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ABSTRACT: To compare the discriminative power of the SF-6D index scores derived from the SF-36 (SF-6D36) and SF-12 (SF-6D12) in the general population.
Data from the National Health Measurement Study were used. The F statistic was used to compare the relative efficiency of the SF-6D36 and SF-6D12, as well as the EQ-5D, HUI2, and HUI3 index scores, in discriminating between respondents with and without 1 of the 11 chronic medical conditions. The efficiency of the multiattribute health classification systems of the study instruments was measured using the Shannon index (H'). The relative efficiency of the SF-6D36 and SF-6D12 was also compared in respondents who were on the ceilings of the EQ-5D, HUI2, and HUI3 scales.
The SF-6D36 score was systematically lower than the SF-6D12 score at the group level (range, 0.022-0.036). The SF-6D36 exhibited higher discriminative power in 8 and 5 conditions than the SF-6D12 and all other index scores, respectively. The SF-6D36 had higher H' values than the SF-6D12 in the dimensions of physical functioning (1.73 vs. 0.78), mental health (1.70 vs. 1.39), and bodily pain (2.16 vs. 1.56) as well as than all other instruments in similar health dimensions. In respondents reporting full health on the EQ-5D, HUI2, or HUI3, the SF-6D36 better discriminated between those with and without medical conditions than the SF-6D12.
The SF-6D derived from the SF-36 is more discriminative than that derived from the SF-12 and is therefore preferred for use in population health surveys where a preference-based health index is needed.
Medical care 03/2012; 50(7):627-32. · 3.24 Impact Factor
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ABSTRACT: Electronic data capture technologies, such as interactive voice response (IVR) systems, are emerging as important alternatives for collecting patient-reported outcome data.
The objective of this study was to assess the test-retest reliability of an IVR version of the EQ-5D.
Outpatient cancer clinic patients (n = 127) were asked to complete the IVR-based EQ-5D twice, 2 days apart. The analyses tested for mean differences (paired t-test) and test-retest reliability (intraclass correlation coefficient [ICC]) to assess measurement stability over time. Equivalence of the means was established if the 95% confidence interval (CI) was within the minimally important difference (MID) interval; namely -0.035 to 0.035 for the EQ-5D index and -3.0 to 3.0 for the visual analog scale (i.e. EQ VAS). Adequacy of the ICC was established by testing whether it differed from a value of 0.70.
Both administrations were completed per protocol by 114 subjects (EQ-5D index) and 110 subjects (EQ VAS). For the EQ-5D index, the means (SD) of the first and second administrations were 0.871 (0.14) and 0.871 (0.15), respectively. The 95% CI of the mean difference was -0.013, 0.013, within the equivalence interval. The ICC was 0.876 (95% lower bound of 0.826) and was significantly different from 0.70. The EQ VAS means (SD) were 81.3 (17.5) and 80.8 (17.5), respectively. The 95% CI of the mean difference was -0.598, 1.617, within the equivalence interval. The EQ VAS ICC was 0.944 (95% lower bound of 0.919) and was significantly greater than 0.70.
This analysis provides substantial evidence that the scores obtained from the IVR version of the EQ-5D are reliable upon repeated administrations.
The patient 01/2012; 5(1):21-6. · 0.57 Impact Factor
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Mark C Hornbrook,
Christopher S Wendel, Stephen Joel Coons,
Marcia Grant,
Lisa J Herrinton,
M Jane Mohler,
Carol M Baldwin,
Carmit K McMullen,
Sylvan B Green,
Andrea Altschuler,
Susan M Rawl,
Robert S Krouse
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ABSTRACT: Societal preference-weighted health-related quality of life (HRQOL) scores enable comparing multidimensional health states across diseases and treatments for research and policy.
To assess the effects of living with a permanent intestinal stoma, compared with a major bowel resection, among colorectal cancer (CRC) survivors.
Cross-sectional multivariate linear regression analysis to explain preference-weighted HRQOL scores.
In all, 640 CRC survivors (≥ 5 years) from 3 group model health maintenance organizations; ostomates and nonostomates with colorectal resections for CRC were matched on gender, age (± 5 years), time since diagnosis, and tumor site (rectum vs. colon).
