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PubMed2003

Validation of a model for evaluating outcome after traumatic brain injury.

OBJECTIVE: To validate a model that examines the contribution of premorbid variables, injury severity, and functional and cognitive status to outcome 1 year after traumatic brain injury (TBI). DESIGN: Cross-validation study using a larger, national, prospective, longitudinal sample. SETTING: Acute inpatient rehabilitation hospitals at Traumatic Brain Injury Model Systems centers. PARTICIPANTS: Two sample populations followed through acute rehabilitation to 1 year after TBI. The original sample included 107 patients, and the cross-validation sample included 294 patients. Participants were predominantly young men who had experienced moderate to severe TBI in motor vehicle crashes. INTERVENTIONS: Acute medical and rehabilitation care. MAIN OUTCOME MEASURES: Disability Rating Scale, Community Integration Questionnaire, and return to employment. RESULTS: Structural equation modeling was used to compare the fit of the data to a path analysis developed through clinical use and previous research. Both samples provided adequate goodness of fit, supporting the model's validity. Injury severity affected cognitive and functional status, and cognitive and functional status significantly influenced 1-year outcome. Premorbid factors and injury severity did not directly influence outcome. CONCLUSIONS: Both samples supported the proposed model, which was cross-validated. Injury severity indirectly influences outcome through its effects on cognitive and functional status. Although treatment to decrease injury severity is obviously important, concentrated rehabilitation interventions aimed at improving patients' cognitive and functional status may have a more significant impact on 1-year outcome and should be the focus of future research.

Adult↗

PubMed2002

Differentiating anxious, aggressive, and socially competent preschool children: validation of the Social Competence and Behavior Evaluation-30 (parent version).

The present study examined the factor structure, internal consistency, and construct validity of the parent version of the Social Competence and Behavior Evaluation-30 for preschoolers (SCBE-30; LaFreniere, P. J. (1990). Social competence and behavior evaluation-30. Unpublished measure.), an adaptation of the validated teacher version of the same measure (LaFreniere & Dumas, Psychol. Asses. 8 (1996) 369). The parent version of the SCBE-30 is a 30-item Likert rating scale questionnaire designed to assess patterns of anxiety/withdrawal, anger/aggression, and social competence. Principal components analysis was used to identify the factor structure of the parent version of the SCBE-30 (N = 218 preschool children). To assess construct validity, a compliance task was utilized to determine whether children identified as high on anxiety/withdrawal, anger/aggression, or social competence with the parent version of the SCBE-30 (n = 20 for each group) could be distinguished behaviorally on several observational variables. Principal components analysis identified three factors accounting for 44% of the variance. Ten items positively loaded onto each factor and matched conceptual expectations. A between-subjects MANOVA demonstrated significant group differences in observed child behaviors including compliance, noncompliance, subtypes of noncompliance, and aversive behavior. Results of the current study suggested that the parent version of the SCBE-30 demonstrated both internal consistency and construct validity, and findings paralleled many of the results from LaFreniere and Dumas' validation of the teacher version of the SCBE-30.

Aggression↗

PubMedDate not supplied

[Validation of the French Version of the Life Skills Profile with people suffering of schizophrenia].

