Establishing Clinically Significant Patient-reported Outcomes for Diverticular Disease

J Surg Res. 2021 Aug;264:20-29. doi: 10.1016/j.jss.2021.01.045. Epub 2021 Mar 18.


Background: Diverticular disease can undermine health-related quality of life. The diverticulitis quality of life (DV-QOL) instrument was designed and validated to measure patient-reported burden of diverticular disease. However, values reflecting meaningful improvement (i.e., minimal clinically important difference [MCID]) and the patient acceptable symptom state (PASS) have yet to be established. We sought to establish the MCID and PASS of the DV-QOL and describe the characteristics of those with DV-QOL above the PASS threshold.

Materials and methods: We performed a prospective cohort study of adults with diverticular disease from seven centers in Washington and California (2016-2018). Patients were surveyed at baseline, then quarterly up to 30 mo. To determine the MCID and PASS for DV-QOL, we applied various previously established distribution- and anchor-based approaches and compared the resulting values.

Results: The study included 177 patients (mean age 57 y, 43% women). A PASS threshold of 3.2/10 distinguished between those with and without health-related quality of life-impacting diverticulitis with acceptable accuracy (area under the curve 0.76). A change of 2.2 points in the DV-QOL was the most appropriate MCID: above the distribution-based MCIDs and corresponding to patient perception of importance of change (AUC 0.70). Patients with DV-QOL ≥ PASS were more often men, younger, had Medicaid, had more serious episodes of diverticulitis, and had an occupational degree or high-school education or less.

Conclusions: Our study is the first to define MCID and PASS for DV-QOL. These thresholds are critical for measuring the impact of diverticular disease and the evaluation of treatment effectiveness.

Keywords: Diverticulitis quality of life; Health-related quality of life (HRQoL); Minimal clinically important difference (MCID); Patient acceptable symptom state (PASS); Patient-reported outcomes; Symptomatic uncomplicated diverticular disease (SUDD).

Publication types

  • Multicenter Study
  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Colectomy / standards*
  • Diverticulitis, Colonic / complications
  • Diverticulitis, Colonic / diagnosis
  • Diverticulitis, Colonic / psychology
  • Diverticulitis, Colonic / surgery*
  • Elective Surgical Procedures / standards*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Minimal Clinically Important Difference
  • Patient Reported Outcome Measures*
  • Practice Guidelines as Topic
  • Prospective Studies
  • Quality of Life*
  • Severity of Illness Index
  • Surveys and Questionnaires / statistics & numerical data
  • Treatment Outcome