Improving the measurement of patient-reported outcomes in patients with psychosis
Abstract
Background: Patient-reported outcomes (PROs) are widely used to evaluate the care of
patients with psychosis. However, there have been concerns that PROs may overlap
considerably, be affected by the psychosis, and poorly corroborated by observer ratings.
Addressing shortcomings in the measurement of PROs, this study aimed: first, to
reliably score PROs according to their multidomain structure; second, to investigate the
extent to which PROs provide distinct information independent from overlap across
measures; third, to detect bias in PRO items attributable to psychiatric symptoms and
cognitive deficits; and, fourth, to assess the relationship of PROs with observer-rated
outcomes.
Method: The study applied confirmatory factor and item response analysis to individual
and pooled datasets obtained from 13 studies that had used the following PROs in
psychotic patients: the Lancashire Quality of Life Profile (LQOLP), Manchester Short
Assessment of Quality of Life (MANSA), Camberwell Assessment of Need (CAN),
Client Satisfaction Questionnaire (CSQ), Patient Satisfaction Questionnaire (PSQ), and
Helping Alliance Scale (HAS).
Results: There was evidence of high structural validity with regard to total scores of
most measures, including the LQOLP, MANSA, CSQ, and HAS. However, this largely
did not hold for specific domain scores. Low precision across the full range of scores
was observed for all measures. Most measures provided distinct information with high
discriminant validity independent from overlap with other PRO measures. Structural
Abstract
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validity was only slightly reduced by bias attributable to symptoms and cognitive
deficits. Finally, high convergent validity was found for CAN clinician and patient
ratings and high discriminant validity for HAS clinician and patient ratings.
Conclusions: The findings suggest that PROs can provide distinct information and may
concur with observer ratings. The study provides an approach to overcome important
shortcomings of PROs in patients with psychosis. This may inform the use and further
development of PROs in psychotic patients.
Authors
Reininghaus, UlrichCollections
- Theses [4125]