SF-6D scoring system was applied to Medical Outcomes Study Short Form-36 version 2 (SF-36v2); City of Hope Quality of Life-Ostomy; and Charlson-Deyo comorbidity index.
Survey of CRC survivors linked to respondents' clinical data extracted from health maintenance organization files.
Response rate was 52%. Ostomates and nonostomates had similar sociodemographic characteristics. Mean SF-6D score was 0.69 for ostomates, compared with 0.73 for nonostomates (P < 0.001), but other factors explained this difference. Complications of initial cancer surgery, and previous year comorbidity burden, and hospital use were negatively associated with SF-6D scores, whereas household income was positively associated.
CRC survivors' SF-6D scores were not associated with living with a permanent ostomy after other factors were taken into account. Surgical complications, comorbidities, and metastatic disease lowered the preference-weighted HRQOL of CRC survivors with and without ostomies. Further research to understand and reduce late complications from CRC surgeries as well as associated depression is warranted.
Medical care 03/2011; 49(3):321-6. · 3.24 Impact Factor
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ABSTRACT: This research was aimed at developing a self-completed questionnaire for use in the assessment of stress-related factors at a US government high-tech worksite.
A literature review was performed to identify existing scales of workplace stress and strain. An initial pool of potential items was developed and assessed for content validity by using focus groups. This item pool was reduced to 38 items covering eight domains based on focus group results. A pilot study was conducted to examine the measurement properties of selected items and scales.
Findings from the pilot study led to the 22-item Workplace Stressors Assessment Questionnaire, which includes six domains/scales that exhibited satisfactory measurement properties.
The Workplace Stressors Assessment Questionnaire is a relatively short and psychometrically sound measure that can be used to systematically monitor employees' perceptions of workplace-related stressors.
Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine 12/2010; 52(12):1192-200. · 1.88 Impact Factor
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ABSTRACT: To estimate minimally important differences (MIDs) for the EQ-5D, Health Utilities Index Mark II (HUI2), HUI3, and SF-6D health index scores using health-state transitions defined by each instrument's multiattribute health classification (MAHC) system.
We assume that changes in preference scores associated with the smallest health transitions defined by an MAHC system are minimally important. Any transitions between 2 health states defined by an MAHC system which differ in only one health dimension or attribute and by only one functional level are considered "smallest health transitions." Thus, each such health transition provides 1 MID estimate. The MID for each of the 4 instruments was estimated using all the hypothetical smallest health transitions defined by its MAHC system.
Based on our definitions, the total number of smallest health transitions was 405 for the EQ-5D, 127,600 for the HUI2, 6,382,800 for the HUI3, and 86,700 for the SF-6D. The mean (standard deviation) MID estimate was 0.040 (0.026) for the EQ-5D (US algorithm), 0.082 (0.032) for the EQ-5D (UK algorithm), 0.045 (0.039) for the HUI2, 0.032 (0.027) for the HUI3, and 0.027 (0.028) for the SF-6D. The effect sizes of these MID estimates ranged from 0.11 to 0.37. These MID estimates are quite comparable to published values estimated from empirical data using anchor-based methods.
It is possible to use health transitions defined by the MAHC system to estimate the MIDs for preference-based health index scores. This study provides new information regarding MID estimates for the 4 health indices examined.
