Replication and validation of higher order models demonstrated that a summary score for the EORTC QLQ-C30 is robust

Johannes M. Giesinger, Jacobien M. Kieffer, Peter Fayers, Mogens Groenvold, Morten Aa. Petersen, Neil W. Scott, Mirjam A. G. Sprangers, Galina Velikova, Neil K. Aaronson

Research output: Contribution to journalArticle

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Abstract

Objective
To further evaluate the higher order measurement structure of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), with the aim of generating a summary score.

Study Design and Setting
Using pretreatment QLQ-C30 data (N = 3,282), we conducted confirmatory factor analyses to test seven previously evaluated higher order models. We compared the summary score(s) derived from the best performing higher order model with the original QLQ-C30 scale scores, using tumor stage, performance status, and change over time (N = 244) as grouping variables.

Results
Although all models showed acceptable fit, we continued in the interest of parsimony with known-groups validity and responsiveness analyses using a summary score derived from the single higher order factor model. The validity and responsiveness of this QLQ-C30 summary score was equal to, and in many cases superior to the original, underlying QLQ-C30 scale scores.

Conclusion
Our results provide empirical support for a measurement model for the QLQ-C30 yielding a single summary score. The availability of this summary score can avoid problems with potential type I errors that arise because of multiple testing when making comparisons based on the 15 outcomes generated by this questionnaire and may reduce sample size requirements for health-related quality of life studies using the QLQ-C30 questionnaire when an overall summary score is a relevant primary outcome.
Original languageEnglish
Pages (from-to)79-88
Number of pages10
JournalJournal of Clinical Epidemiology
Volume69
Early online date29 Aug 2015
DOIs
Publication statusPublished - Jan 2016

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Quality of Life
Organizations
Research
Neoplasms
Surveys and Questionnaires
Sample Size
Statistical Factor Analysis

Keywords

  • health-related quality of life
  • questionnaires
  • EORTC QLQ-C30
  • measurement model
  • higher order factor scores
  • confirmatory factor analysis

Cite this

Replication and validation of higher order models demonstrated that a summary score for the EORTC QLQ-C30 is robust. / Giesinger, Johannes M.; Kieffer, Jacobien M.; Fayers, Peter; Groenvold, Mogens; Petersen, Morten Aa.; Scott, Neil W.; Sprangers, Mirjam A. G.; Velikova, Galina; Aaronson, Neil K.

In: Journal of Clinical Epidemiology, Vol. 69, 01.2016, p. 79-88.

Research output: Contribution to journalArticle

Giesinger, Johannes M. ; Kieffer, Jacobien M. ; Fayers, Peter ; Groenvold, Mogens ; Petersen, Morten Aa. ; Scott, Neil W. ; Sprangers, Mirjam A. G. ; Velikova, Galina ; Aaronson, Neil K. / Replication and validation of higher order models demonstrated that a summary score for the EORTC QLQ-C30 is robust. In: Journal of Clinical Epidemiology. 2016 ; Vol. 69. pp. 79-88.
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title = "Replication and validation of higher order models demonstrated that a summary score for the EORTC QLQ-C30 is robust",
abstract = "ObjectiveTo further evaluate the higher order measurement structure of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), with the aim of generating a summary score.Study Design and SettingUsing pretreatment QLQ-C30 data (N = 3,282), we conducted confirmatory factor analyses to test seven previously evaluated higher order models. We compared the summary score(s) derived from the best performing higher order model with the original QLQ-C30 scale scores, using tumor stage, performance status, and change over time (N = 244) as grouping variables.ResultsAlthough all models showed acceptable fit, we continued in the interest of parsimony with known-groups validity and responsiveness analyses using a summary score derived from the single higher order factor model. The validity and responsiveness of this QLQ-C30 summary score was equal to, and in many cases superior to the original, underlying QLQ-C30 scale scores.ConclusionOur results provide empirical support for a measurement model for the QLQ-C30 yielding a single summary score. The availability of this summary score can avoid problems with potential type I errors that arise because of multiple testing when making comparisons based on the 15 outcomes generated by this questionnaire and may reduce sample size requirements for health-related quality of life studies using the QLQ-C30 questionnaire when an overall summary score is a relevant primary outcome.",
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author = "Giesinger, {Johannes M.} and Kieffer, {Jacobien M.} and Peter Fayers and Mogens Groenvold and Petersen, {Morten Aa.} and Scott, {Neil W.} and Sprangers, {Mirjam A. G.} and Galina Velikova and Aaronson, {Neil K.}",
note = "The authors would like to express their gratitude to many individuals who provided the data used in these analyses, and to Chad Gundy (deceased) who played a key role in the design and execution of the original study investigating the higher order scale structure of the QLQ-C30. Funding: The work of J.M.G. was supported by a grant from the Austrian Science Fund (FWF J3353).",
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AU - Giesinger, Johannes M.

