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The psychometric properties of cancer multisymptom assessment instruments: a clinical review

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Abstract

Purpose

Various instruments are used to assess both individual and multiple cancer symptoms. We evaluated the psychometric properties of cancer multisymptom assessment instruments.

Methods

An Ovid MEDLINE search was done. All searches were limited to adults and in English. All instruments published from 2005 to 2014 (and with at least one validity test) were included. We excluded those who only reported content validity. Instruments were categorized by the three major types of symptom measurement scales employed as follows: visual analogue (VAS), verbal rating (VRS), and numerical rating (NRS) scales. They were then examined in two areas: (1) psychometric thoroughness (number of tests) and (2) psychometric strength of evidence (validity, reliability, generalizability). We also assigned an empirical global psychometric quality score (which combined the concepts of thoroughness and strength of evidence) to rank the instruments.

Results

We analyzed 57 instruments (17 original, 40 modifications). They varied in types of scales used, symptom dimensions measured, and time frames evaluated. Of the 57, 10 used VAS, 28 VRS, and 19 NRS. The Edmonton Symptom Assessment System (ESAS), ESAS-Spanish, Hospital Anxiety and Depression Scale (HADS), Profile of Mood States (POMS), Symptom Distress Scale (SDS), M.D. Anderson Symptom Inventory (MDASI)-Russian, and MDASI-Taiwanese were the most comprehensively tested for validity and reliability. The ESAS, ESAS-Spanish, ASDS-2, Memorial Symptom Assessment Scale (MSAS)-SF, POMS, SDS, MDASI (and some translations), and MDASI-Heart Failure all showed good validity and reliability.

Conclusions

The MDASI appeared to be the best overall from a psychometric perspective. This was followed by the ESAS, ESAS-Spanish, POMS, SDS, and some MDASI translations. VRS-based instruments were most common. There was a wide range of psychometric rigor in validation. Consequently, meta-analysis was not possible. Most cancer multisymptom assessment instruments need further extensive validation to establish the excellent reliability and validity required for clinical utility and meaningful research.

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Acknowledgments

This paper was completed in part while one of the authors (D.W.) was a Lord Harris Visiting Fellow at the Tseu Medical Institute, Manchester Harris College, University of Oxford, UK, May–June 2011. We are grateful to Gretchen Hallerberg for help with the review of the literature. We thank Matthew Karafa, PhD; Wael Lasheen, MD; and Curtis Tatsuoka, PhD for their comments on the manuscript and Ellen Schleckman and Aditya Nair for their administrative assistance.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Jordanka Kirkova was supported in part by a fellowship grant in End-of-Life Care from the Mt. Sinai Health Care Foundation.

Conflict of interest

The authors declare that there is no conflict of interest.

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Authors and Affiliations

  1. Section of Palliative Medicine and Supportive Oncology, Department of Solid Tumor Oncology, Cleveland Clinic, Taussig Cancer Institute, Cleveland, OH, USA

    Aynur Aktas, Declan Walsh & Jordanka Kirkova

  2. The Harry R. Horvitz Center Chair in Palliative Medicine and Supportive Oncology, Cleveland Clinic, Cleveland, OH, USA

    Declan Walsh

  3. Faculty of Health Sciences, Trinity College Dublin, University College Dublin, Old Chemistry Building Extension Trinity College Dublin 2, Dublin, Ireland

    Declan Walsh

Authors
  1. Aynur Aktas
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  2. Declan Walsh
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  3. Jordanka Kirkova
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Corresponding author

Correspondence to Declan Walsh.

Additional information

Harry R. Horvitz Center is a World Health Organization Demonstration Project in Palliative Medicine and an ESMO Designated Center of Integrated Oncology and Palliative Care.

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Aktas, A., Walsh, D. & Kirkova, J. The psychometric properties of cancer multisymptom assessment instruments: a clinical review. Support Care Cancer 23, 2189–2202 (2015). https://doi.org/10.1007/s00520-015-2732-7

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