INTRODUCTION: Since the discovery of neuroleptics and the reintegration of people with schizophrenia in the community, psycho-social reeducation became an essential part of the treatment. The Life Skills Profile is a tool of reference for assessment of the dimensions, which have an impact on the adaptation in community. Each item describes an observable behavior, written in common language, to allow the care-givers and the family to evaluate it without having a specific formation. The long version (39 items) is recommended for therapeutic interventions with a person and the short one (20 items) for large scale studies on outcome in community. AIM OF THE STUDY: In order to dispose of a measure of function and disability in schizophrenia, we have translated the Life Skills Profile (LSP) in French and tested the validity of this translation for the long version (39 items) and the short ones (16 and 20 items). The 4 dimensions of the 16-items version--"withdrawal", "self-care", "compliance" and "antisocial"--were used for people with mental disorders and the 20-items version enhanced with a fifth dimension "bizarre", especially useful for people with schizophrenia. METHOD: 175 people suffering of schizophrenia (DSM IV, codes F20.0 to F20.5) were evaluated by their caregivers in 3 settings: psychiatric hospital, ambulatory care and sheltered homes. Confirmatory factorial analyses were performed to test the dimensional models and their psychometric characteristics were established. RESULTS: The original structure in 5 dimensions of the long version (39 items) is not confirmed. However, the short versions in 16 and 20 items were confirmed, without any modification. The required psychometric qualities of reliability and validity of the 20-items version were fulfilled. The inter-rater reliability ranged from 0.65 to 0.75 for the 5 dimensions; the test-retest reliability ranged from 0.80 to 0.91 and the internal consistency from 0.67 to 0.81. The validity was evaluated by comparison of the LSP scores upon living arrangements (people living in sheltered homes had lesser scores) and pathologies (19 people with severe major depression had higher scores). CONCLUSION: The 39-items version of the Life Skills Profile was not validated in French. However, for clinical practice of social rehabilitation, this tool remains useful for a single person to check specific behaviors, which could hinder his/her integration into the community, to plan specific interventions and to evaluate changes, in addition with other scales. By the validation of the short version of the Life Skills Profile, an instrument is at disposal in French for outcome studies which allow to: 1) quickly assess the social functioning of person suffering of schizophrenia by a caregiver or a family member; 2) to detect insufficient skills in specific domains; and 3) to evaluate therapeutic efficiency.

Adaptation, Psychological↗

PubMed2006

Validity and reliability of parental report of frequency, severity and risk factors of urinary tract infection and urinary incontinence in children.

PURPOSE: We describe the validity and reliability of a questionnaire designed to determine frequency, severity and risk factors of urinary tract infection and daytime urinary incontinence in primary school-age children. MATERIALS AND METHODS: Based on published validated questionnaires and advice from content experts, a questionnaire was developed and piloted in children attending outpatient clinics. Construct validity for parent report of frequency and severity of daytime urinary incontinence was tested by comparison with a daily accident diary in 52 primary school children, and criterion validity of parent report for UTI was verified by comparison with the reference standard (urine culture) in 100 primary school children. Test-retest reliability of the questionnaire was assessed in 106 children from primary schools. RESULTS: There was excellent agreement between the questionnaire and accident diary in severity (weighted kappa 0.94, 95% confidence intervals 0.85 to 1.03) and frequency of daytime urinary incontinence (0.88, 0.7 to 1.0). Parents reported urinary tract infection in 15% of children, compared to a positive urine culture in 8% (sensitivity 100% and specificity 68.5%). Test-retest reliability of the questionnaire was excellent (mean k 0.78, range 0.61 to 1.00). CONCLUSIONS: Parents overreport UTI by about 2-fold but can recall frequency and severity of daytime urinary incontinence well during a 3-month period. The developed questionnaire is a valid tool to estimate frequency, severity and risk factors of daytime urinary incontinence and UTI in primary school children.

Child↗

PubMed2001

[Spanish language adaptation and validation of the Pfeiffer's questionnaire (SPMSQ) to detect cognitive deterioration in people over 65 years of age].