Medical care 04/2010; 48(4):365-71. · 3.24 Impact Factor
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Carmit K McMullen,
Mark C Hornbrook,
Lisa J Herrinton,
Andrea Altschuler,
Marcia Grant,
Christopher Wendel, Stephen Joel Coons,
Sylvan B Green,
M Jane Mohler,
Carol M Baldwin,
Michelle Ramirez,
Robert S Krouse
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ABSTRACT: Aims: Understand the determinants of health related quality of life (HRQOL) and the lived experiences among colorectal cancer (CRC) survivors, and identify strategies to help maintain or enhance CRC survivors' HRQOL. Methods: Mail survey and focus groups. Subjects were 283 ostomy and 392 anastomosis long-term CRC survivors within an HMO. Focus groups for subjects with ostomy were divided by gender and high and low HRQOL. Outcome measures were the modified City of Hope Quality of Life (mCOH-QOL)-Ostomy (abridged for anastomosis) and SF-36v2 questionnaires. The SF-6D scoring algorithm was used to calculate an overall HRQOL score from SF-36v2 data. Focus groups were conducted to explore ostomy-related barriers to effective self-care and adaptation strategies. Results: CRC survivors with an ostomy experienced multiple persistent HRQOL losses that differ between men and women. Women CRC survivors with ostomies, for example, reported more sleep disruption and fatigue than men. Living with an ostomy, co-morbidities, socioeconomic status, self-reported depression, and employment status were independent predictors of SF-6D scores. Among CRC survivors with ostomy, fistulas had important implications for HRQOL. Psychological wellbeing among CRC survivors was positively associated with income. Intestinal stomas significantly influenced spiritual HRQOL. Provision or withdrawal of a partners' support affected both short- and long-term psychosocial adjustment of female CRC ostomy patients. Focus group participants identified dietary changes to control bowel output and odor, demands of coping and adjustment, and the time it took to accept the reality of daily living with an ostomy as significant challenges. Conclusions: The greatest challenges reported by CRC survivors confirmed the IOMs findings that survivorship is a distinct, chronic phase of cancer care, and that cancer effects are broad and pervasive. CRC survivors could benefit from dietary and behavioral interventions even 5+ years after their cancer surgery. Women with ostomies seem to do worse than men with ostomies and report a different profile of HRQOL challenges, including sleep disruption and fatigue. Depression screening and psychosocial interventions should be part of survivorship care for CRC patients. CRC survivors should be assessed for income and financial need. Survivorship care should aim at minimizing hospitalizations, depression, and ostomy-related complications among long- term CRC survivors.
Clinical Medicine & Research 03/2010; 8(1):32-3.
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ABSTRACT: The D1 model that was developed to predict US societal preferences for EQ-5D health states addressed several important conceptual and statistical issues. However, it has been criticized for being too complex, failing to account for the nonnormal distribution of health state values, and the transformation of preferences for worse-than-death health states before estimation. This research was conducted to develop an improved model for predicting median preferences for EQ-5D health states for the US population.
Probability-weighted least absolute deviations regression was used to fit models to the time trade-off data collected in the US Valuation of the EQ-5D Health States study. No transformation was applied to the values for states considered worse than death. Several model specifications that differed with respect to explanatory variables were evaluated using two-sample cross-validation.
The best-fitting model included only fixed effects for moderate or severe problems in each of the 5 EQ-5D dimensions and excluded a constant. This specification yielded rank correlations between observed and predicted values and median observed and predicted values of 0.635 and 0.991, respectively, as well as a median absolute error of 0.026. The predicted median preferences ranged from 1.00 for full health, to -0.81 for the worst possible health state.
Due to its simplicity and robustness, a median model is superior to other models for predicting US population preferences for EQ-5D health states. The predictions of this model are suggested for use in applications that require US societal health state values.
Value in Health 12/2009; 13(2):278-88. · 2.19 Impact Factor
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Robert S Krouse,
Lisa J Herrinton,
Marcia Grant,
Christopher S Wendel,
Sylvan B Green,
M Jane Mohler,
Carol M Baldwin,
Carmit K McMullen,
Susan M Rawl,
Eric Matayoshi, Stephen Joel Coons,
Mark C Hornbrook
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ABSTRACT: Intestinal stomas can pose significant challenges for long-term (> or = 5 years) rectal cancer (RC) survivors. Specifying common challenges and sociodemographic or clinical differences will further the development of tailored interventions to improve health-related quality of life (HRQOL).
This was a matched cross-sectional study of long-term RC survivors conducted in three Kaiser Permanente regions. The mailed questionnaire included the modified City of Hope Quality of Life-Ostomy (mCOH-QOL-Ostomy) and Medical Outcomes Study 36-Item Short-Form Health Survey, version 2 (SF-36v2). Groups surveyed were permanent ostomates (cases) and those who did not require an ostomy (controls). RC survivors were matched on sex, age, and time since diagnosis. Comparisons between groups used regression analysis with adjustment for age, comorbidity score, history of radiation therapy, income, and work status.
