpose and Concern With Death and Dying From HDQLIFE (A Patient-Reported Outcomes Measurement System)

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Free PMC article

New Measures to Capture End of Life Concerns in Huntington Disease: Meaning and Purpose and Concern With Death and Dying From HDQLIFE (A Patient-Reported Outcomes Measurement System)

N E Carlozzi et al. Qual Life Res. .
Free PMC article

Abstract

Purpose: Huntington disease (HD) is an incurable terminal disease. Thus, end of life (EOL) concerns are common in these individuals. A quantitative measure of EOL concerns in HD would enable a better understanding of how these concerns impact health-related quality of life. Therefore, we developed new measures of EOL for use in HD.

Methods: An EOL item pool of 45 items was field tested in 507 individuals with prodromal or manifest HD. Exploratory and confirmatory factor analyses (EFA and CFA, respectively) were conducted to establish unidimensional item pools. Item response theory (IRT) and differential item functioning analyses were applied to the identified unidimensional item pools to select the final items.

Results: EFA and CFA supported two separate unidimensional sets of items: Concern with Death and Dying (16 items), and Meaning and Purpose (14 items). IRT and DIF supported the retention of 12 Concern with Death and Dying items and 4 Meaning and Purpose items. IRT data supported the development of both a computer adaptive test (CAT) and a 6-item, static short form for Concern with Death and Dying.

Conclusion: The HDQLIFE Concern with Death and Dying CAT and corresponding 6-item short form, and the 4-item calibrated HDQLIFE Meaning and Purpose scale demonstrate excellent psychometric properties. These new measures have the potential to provide clinically meaningful information about end-of-life preferences and concerns to clinicians and researchers working with individuals with HD. In addition, these measures may also be relevant and useful for other terminal conditions.

Keywords: End of life; HDQLIFE; Health-related quality of life; Huntington disease; Neuro-QoL; PROMIS; Patient-reported outcome (PRO).

Figures

Figure 1
Figure 1
Procedures to develop the new end of life concerns item pool
Figure 2
Figure 2. HDQLIFE Meaning and Purpose Test Information
In general, we want total information to be > 9.0 and standard error to be < 0.33 (this provides a reliability of 0.9). This figure shows excellent total information and standard error for Meaning and Purpose scale scores between −3 and 0.5.
Figure 3
Figure 3. HDQLIFE Concern with Death and Dying Test Information
This figure shows the test information and scale score standard error for different scale scores in standard deviation units for the Concern with Death and Dying scale. Information was good (i.e., reliability ≥ .80), for scale scores between −1.5 and 3.0.
Figure 4
Figure 4. HDQLIFE Concern with Death and Dying Number of CAT Items by CAT Theta
This figure shows the number of CAT items used for different scale scores in standard deviation units: at −1 SD units, the CAT always used all 12 items in the item bank; at +1 and +2 SD units, the CAT always used the minimum number of 4 items in the item bank; and at 3 SD units the CAT used all 12 items in the item bank.

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