BACKGROUND: Our aims were to develop a Spanish version of the short portable mental status questionnaire (SPMSQ) (Pfeiffer's test) and to validate the resultant Spanish version of the test among a general population aged 65 years or older. PATIENTS, MATERIAL AND METHODS: First, we developed the Spanish version of the SPMSQ by means of a cross-cultural adaptation methodology. Patients were the assessed by independent teams in two sessions the same day. The first team (two trained psychiatrists and one trained family physician) carried out a standardised neuropsychological assessment to diagnose cognitive impairment/dementia according to ICD-10 criteria which was regarded as the reference "gold standard" to calculate validity parameters (sensitivity and specificity). The second team (family physicians/nurses) assessed the presence of cognitive impairment with the Spanish version of the SPMSQ. RESULTS: 255 subjects (66.7%, females) underwent the assessment. Mean age was 74.5 years and 65.5% of them were illiterate. The inter-rater reliability and test-retest reliability of the SPMSQ Spanish version were 0.738 (p < 0.001), and 0.925 (p < 0.001), respectively,with a convergent validity of 0.74 (p < 0.001) and a discriminant validity of 0.230 (p < 0.001). The internal consistency was high with an *value of 0.82. The area under the ROC curve was 0.89. Sensitivity and specificity were 85.7 and 79.3, respectively (cut-off of 3 or more). CONCLUSIONS: The Spanish version of the SPMSQ test has a good reliability and validity. For clinical use, a cut-off of 3 appears to be most useful. When illiterate patients are assessed, the it is recommended to employ a cut-off of 4 or more.

Age Factors↗

PubMed2002

[Spanish version of a scale for the assessment of mania: validity and reliability of the Young Mania Rating Scale].

BACKGROUND: The Young Mania Rating Scale is the most widely used tool for the assessment of the intensity of manic symptoms. Unfortunately, to date, there was no Spanish validated version available. This study validated the Spanish version of the YMRS. PATIENTS AND METHOD: A sample of 541 DSM-IV manic or hypomanic bipolar patients were recruited in 56 different psychiatric settings in Spain and assessed with the YMRS by 112 clinicians specifically trained in its use on days 1, 7, 14, 30, 45 and at 3 and 6 months. The mania subscale of the Clinical Global Impression for Bipolar Disorders was also performed in order to have a standard measure to compare our results. Feasibility, reliability, validity and sensitivity of the YMRS were analysed. RESULTS: The YMRS Spanish version showed reliability index of 0.88 (internal consistency) and 0.76 (test-retest reliability), and good internal validity and external (p < 0.001) when compared to the mania subscale of the Modified Clinical Global Impression. The results also showed good sensitivity and feasibility. CONCLUSIONS: The YMRS Spanish Version is a useful, valid and reliable tool for the assessment of manic symptoms.

Bipolar Disorder↗

PubMed2003

[A validation study of the Spanish versions of the Clinical Anxiety Scale and the Physician Questionnaire for the assessment of anxiety disorders].

BACKGROUND AND OBJECTIVE: To validate the Spanish versions of both the Clinical Anxiety Scale (CAS) and the Physician Questionnaire (PQ) to assess the severity of symptoms in patients with Anxiety Disorders (AD) treated in ambulatory psychiatric care facilities. PATIENTS AND METHOD: Observational, prospective and multi-centre study (15 psychiatric facilities included) with a follow-up of 1 to 6 weeks in clinically stable or unstable AD patients. We assessed their convergent validity (with the Hamilton Anxiety Rating Scale as reference), discriminant validity (as compared with the Clinical Global Impression), reliability (internal consistency, test-retest and inter-raters) and sensitivity to change. RESULTS: One hundred and sixty one AD patients were included (48 stable and 133 unstable patients). Both the CAS and the PQ showed appropriate convergent (r >= 0.70) and discriminant validity (p 0.001), internal consistency (Cronbach's a > 0.75), test-retest reliability (intraclass correlation coefficient [ICC] > 0,90), inter-raters reliability (ICC > 0.90) and sensitivity to change (p < 0.0001; effect size >= 1.5). CONCLUSIONS: The Spanish versions of both rating scales show appropriate validity and reliability and thus can be used to assess the severity of anxiety symptoms and their change in AD patients treated in ambulatory care.

Adolescent↗

PubMed2004

[Validation study of the Multidimensional Alcohol Craving Scale (MACS)].

