Order effects: a randomised study of three major cancer-specific quality of life instruments

Health and Quality of Life Outcomes

Joseph Wee³  Julian Thumboo²  Cynthia Goh¹  Celestine Lim³  Yin-Bun Cheung⁴ 

[1] Department of Palliative Medicine, National Cancer Centre, 11 Hospital Drive, 169610, Singapore;Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, 169608, Singapore;Clinical Trials and Epidemiological Sciences, National Cancer Centre, 11 Hospital Drive, 169610, Singapore;MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK

关键词: order effect;    cancer;    health-related quality of life;   

Others  :  1216869
DOI  :  10.1186/1477-7525-3-37

 received in 2005-04-25, accepted in 2005-05-31,  发布年份 2005

【 摘 要 】

Background

In methodological studies and outcomes research, questionnaires often comprise several health-related quality of life (HRQoL) measures. Previous psychological studies have suggested that changing the sequential order of measurement scales within a questionnaire could alter the pattern of responses. Yet, information on the presence or absence of order effects on the assessment of HRQoL in cancer patients is limited.

Methods

An incomplete block design was used in this study of 1277 cancer patients. Each patient filled out a questionnaire package that contained two of the three major cancer-specific HRQoL instruments, namely the Functional Assessment of Cancer Therapy – General, the European Organization for the Research and Treatment of Cancer Core Quality of Life Questionnaire and the Functional Living Index – Cancer. Within a questionnaire package the sequential order of the instruments contained were randomised. Measurement properties of the instruments, including the number of missing values, mean HRQoL scores, known-groups validity and internal consistency were compared between samples of different presentation orders.

Results

No effect of presentation order on the four properties aforementioned was found.

Conclusion

Presentation order is unlikely to alter the responses to these HRQoL instruments administered in cancer patients when any two of them are used together.

【 授权许可】

   
2005 Cheung et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Serdula MK, Mokdad AH, Pamuk ER, Williamson DF, Byers T: Effects of question order on estimates of the prevalence of attempted weight loss. Am J Epidemiol 1995, 42:64-67.
• [2]Bowling A: Research Methods in Health. Buckingham: Open University Press; 1997:241-270.
• [3]Schuman H, Presser S: Questions and Answers in Attitude Surveys. NY: Academic Press; 1981.
• [4]Streiner DL, Norman GR: Health Measurement Scales: A Practical Guide to their Development and Use. Oxford: Oxford University Press; 1989:144.
• [5]Jensen PS, Watanabe HK, Richters JE: Who's up first? Testing for order effects in structured interviews using a counterbalanced experimental design. J Abnorm Child Psychol 1999, 27:439-436.
• [6]Mook DG: Psychological Research: Strategy and Tactics. NY: Harper & Row; 1982.
• [7]Lucas CP: The order effect: reflections on the validity of multiple test presentations. Psychol Med 1992, 22:197-202.
• [8]Dunn KM, Jordan K, Croft PR: Does questionnaires structure influence response in postal surveys. J Clin Epidemiol 2003, 56:10-16.
• [9]Kemmler G, Holzner B, Kopp M, Dunser M, Margreiter R, Greil R, Sperner-Unterweger B: Comparison of two quality-of-life instruments for cancer patients: the Functional Assessment of Cancer Therapy-General and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30. J Clin Oncol 1999, 17:2932-2940.
• [10]Cheung YB, Goh C, Wong LC, Ng GY, Lim WT, Leong SS, Tan EH, Khoo KS: Quick-FLIC: Validation of a short questionnaire for assessing quality of life of cancer patients. Br J Cancer 2004, 90:1747-1752.
• [11]Cheung YB, Wong LC, Tay MH, Toh CK, Koo WH, Epstein R, Goh C: Order effects in the assessment of quality of life of cancer patients. Qual Life Res 2004, 13:1217-1223.
• [12]Senn S: Cross-over Trials in Clinical Research. Chichester and New York: Wiley; 1993.
• [13]Pocock S: Clinical Trials: A Practical Approach. Chichester and New York: Wiley; 1983.
• [14]Goh CR, Lee KS, Tan TC, Wang TL, Tan CH, Wong J, Ang PT, Chan ME, Clinch J, Olweny CL, Schipper H: Measuring quality of life in different cultures: translation of the Functional Living Index for Cancer (FLIC) into Chinese and Malay in Singapore. Ann Acad Med Singapore 1996, 25:323-334.
• [15]Cheung YB, Ng GY, Wong LC, Koo WH, Tan EH, Tay MH, Lim D, Poon D, Goh C, Tan SB: Measuring quality of life in Chinese cancer patients: a new version of the Functional Living Index – Cancer (Chinese). Ann Acad Med Singapore 2003, 32:376-380.
• [16]Conner-Spady B, Cumming C, Nabholtz JM, Jacobs P, Stewart D: Responsiveness of the EuroQol in breast cancer patients undergoing high dose chemotherapy. Qual Life Res 2001, 10:479-486.
• [17]Takeda F, Uki J: Recent progress in cancer pain management and palliative care in Japan. Ann Acad Med Singapore 1994, 23:296-299.
• [18]Blagden SP, Charman SC, Sharples LD, Magee LR, Gilligan D: Performance status score: do patients and their oncologists agree. Br J Cancer 2003, 89:1022-1027.
• [19]Cella D: FACIT Manual: Manual of the Functional Assessment of Chronic Illness Therapy (FACIT) Measurement System. Evanston, IL: Northwestern University; 1997.
• [20]Hardin J, Hilber J: Generalized Linear Models and Extensions. College Station, TX: Stata Corporation; 2001.
• [21]Efron B, Tibshirani R: An Introduction to the Bootstrap. New York: Chapman & Hall; 1993.
• [22]Machin D, Campbell M, Fayers P, Pinol A: Sample Size Tables for Clinical Studies. 2nd edition. Oxford: Blackwell; 1997.
• [23]Senn S: Statistical Issues in Drug Development. Chichester: Wiley; 1997:320.
• [24]Cella D, Eton DT, Lai JS, Peterman AH, Merkel DE: Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manage 2002, 24:547-561.
• [25]Osoba D, Rodriges G, Myles J, Zee B, Pater J: Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol 1998, 16:139-144.
• [26]Cohen J: Statistical Power Analysis for the Behavioural Sciences. 2nd edition. Hilllsdale, NJ: L.Erlbaum Associates; 1988.
• [27]Cheung YB, Goh C, Thumboo J, Khoo KS, Wee J: Variability and sample size requirements of quality of life measures: A randomized study of three major questionnaires. J Clin Oncol, in press.