Response rate was 54% (491 of 909). Cases and controls had similar demographic characteristics. On the basis of the mCOH-QOL-Ostomy, both male and female cases had significantly worse social well-being compared with controls, while only female cases reported significantly worse overall HRQOL and psychological well-being. For younger females (< age 75 years), ostomy had a greater impact on physical well-being compared with older females. Based on the SF-36v2, statistically significant and meaningful differences between female cases and controls were observed for seven of the eight scales and on the physical and mental component summary scores.
Men and women report a different profile of challenges, suggesting the need for targeted or sex-specific interventions to improve HRQOL in this population. This may include focus on physical HRQOL for female ostomy survivors younger than age 75.
Journal of Clinical Oncology 08/2009; 27(28):4664-70. · 18.37 Impact Factor
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ABSTRACT: Patient-reported outcomes (PROs) are the consequences of disease and/or its treatment as reported by the patient. The importance of PRO measures in clinical trials for new drugs, biological agents, and devices was underscored by the release of the US Food and Drug Administration's draft guidance for industry titled "Patient-Reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims." The intent of the guidance was to describe how the FDA will evaluate the appropriateness and adequacy of PRO measures used as effectiveness end points in clinical trials. In response to the expressed need of ISPOR members for further clarification of several aspects of the draft guidance, ISPOR's Health Science Policy Council created three task forces, one of which was charged with addressing the implications of the draft guidance for the collection of PRO data using electronic data capture modes of administration (ePRO). The objective of this report is to present recommendations from ISPOR's ePRO Good Research Practices Task Force regarding the evidence necessary to support the comparability, or measurement equivalence, of ePROs to the paper-based PRO measures from which they were adapted.
The task force was composed of the leadership team of ISPOR's ePRO Working Group and members of another group (i.e., ePRO Consensus Development Working Group) that had already begun to develop recommendations regarding ePRO good research practices. The resulting task force membership reflected a broad array of backgrounds, perspectives, and expertise that enriched the development of this report. The prior work became the starting point for the Task Force report. A subset of the task force members became the writing team that prepared subsequent iterations of the report that were distributed to the full task force for review and feedback. In addition, review beyond the task force was sought and obtained. Along with a presentation and discussion period at an ISPOR meeting, a draft version of the full report was distributed to roughly 220 members of a reviewer group. The reviewer group comprised individuals who had responded to an emailed invitation to the full membership of ISPOR. This Task Force report reflects the extensive internal and external input received during the 16-month good research practices development process. RESULTS/RECOMMENDATIONS: An ePRO questionnaire that has been adapted from a paper-based questionnaire ought to produce data that are equivalent or superior (e.g., higher reliability) to the data produced from the original paper version. Measurement equivalence is a function of the comparability of the psychometric properties of the data obtained via the original and adapted administration mode. This comparability is driven by the amount of modification to the content and format of the original paper PRO questionnaire required during the migration process. The magnitude of a particular modification is defined with reference to its potential effect on the content, meaning, or interpretation of the measure's items and/or scales. Based on the magnitude of the modification, evidence for measurement equivalence can be generated through combinations of the following: cognitive debriefing/testing, usability testing, equivalence testing, or, if substantial modifications have been made, full psychometric testing. As long as only minor modifications were made to the measure during the migration process, a substantial body of existing evidence suggests that the psychometric properties of the original measure will still hold for the ePRO version. Hence, an evaluation limited to cognitive debriefing and usability testing only may be sufficient. However, where more substantive changes in the migration process has occurred, confirming that the adaptation to the ePRO format did not introduce significant response bias and that the two modes of administration produce essentially equivalent results is necessary. Recommendations regarding the study designs and statistical approaches for assessing measurement equivalence are provided.
The electronic administration of PRO measures offers many advantages over paper administration. We provide a general framework for decisions regarding the level of evidence needed to support modifications that are made to PRO measures when they are migrated from paper to ePRO devices. The key issues include: 1) the determination of the extent of modification required to administer the PRO on the ePRO device and 2) the selection and implementation of an effective strategy for testing the measurement equivalence of the two modes of administration. We hope that these good research practice recommendations provide a path forward for researchers interested in migrating PRO measures to electronic data collection platforms.