BACKGROUND AND OBJECTIVE: Craving is a psychobiological phenomenon characteristic of addictive behaviours, which is difficult to assess due to its subjective nature and multidimensionality. The aim of this study was to validate a multidimensional alcohol craving scale (MACS) entirely developed in Spain. MATERIAL AND METHOD: The validation of the MACS was based on an observational study, carried out in 452 alcohol-dependent patients treated with naltrexone. The scales used as standards were an Analogic Visual Scale (AVS) for alcohol craving and the Obsessive-Compulsive Drinking Scale (OCDS). Validity, reliability and sensitivity were studied for the validation process. RESULTS: The factorial analysis (construct validity) showed that the scale had two factors: desire and behavioural disinhibition (lack of resistance). Their correlation values with the assessment scales were r = 0.56 and r = 0.50, respectively. The scale's internal consistency was alpha = 0.94. The correlation of the scores on the scale with the AVS oscillated between 0.56 and 0.46 (p < 0.01) throughout the course of treatment. CONCLUSIONS: The MACS has good psychometric properties: it measures two craving factors --desire and behavioural disinhibition-- and may be considered as an accurate and precise instrument to use in both research studies and medical and psychological clinical practice.

Adult↗

PubMed2001

Validation of biomarkers as early predictors of disease.

The development and validation of biomarkers that link environmental exposures to the pathogenesis of human disease is a leading priority in the field of environmental research. The validation of biomarkers as early predictors of clinical disease can enhance health risk assessment and contribute to effective new disease prevention policies in environmental and occupational settings. The process of validating biomarkers involves dealing with a range of characteristics that include the intrinsic qualities of the biomarker, its determinants, and the analytic procedure. We discuss here a three phase approach to validation. The final phase, consisting of longitudinal studies, is reached after the biomarker has been determined to be technically reliable and after the effect of external variables on the association with the outcome has been evaluated. We provide some examples of biomarkers reputed to be early predictors of cancer and cardiovascular disease (CVD). We then present original data to support the potential of DNA adducts to predict cancer and show, through re-evaluation of the Italian database on cytogenetic biomarkers, a lack of association between the frequency of chromosomal aberrations in circulating lymphocytes and CVD mortality rates -- a finding that should not be considered conclusive. In general, whenever a biomarker has been determined to be a valid predictor of disease, it should be used in risk assessment and public health policy.

Biomarkers↗

PubMed1998

Computer system validation: an overview of official requirements and standards.

A brief overview of the relevant documents for companies in the pharmaceutical industry, which are to be taken into consideration to fulfil computer system validation requirements, is presented. We concentrate on official requirements and valid standards in the USA, European Community and Switzerland. There are basically three GMP-guidelines. their interpretations by the associations of interests like APV and PDA as well as the GAMP Suppliers Guide. However, the three GMP-guidelines imply the same philosophy about computer system validation. They describe more a what-to-do approach for validation, whereas the GAMP Suppliers Guide describes a how-to-do validation. Nevertheless, they do not contain major discrepancies.

Computer Systems↗

PubMed2002

Toward validation of atypical depression in the community: results of the Zurich cohort study.

AIMS: This paper (1) examines the validity of the atypical subtype of depression in a community-based longitudinal cohort study, (2) presents estimates of the prevalence and sex differences of DSM-IV atypical depression and a newly more broadly defined atypical syndrome in the community and (3) compares the clinical correlates and treatment patterns of those with atypical depression with other depressives. METHODS: The Zurich cohort study is comprised of 591 subjects selected from a population-based cohort of young adults representative of the canton of Zurich in Switzerland, who were screened in 1978 with the Symptom Checklist 90-R [L.R. Derogatis (1977)] and followed prospectively with five interviews between 1979 and 1993. Atypical depression was defined on a spectrum ranging from atypical major to minor to atypical depressive symptoms alone. RESULTS: The rate of DSM-IV atypical major depressive episodes in this community is 4.8% and for major atypical depression syndrome is 7.3%. Whereas there was no marked sex difference for nonatypical features, there was a significant female preponderance for DSM-IV and broadly defined atypical depressive subtypes. Systematic investigation of the diagnostic criteria for atypical depression revealed that a nonhierarchical definition of atypical depression with respect to mood reactivity yielded as valid a syndromic definition as the current hierarchy based on mood reactivity as an essential feature. Very high comorbidity (odd ratios>2.0) was found with seasonality, bipolar II, social phobia, binge eating, neurasthenia and sociopathy. LIMITATIONS: Atypical depression was not defined à priori, its criteria were derived from two sections of the Zurich interview. CONCLUSIONS: Atypical depression has high population prevalence and substantial significance in terms of clinical severity, impairment, and service use. The intriguing finding that the sex difference in depression may be attributed to atypical features of depression will need further investigation. Overall, our data indicate that the atypical subtype of depression is a valid entity based on evidence from such traditional indicators of validity as inclusion criteria and indicators of course. However, there are some problems with discriminatory validity from other disorders. Although comorbidity with these disorders may in part reflect an operational artifact of symptom overlap, further work needs to be done in distinguishing atypical depression from bipolar II.