AU - Kieffer, Jacobien M.

AU - Fayers, Peter

AU - Groenvold, Mogens

AU - Petersen, Morten Aa.

AU - Scott, Neil W.

AU - Sprangers, Mirjam A. G.

AU - Velikova, Galina

AU - Aaronson, Neil K.

N1 - The authors would like to express their gratitude to many individuals who provided the data used in these analyses, and to Chad Gundy (deceased) who played a key role in the design and execution of the original study investigating the higher order scale structure of the QLQ-C30. Funding: The work of J.M.G. was supported by a grant from the Austrian Science Fund (FWF J3353).

PY - 2016/1

Y1 - 2016/1

N2 - ObjectiveTo further evaluate the higher order measurement structure of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), with the aim of generating a summary score.Study Design and SettingUsing pretreatment QLQ-C30 data (N = 3,282), we conducted confirmatory factor analyses to test seven previously evaluated higher order models. We compared the summary score(s) derived from the best performing higher order model with the original QLQ-C30 scale scores, using tumor stage, performance status, and change over time (N = 244) as grouping variables.ResultsAlthough all models showed acceptable fit, we continued in the interest of parsimony with known-groups validity and responsiveness analyses using a summary score derived from the single higher order factor model. The validity and responsiveness of this QLQ-C30 summary score was equal to, and in many cases superior to the original, underlying QLQ-C30 scale scores.ConclusionOur results provide empirical support for a measurement model for the QLQ-C30 yielding a single summary score. The availability of this summary score can avoid problems with potential type I errors that arise because of multiple testing when making comparisons based on the 15 outcomes generated by this questionnaire and may reduce sample size requirements for health-related quality of life studies using the QLQ-C30 questionnaire when an overall summary score is a relevant primary outcome.

AB - ObjectiveTo further evaluate the higher order measurement structure of the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30), with the aim of generating a summary score.Study Design and SettingUsing pretreatment QLQ-C30 data (N = 3,282), we conducted confirmatory factor analyses to test seven previously evaluated higher order models. We compared the summary score(s) derived from the best performing higher order model with the original QLQ-C30 scale scores, using tumor stage, performance status, and change over time (N = 244) as grouping variables.ResultsAlthough all models showed acceptable fit, we continued in the interest of parsimony with known-groups validity and responsiveness analyses using a summary score derived from the single higher order factor model. The validity and responsiveness of this QLQ-C30 summary score was equal to, and in many cases superior to the original, underlying QLQ-C30 scale scores.ConclusionOur results provide empirical support for a measurement model for the QLQ-C30 yielding a single summary score. The availability of this summary score can avoid problems with potential type I errors that arise because of multiple testing when making comparisons based on the 15 outcomes generated by this questionnaire and may reduce sample size requirements for health-related quality of life studies using the QLQ-C30 questionnaire when an overall summary score is a relevant primary outcome.

KW - health-related quality of life

KW - questionnaires

KW - EORTC QLQ-C30

KW - measurement model

KW - higher order factor scores

KW - confirmatory factor analysis

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