Value in Health 06/2009; 12(4):419-29. · 2.19 Impact Factor
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ABSTRACT: Intestinal stomas (ostomies) create challenges for veterans. The goal of this qualitative analysis was to understand better patients' perspectives regarding their greatest challenge.
Ostomates at three Veterans Affairs locations were surveyed using the modified City of Hope Quality of Life-Ostomy questionnaire that contained an open-ended request for respondents to describe their greatest challenge. The response rate was 51% (239 of 467); 68% (163 of 239) completed the open-ended item. Content analysis was performed by an experienced qualitative research team.
Coping and acceptance were the most commonly addressed themes. The most frequently expressed issues and advice were related to a need for positive thinking and insight regarding adjustment over time. Coping strategies included the use of humor, recognition of positive changes resulting from the stoma, and normalization of life with an ostomy.
Coping and acceptance are common themes described by veterans with an intestinal stoma. Health-care providers can assist veterans by utilizing ostomate self-management strategies, experience, and advice.
Journal of Psychosomatic Research 04/2009; 66(3):227-33. · 3.30 Impact Factor
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ABSTRACT: The odds of surviving an out-of-hospital cardiac arrest are significantly improved by the provision of bystander cardiopulmonary resuscitation (CPR), but many cardiac arrest victims do not receive it. The existing literature remains equivocal as to why people are unwilling to perform traditional CPR. This study's objectives were to determine the behavioral intentions of the general population in Arizona regarding performing bystander CPR and to assess the reasons for being unwilling to perform CPR.
This was a general population survey using a mailed, self-administered questionnaire. The questionnaire was mailed to random samples of Arizona residents in a rural and urban county.
Usable questionnaires were received from 49.5% (n=370) and 49.6% (n=385) of the samples from the urban and rural county, respectively. More than 50% of respondents reported being willing to perform CPR on a stranger and over 80% reported being willing to perform CPR on a family member. There were no significant differences between the proportions of respondents in each county willing to perform CPR. The reasons for not being willing to perform CPR were relatively evenly divided among the five reasons listed.
Although our findings likely overestimate the proportion of individuals who would perform bystander CPR, the relative importance of the reasons for not performing CPR is informative. Based on the reasons reported, there is potential to change the CPR-related attitudes, beliefs, and skill levels of the general public to enhance the number of people willing and able to perform bystander CPR.
Resuscitation 02/2009; 80(3):334-40. · 3.60 Impact Factor
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ABSTRACT: The objective of this paper is to describe the complex mixed-methods design of a study conducted to assess health-related quality of life (HRQOL) outcomes and ostomy-related obstacles and adjustments among long-term (>5 years) colorectal cancer (CRC) survivors with ostomies (cases) and without ostomies (controls). In addition, details are provided regarding the study sample and the psychometric properties of the quantitative data collection measures used. Subsequent manuscripts will present the study findings.
The study design involved a cross-sectional mail survey for collecting quantitative data and focus groups for collecting qualitative data. The study subjects were individuals identified as long-term CRC survivors within a community-based health maintenance organization's enrolled population. Focus groups comprised of cases were conducted. The groups were divided by gender and HRQOL high and low quartile contrasts (based on the mail survey data).
The modified City of Hope Quality of Life (mCOH-QOL)-Ostomy and SF-36v2 questionnaires were used in the mail survey. An abridged version of the mCOH-QOL-Ostomy was used for the control subjects. Focus groups explored ostomy-related barriers to self-care, adaptation methods/skills, and advice for others with an ostomy.
The survey response rate was 52% (679/1308) and 34 subjects participated in focus groups. The internal consistency reliability estimates for the mCOH-QOL-Ostomy and SF-36v2 questionnaires were very acceptable for group comparisons. In addition, evidence supports the construct validity of the abridged version of the mCOH-QOL-Ostomy. Study limitations include potential non-response bias and limited minority participation.
We were able to successfully recruit long-term CRC survivors into this study and the psychometric properties of the quantitative measures used were quite acceptable. Mixed-methods designs, such as the one used in this study, may be useful in identification and further elucidation of common problems, coping strategies, and HRQOL outcomes among long-term cancer survivors.