Adult↗

PubMed2003

Model validation software for classification models using repeated partitioning: MVREP.

The process of assessing the prediction ability of a computational model is called model validation. For models predicting a categorical response, the prediction ability is usually quantified by prediction measures such as sensitivity, specificity, and accuracy. This paper presents a software Model Validation using Repeated Partitioning (MVREP) that implements a computer-intensive, nonparametric approach to model validation, which we call the re-partitioning method. MVREP, developed using the SAS Macro language, repeats the process of randomly partitioning a dataset and subsequently performing standard model validation procedures, such as cross-validation, a large number of times and generates the empirical sampling distributions of prediction measures. The means of the sampling distributions serve as the point estimates of prediction measures of the model. The variances of the sampling distributions provide a direct assessment of variability for the point estimates of prediction measures. An example is presented using a mouse developmental toxicity chemical dataset to illustrate how the software can be used for the assessment of structure-activity relationships models.

Animals↗

PubMed2001

[Design and validation of a questionnaire in Spanish for measuring the quality of life in postmenopausal women: the MENCAV questionnaire].

OBJECTIVE: To calculate the validity and reliability of a questionnaire to measure the quality of life in post-menopausal women. DESIGN: Cross-sectional observation study. SETTING: Three health districts in the province of Cuenca. PARTICIPANTS: 203 menopausal women between 44 and 60 years of age, chosen through simple randomised sampling. MEASUREMENTS AND MAIN RESULTS: On the basis of the analysis of various scales of health-related quality of life, some for measuring physical disorders, and others for psychological disorders, a questionnaire was designed. This had 85 items structured as a Likert-like additive scale and explored four dimensions (physical health, psychological health, family environment and social support). In the view of a multi-disciplinary group of health professionals, it met criteria of logical validity and validity of contents for the different spheres that are usually affected in the menopause. After the administration of the questionnaire to the women taking part, a process of "purging" items began, in which those items with a reply frequency to one of the five options of below 5% or above 95% were discarded. Also discarded were those items for which the inter-item correlation was below 0.20, with analysis too of the behaviour of the Cronbach's alpha coefficient as each item was eliminated from its scale. Finally, through exploratory factorial analysis techniques (main components), the distribution of the items in dimensions was evaluated. A final questionnaire made up of 37 items in 5 dimensions, which we named physical health, psychological health, family environment, sexual relationships and social support was reached. This questionnaire had an overall Cronbach's alpha value of 0.84. Finally, the correlations existing between the sum of scores of the items on each of the dimensions were analysed. The correlation coefficients showed values between 0.08 and 0.69. CONCLUSIONS: The MENCAV questionnaire is the first in Spanish which assesses quality of life in menopausal women. Experts analysed its logical validity and contents validity and found it had a high degree of internal consistency.

Cross-Sectional Studies↗

PubMedDate not supplied

[Validation of the Job Content Questionnaire in hospital nursing staff].

