Abstract

Objectives: Quality of life assessment is a valuable tool in cancer care as it allows us to understand how cancer and healthcare interventions influence the lives of the patients. An appropriate QoL assessment instrument would enable healthcare practitioners to identify and manage problems, which have a negative influence on QoL of cancer patients, timeously. The objective of the study was to develop and validate a patient informed QoL assessment instrument for our patient population.

Methods: A quantitative design was used. A Quality of Life questionnaire was developed by using the themes and categories identified during interviews with cancer patients and subjected to psychometric analysis using the Rasch Measurement Model.

Results: After validation of the questionnaire, by means of the Rasch model, it was found that the questionnaire conformed to Rasch model expectations. The developed instrument comprised relevant domains of QoL for South African cancer patients who access public healthcare for treatment, as identified during interviews with patients. It is proposed that the instrument be further validated for other populations in South Africa.

Significance of the Results: An appropriate QoL assessment instrument can be used for the assessment of QoL of cancer patients in order to identify and address problems timeously. The instrument needs to be culturally sensitive and include the domains of QoL which are relevant to the patient population. The QoL assessment instrument developed in this study is appropriate for cancer patients in South Africa who access public health service for treatment.

Keywords: Quality of Life (QoL); Domains of QoL; QoL Assessment; Rasch Measurement Model (RMM)

References

1. Selman L., et al. “Quality of life among patients receiving palliative care in South Africa and Uganda: a multi-centred study”. Health and Quality of Life Outcomes (2011): 9.
2. Maree J., et al. “Suitability of quality-of-life outcome measures in palliative care in the South African setting”. Palliative and Supportive Care (2016): 1-11.
3. Jansen Van Rensburg J., et al. “An investigation into the quality of life of cancer patients in South Africa”. Asia Pacific Journal of Oncology Nursing 4 (2017): 336-341.
4. CANSA. 2016 Statistics (2016).
5. Lingwood Rj., et al. “The challenge of cancer control in Africa”. Nature Reviews Cancer 8 (2008): 398-403.
6. Morhason-Bello Io., et al. “Challenges and opportunities in cancer control in Africa: a perspective from the African Organisation for Research and Training in Cancer”. The Lancet Oncology 14 (2013): e142-e151.
7. Statistics South Africa. Public healthcare: How much per person (2017).
8. Mojaki M., et al. “Referral steps in district health system are side-stepped”. South African Medical Journal 101 (2011): 109-109.
9. Ferrans C. “Quality of life as an outcome of cancer care”. In: Yarbro C, Wujcik D and Gobel B (editions). Cancer Nursing. Principles and Practice. Massachusetts: Jones and Bartlett (2011).
10. Bennett M and Closs S. “Clinical assessment and measurement”. In: Payne S, Seymore J and Ingleton C (editions). Palliative nursing: principles and evidence for practice. 2^nd edition. London: McGraw-Hill (2008).
11. Diehr P., et al. “Quality of life at the end of life”. Health and Quality of Life Outcomes (2007): 5.
12. Zeng Y., et al. “Quality of life measurement in women with cervical cancer: implications for Chinese cervical cancer survivors”. Health and Quality of Life Outcomes (2010): 8.
13. Ding Y., et al. “Psychometric properties of the Chinese version of the Functional Assessment of Cancer Therapy-Cervix (FACT-Cx measuring health-related quality of life”. Health and Quality of Life Outcomes 10 (2012):124.
14. Ferrans Ce. “Quality of life: conceptual issues”. Seminars in Oncology Nursing (1990): 248-254.
15. Mitchell A. “Quality of life in palliative care: patient as expert”. In: Kinghorn S and Gamlin R (editions). Palliative nursing: bringing comfort and hope. London: Balliere Tindall (2001). 
16. Dunn J., et al. “Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment”. Health and Quality of Life Outcomes 11 (2013): 46.
17. Jansen Van Rensburg J. “The Development and Validation of a Quality of Life Assessment Instrument for Cancer Patients in South Africa”. PhD Thesis, University of the Witwatersrand (2016).
18. Kaasa S and Loge JH. “Quality of life in palliative care: principles and practice”. Palliative Medicine 17 (2003): 11-20.
19. Granda-Cameron C., et al. “Measuring patient-oriented outcomes in palliative care: Functionality and quality of life”. Clinical Journal of Oncology Nursing 12 (2008): 65-77.
20. Byock I and Merriman M. “Measuring quality of life for patients with terminal illness: The Missoula-VITAS Quality of Life Index”. Palliative Medicine 12 (1998): 231-244.
21. Business report. More people living below breadline - Stats SA (2015).
22. Pallant J and Tennant A. “An introduction to the Rasch measurement model: An example using the Hospital Anxiety and Depression Scale (HADS)”. British Journal of Clinical Psychology 46 (2007): 1-18.
23. Khadka J., et al. “The importance of rating scales in measuring patient-reported outcomes”. Health and Quality of Life Outcomes (2012): 10.
24. Tennant A and Conaghan P. “The Rasch Measurement Model in Rheumatology: What is it and why use it? When should it be applied, and what should one look for in a Rasch paper?” Arthritis and Rheumatism 57 (2007): 1358-1362.
25. Zucca A., et al. “Rasch analysis of the Mini-Mental Adjustment to Cancer Scale (mini-mac) among heterogenous sample of long-term cancer survivors: a cross-sectional study”. Health and Quality of Life Outcomes (2012): 10.
26. Mallinson T. “Why measurement matters for measuring patient vision outcomes”. Optometry and Vision Science 84 (2007): 675-682.
27. Adnane C., et al. “Cross-cultural and Moroccan validation of the University of Washington Quality of Life Questionnaire for patients with head and neck cancer”. Annals of Otology, Rhinology and Laryngology (2016): 125.
28. Andrich D and Hagquist C. “Real and artificial differential item functioning”. Journal of Educational and Behavioral Statistics 37 (2012): 387-416.
29. Polit D and Beck C. “Nursing research: generating and assessing evidence for nursing practice., Philadelphia, Lippincott Williams and Wilkins (2008). 
30. Pretorius S. SA's real level of literacy. The Citizen (2013).