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Instrument Validation

Jeffrey E. Terrell, MD; Kinjal A. Nanavati, MPH; Ramon M. Esclamado, MD; Julie K. Bishop, CCC-SLP; Carol R. Bradford, MD; Gregory T. Wolf, MD

Arch Otolaryngol Head Neck Surg. 1997;123(10):1125-1132.

Abstract
Background
The disfigurement and dysfunction associated with head and neck cancer affect emotional well-being and some of the most basic functions of life. Most cancer-specific quality-of-life assessments give a single composite score for head and neck cancer—related quality of life.

Objective
To develop and evaluate an improved multidimensional instrument to assess head and neck cancer—related functional status and well-being.

Methods
The item selection process included literature review, interviews with health care workers, and patient surveys. A survey with 37 disease-specific questions and the SF-12 survey were administered to 253 patients in 3 large medical centers. Factor analysis was performed to identify disease-specific domains. Domain scores were calculated as the standardized score of the component items. These domains were assessed for construct validity based on clinical hypotheses and test-retest reliability.

Results
Four relevant domains were identified: Eating (6 items), Communication (4 items), Pain (4 items), and Emotion (6 items). Each had an internal consistency (Cronbach value) of greater than 0.80. Construct validity was demonstrated by moderate correlations with the SF-12 Physical and Mental component scores (r=0.43-0.60). Test-retest reliability for each domain demonstrated strong reliability between the 2 time points. Correlations were strong for each individual question, ranging from 0.53 to 0.93. Construct validity testing demonstrated that the direction of differences for each domain were as hypothesized.

Conclusion
The Head and Neck Quality of Life questionnaire is a promising multidimensional tool with which to assess head and neck cancer—specific quality of life.

Arch Otolaryngol Head Neck Surg. 1997;123:1125-1132

Author Affiliations
From the Department of Otolaryngology, University of Michigan (Drs Terrell, Bradford, and Wolf and Ms Bishop), and the Ann Arbor Health Services Research and Development, Department of Veterans Affairs (Dr Terrell and Ms Nanavati), Ann Arbor, Mich, and The Cleveland Clinic Foundation, Cleveland, Ohio (Dr Esclamado).

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