OBJECTIVE: The aim of this study was to determine the reliability and construct validity of the three dimensions of the Job Content Questionnaire (JCQ): demand, control and job support among hospital nursing staff. METHODS: The minimun reduced version of the JCQ was used, which include three dimensions: psychological demands (9 items), job control (9 items) and job support (11 items). Validity was assessed in a random sample of 330 nursing staff from two general hospitals in the province of Alicante (Spain). The reliability of the questionnaire was evaluated after re-interviewing a subsample of 50 nurses 15 days after the first interview. Construct validity was evaluated by calculating correlations between the three dimensions of the JCQ obtained after factorial analysis with the burnout scale and six dimensions of the 36-item short-form health survey (SF-36) questionnaire. RESULTS: Factorial analysis revealed that the version of the JCQ validated in this study had the same factorial structure as the original questionnaire. The intraclass correlation between the first and second interview was high for each of the three dimensions (between 0.83 and 0.87). Cronbach's alpha was also high (between 0.74 and 0.88). A moderate but significant correlation was found between the three JCQ dimensions and the burnout scale: (-0,27 for job support, 0.31 for psychological demands and -0.12 for job control). A moderate correlation was also found for some SF-36 dimensions. CONCLUSION: The factorial structure of the JCQ was similar to that proposed by the author in the context of Spanish culture. The reliability and internal consistency of each of the three dimensions was high while construct validity was moderate.

Job Description↗

PubMed2003

European psychometric validation of the CONTILIFE: a Quality of Life questionnaire for urinary incontinence.

OBJECTIVE: To validate 5 language versions (French, Dutch, German, English and Danish) of CONTILIFE, a urinary incontinence-specific measure of Quality of Life (QoL). METHODS: CONTILIFE was administered to Belgian, Danish, English, French, German, and Dutch women with genuine stress incontinence. The internal consistency, the construct and clinical validity, and the responsiveness to change over time were assessed using standardised procedures. RESULTS: 505 women filled in the CONTILIFE at baseline. Quality of completion was good. The mean number of missing data varied between 0.33 (1.17%) and 0.94 (3.36%) according to the country. Internal consistency was good for all dimensions except for the Effort Activities dimension. Construct validity was good for the Danish, French and pooled sample, and acceptable for English, German and Dutch samples. The distribution of QoL scores differed according to the number of urinary leaks (p<0.007). 477 women completed the questionnaire twice with a 28-day interval. Responsiveness to clinical improvement was good (/ES/> or =0.50) except for the Sexuality and Well-Being dimensions. CONCLUSION: In this international European study, CONTILIFE matched the psychometric requirements to be used as a valid, reliable, and sensitive measure of the QoL of the patients. The Daily Activities, Effort Activities, Self-Image and Emotional Consequences dimensions are the most relevant and valid dimensions for purposes of comparison.

Adaptation, Psychological↗

PubMed2003

Validation of a Norwegian version of the Burn Specific Health Scale.

BACKGROUND: The abbreviated Burn Specific Health Scale (BSHS-A) is an 80-item questionnaire that has proven useful in measuring physical, mental, social and general health in burn survivors. The aim of this study was to adapt the BSHS-A into Norwegian, including assessing reliability and validity. METHODS: Standard procedures for forward and backward translation including discussions with professionals and patients to ensure conceptual equivalence were used. A pilot study (11 burn patients) confirmed that the Norwegian version (BSHS-N) was clear, understandable and easy to self-administer. Subsequently, 95 adults admitted to the Burn Center, Haukeland University Hospital, between 1995 and 2000 entered a validation study by completing the BSHS-N and the general health measure SF-36. Sixty-nine of the 95 (72%) responders completed a retest. RESULTS: The overall internal consistency reliability (Cronbach's alpha=0.97) and the test-retest reliability (ICC=0.95) for the BSHS-N were satisfactory. Tests for criterion validity showed expected patterns for association between comparable domains in the BSHS-N and the SF-36, with correlations ranging from r=0.61 to 0.81. Tests for construct validity showed that patients with full thickness injury (P=0.003), patients hospitalised more than 10 days (P=0.003), patients undergoing more than two operations (P=0.001) and patients unemployed at the time of study (P<0.001), had significantly lower total scores than the rest of the patients. CONCLUSION: BSHS-N seems to be a reliable and valid instrument for use in the Norwegian population. The translation and cross-cultural adaptation of this instrument allows for comparative international studies.