Current Medical Research and Opinion 07/2008; 24(7):2059-70. · 2.38 Impact Factor
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ABSTRACT: Intestinal stomas have a major impact on Cases' lives. It is essential to better understand the areas in which interventions may help to minimize the negative consequences.
This was a case-control survey study using validated instruments (City of Hope Quality of Life-Ostomy and Short Form 36 for Veterans). Cases were accrued from Veterans Affairs Medical Centers in Tucson, Indianapolis, and Los Angeles. Eligibility included a major intra-abdominal surgical procedure that led to an ostomy (cases), or a similar procedure that did not mandate a stoma (controls). Analysis included quantitative and qualitative responses.
The response rate was 48 percent (511/1,063). Cases and controls had relatively similar demographic characteristics. Because of low numbers of female respondents (13 cases and 11 controls), only results for males are reported. Based on both the City of Hope Quality of Life-Ostomy and Short Form 36 for Veterans, cases reported significantly poorer scores on scales/domains reflecting psychologic and social functioning and well being. Additionally, cases reported poorer scores on Short Form 36 for Veterans scales reflecting physical functioning and significantly lower scores on multiple items in the social domain of the City of Hope Quality of Life-Ostomy compared with controls. Two-thirds of cases replied to an open-ended question on their "greatest challenge" related to their ostomy, which led to further clarification of major issues.
Multiple health-related quality of life problems were reported by male veterans with intestinal stomas. The greatest differences between cases and controls were observed in the social and psychologic domains/scales. Findings from this study provide a greater understanding of the challenges faced by ostomates and will inform the development and evaluation of urgently needed intervention strategies.
Diseases of the Colon & Rectum 01/2008; 50(12):2054-66. · 3.13 Impact Factor
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Sushma Jain,
Marcia L McGory,
Clifford Y Ko,
Alla Sverdlik,
James S Tomlinson,
Christopher S Wendel, Stephen Joel Coons,
Susan M Rawl,
C Max Schmidt,
Marcia Grant,
Ruth McCorkle,
M Jane Mohler,
Carol M Baldwin,
Robert S Krouse
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ABSTRACT: Previous research suggests an ostomy worsens health-related quality of life (HR-QOL), but comorbidities also can affect HR-QOL.
Eligible patients had abdominal operation with ostomy (cases) or similar procedure without ostomy (controls). Patients were recruited for this case-control study from 3 Veterans Affairs hospital medical and pharmacy records. Comorbidities were assessed with Charlson-Deyo Comorbidity Index. Multinomial logistic regression evaluated the impact of comorbidities and having an ostomy on HR-QOL, measured using the Medical Outcomes Study Short Form 36 for Veterans.
A total of 237 ostomates (cases) and 268 controls were studied. Average age was 69 years; 64% of cases had colostomy, 36% ileostomy. Twenty-nine percent of patients had a high level of comorbidities. Cases and controls were similar except for reasons for undergoing surgery. High comorbidity was a significant predictor of low HR-QOL in 6 domains of the Short Form 36 for Veterans; having an ostomy was a significant predictor in 4.
High comorbidity significantly influences low HR-QOL and impacted more domains than having an ostomy.
American journal of surgery 01/2008; 194(6):774-9; discussion 779. · 2.36 Impact Factor
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ABSTRACT: This secondary analysis was conducted to expand our understanding of the challenges men with ostomies face regarding intimate relationships and sexual functioning. We examined quantitative and qualitative data to examine sexual functioning, intimate relationships, and health-related quality of life (HR-QOL) among military veterans who are living with an intestinal stoma.
Three Veterans Health Administration sites.
Four hundred eighty-one male veterans.
Case-control, mixed-methods design; cases were those who had ostomies for at least 2 months, and controls had a similar major intestinal surgical procedure that did not result in an ostomy. Quantitative and qualitative data on sexual functioning, relationships, and other dimensions of HR-QOL were collected using the modified City of Hope Quality of Life-Ostomy questionnaire.
The overall response rate was 49%. Prevalence of erectile dysfunction was significantly higher among ostomates compared with controls (P < .001). Although a greater proportion of veterans with ostomies reported being sexually active before surgery compared with controls (P < .001), the proportion of men who had resumed sexual activity after surgery is significantly lower among the ostomy group (P = .015). Compared with veterans with ostomies who did not resume sexual activity after surgery, those who were sexually active reported a higher total HR-QOL score and higher scores on all 4 modified City of Hope Quality of Life-Ostomy dimensions (psychological, social, physical, and spiritual well-being). Veterans with ostomies who had resumed sexual activity after their ostomy also reported that their ostomy had caused significantly less interference with social activities, less isolation, less interference with their personal relationships, and less interference with their ability to be intimate. These men also reported less difficulty adjusting to the ostomy. Results of qualitative analyses showed that problems with intimacy and sexual function are among the greatest challenges faced by ostomates.
Presence of an ostomy was associated with lower rates of sexual activity and higher erectile dysfunction. The lower rates of sexual activity and sexual satisfaction were related to the social and psychological dimensions of HR-QOL among men with ostomies. Interventions to address sexual concerns of male ostomates and their partners may prevent decrements to HR-QOL for these patients.
Results of the study have implications for the clinical nurse specialist role in supporting and educating patients with ostomies to minimize the negative impact of an intestinal ostomy on sexual health and HR-QOL. Implications also relate to the need to educate current and future nurses about the importance of assessing sexual health.
Clinical Nurse Specialist 12/2007; 22(1):30-40. · 0.81 Impact Factor
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ABSTRACT: To explore whether there was a significant relationship between difficulty paying for ostomy supplies and overall quality of life among a sample of ostomates receiving care from the Veterans Health Administration (VHA).
The data were collected as part of the Veterans Affairs (VA) Ostomy Health-Related Quality of Life Study, in which 511 respondents (239 cases, 272 controls) completed a survey instrument that included the modified City of Hope Quality of Life (mCOH-QOL) Ostomy questionnaire, SF-36V, and sociodemographic items. Responses from the 239 cases (ie, patients with intestinal stomas) were used in this analysis. The modified City of Hope Quality of Life Ostomy questionnaire item, "How good is your overall quality of life?," was the dependent variable for this analysis. The primary independent variable was the response (yes/no) to the item, "If you pay for any of the (ostomy) costs, is it difficult for you?" A hierarchical regression model was used to examine whether difficulty paying was significantly related to overall quality of life after adjusting for age, income, race/ethnicity, and physical health.
After accounting for the proportion of variance explained by age, income, race/ethnicity, and physical health, the additional proportion of variance explained by difficulty paying was statistically significant. Individuals reporting difficulty paying had a roughly 1 point lower (ie, beta-coefficient = -1.052; SE = 0.481) overall quality of life score on the 11-point scale.
We found a significant association between difficulty paying for ostomy supplies and overall quality of life. Although the cross-sectional study design does not allow causal inference, the results suggest a relationship that merits further examination.
Medical Care 10/2007; 45(9):891-5. · 3.41 Impact Factor
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Richard A Mularski,
Kenneth Rosenfeld, Stephen Joel Coons,
Amylou Dueck,
David Cella,
David J Feuer,
Joseph Lipscomb,
Martin S Karpeh,
Tom Mosich,
Jeff A Sloan,
Robert S Krouse
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ABSTRACT: Palliative care aims to improve the quality of life of patients and their families and reduce suffering from life-threatening illness. In assessing palliative care efficacy, researchers must consider a broad range of potential outcomes, including those experienced by the patient's family/caregivers, clinicians, and the health care system. The purpose of this article is to summarize the discussions and recommendations of an Outcomes Working Group convened to advance the palliative care research agenda, particularly in the context of randomized controlled trials. These recommendations address the conceptualization of palliative care outcomes, sources of outcomes data, application of outcome measures in clinical trials, and the methodological challenges to outcome measurement in palliative care populations. As other fields have developed and refined methodological approaches that address their particular research needs, palliative care researchers must do the same to answer important clinical questions in rigorous and credible ways.