Adolescent↗

PubMed2000

Psychometric validation of two Italian quality of life questionnaires in menopausal women.

OBJECTIVE: To establish the psychometric properties of the Italian version of two quality of life (QOL) questionnaires in menopausal women: the psychological general well being index (PGWBI) and the women's health questionnaire (WHQ). METHOD: These questionnaires were translated into Italian and then self-administered to out-patient women a first time, 1 week later in stable women to assess reproducibility, and 3 months later to evaluate responsiveness over time. Baseline analyses included: factorial structure, multitrait analysis, internal consistency reliability, and clinical validity. RESULTS: Questionnaires were returned by 155 women (median age: 54 years, median duration of amenorrhoea: 56 months, median Kupperman index 26). Principal component analysis (PCA) of the PGWBI showed an important general factor and then, after rotation, three factors. The PCA of the WHQ showed ten factors. Only five reproduced the dimensions postulated à priori quite well. The item convergent validity was confirmed for all items of the major dimension of the two questionnaires, and the item divergent validity, although acceptable, was less satisfying for the PGWBI than the WHQ. The internal reliability was good (Cronbach's alpha > or = 0.70) for the PGWBI and for nine scales out of ten for the WHQ. The six dimensions of the PGWBI and most of the dimensions of the WHQ were significantly correlated to the Kupperman index, indicating the clinical validity of the instruments. The responsiveness to change in clinical status at 3 months was better in the PGWBI than in the WHQ with moderate effect size (around 0.5). CONCLUSION: The Italian versions of the PGWBI and the WHQ are reliable and useful for HRT clinical trials but the dimensional scores must be calculated bearing in mind the limitations in the structure. Other studies are needed to improve the factorial stability of certain WHQ dimensions. For the Italian version of the PGWBI, the validation process is to be completed by studies of mixed populations suffering from other types of disease.

Adult↗

PubMed2001

The decisional conflict scale: further validation in two samples of Dutch oncology patients.

The importance of patient involvement in medical decision making is indisputable. Yet, decision making concerning medical treatment options is a difficult task for most patients. In order to study decision-making processes in health care, O'Connor developed the decisional conflict scale (DCS). The DCS assesses the level of 'decisional conflict' that patients experience while making health care decisions, and encompasses the following three subscales: (1) uncertainty about choosing among alternatives; (2) factors contributing to uncertainty; (3) perceived effectiveness of the decision. The aim of the present study is to investigate the reliability and validity of the Dutch version of the DCS. A written version of the DCS was administered in two samples of Dutch cancer patients. One sample consisted of cancer patients faced with the decision whether or not to undergo palliative chemotherapy (N=29). The other sample included women with early stage breast cancer who had to choose between mastectomy or lumpectomy followed by radiation therapy (N=141). The response rates were 76% and 91%, respectively. The reliability coefficients of the three subscales were 0.52, 0.80, 0.84, and 0.74, 0.83, 0.83 in the two samples, respectively. Construct validity was partly supported. Criterion validity was substantiated. In evaluating the factorial validity, it was found that the original three-factor model had to be rejected (chi(2)(87)=293, root mean square error of approximation (RMSEA)=0.137). A subsequent exploratory factor analysis suggested an alternative four-factor model. The psychometric properties of the DCS were partly confirmed in Dutch cancer patients. Improved 'wording' of certain items, e.g. to avoid double negatives, could further increase the factorial validity of the DCS. Then, this scale may be a valuable tool for studies that address the quality of medical decision making.

Conflict, Psychological↗