Journal of Pain and Symptom Management 08/2007; 34(1 Suppl):S7-S19. · 2.50 Impact Factor
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ABSTRACT: Many of the large ongoing national surveys of the US population contain a question that asks for the respondent's self-reported health status: "excellent," "very good," "good," "fair," or "poor." These surveys could be used to conduct cost-utility analyses of health care policies, treatments or other interventions if quality-of-life (QOL) weights for the self-reported health statuses were also available.
The objective of this study was to produce nationally representative QOL weights for self-reported health status and for 10 "priority" health conditions, by a series of demographic variables.
The Medical Expenditure Panel Survey contains the questions from the EQ-5D health status measure. A recent study has calculated time-trade-off-derived QOL weights corresponding to the EQ-5D health states for a large sample of Americans. We use these data to construct QOL weights for the 5 self-reported health status categories and 10 priority health conditions, by a series of demographic variables.
Mean and median QOL weights were produced for self-reported health status, the 10 priority health conditions, and the demographic variables. We also report mean QOL weights for the self-reported health state and priority health conditions, by the demographic variables. Finally, ordinary least squares and censored least absolute deviation regression equations were used to estimate adjusted QOL weights for these variables.
By providing nationally representative QOL weights for self-reported health status and 10 priority health conditions, by demographic variable, we have facilitated the use of large national surveys for conducting cost-utility analysis and increased their value to researchers and policy makers.
Medical Care 08/2007; 45(7):618-28. · 3.41 Impact Factor
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ABSTRACT: We examined differences in preferences for the EQ-5D health states among blacks, Hispanics, and others living in the United States.
A multi-stage probability sample was selected from the adult U.S. population. Each respondent valued a subset of the 243 EQ-5D health states. Regression analysis was used to analyze differences in mean valuations for 13 health states among the racial/ethnic groups. First, we compared unadjusted mean valuations among the three groups. Second, we evaluated differences in mean valuations among the groups after adjusting for other sociodemographic characteristics. Third, we evaluated the impact of race/ethnicity on estimates derived from the U.S. health state valuation (i.e., D1) model.
Valuations differed among the groups for seven of the 13 health states, and these differences persisted after adjusting for other sociodemographic factors. Blacks appeared to perceive extreme health problems to be associated with less disutility than did members of the other two groups.
Within the United States, there exist racial/ethnic differences in the perceived desirability of the EQ-5D health states that cannot be readily explained by socioeconomic disparities.
Journal of Clinical Epidemiology 06/2007; 60(5):479-90. · 4.27 Impact Factor
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Yu Ko, Stephen Joel Coons
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ABSTRACT: To examine the unique health-related quality of life (HRQoL) decrements associated with common chronic conditions in the general US adult population.
Data were obtained from a study aimed at establishing a US population-based set of preference weights for the health states defined by the EQ-5D. The EQ-5D is a brief, self-completed instrument for describing and valuing HRQoL. As part of that study, along with the EQ-5D items, data regarding socio-demographic characteristics and chronic medical conditions were collected. The EQ-5D has five dimensions, from which an index score can be calculated that falls on a scale where 0.0 = death and 1.0 = perfect health. Ordinary least squares regression models were conducted using the EQ-5D index score as the dependent variable to estimate the association between each chronic condition and the index score after adjusting for socio-demographic variables. The population sampling weights were applied in the analyses to adjust for the over-sampling of the minority groups.
Approximately three-fifths (62.5%) of the study sample reported having at least one of the 18 chronic medical conditions; sinusitis(24.8%), hypertension (23.5%), and arthritis (21.5%) were the most commonly reported conditions. The chronic conditions that had the greatest negative association with EQ-5D index scores were depression and arthritis.
Unique associations were found between several chronic conditions and HRQoL after accounting for the presence of other conditions and socio-demographic characteristics. The results of this study provide an indication of the relative HRQoL decrements associated with various chronic conditions in the general US adult population. The major limitation of this analysis is the uncertainty of the causal relationship between chronic conditions and HRQoL due to the cross-sectional nature of the study data. In addition, because it was unknown how well the conditions were managed, caution is needed in interpreting study results regarding the relative impact of chronic conditions on HRQoL.
Current Medical Research and Opinion 11/2006; 22(10):2065-71. · 2.38 Impact Factor
