Treatment Burden Questionnaire Research Articles

Factors associated with patients\u2019 and GPs\u2019 assessment of the burden of treatment in multimorbid patients: a cross-sectional study in primary care

BackgroundMultimorbid patients may experience a high burden of treatment. This has a negative impact on treatment adherence, health outcomes and health care costs. The objective of our study was to identify factors associated with the self-perceived burden of treatment of multimorbid patients in primary care and to compare them with factors associated with GPs assessment of this burden.MethodA cross sectional study in general practices, 100 GPs in Switzerland and up to 10 multimorbid patients per GP. Patients reported their self-perceived burden of treatment using the Treatment Burden Questionnaire (TBQ, possible score 0–150), whereas GPs evaluated the burden of treatment on a Visual Analog Scale (VAS) from 1 to 9. The study explored medical, social and psychological factors associated with burden of treatment, such as number and type of chronic conditions and drugs, severity of chronic conditions (CIRS score), age, quality of life, deprivation, health literacy.ResultsThe GPs included 888 multimorbid patients. The overall median TBQ was 20 and the median VAS was 4. Both patients’ and GPs’ assessment of the burden of treatment were inversely associated with patients’ age and quality of life. In addition, patients’ assessment of their burden of treatment was associated with a higher deprivation score and lower health literacy, and with having diabetes or atrial fibrillation, whereas GPs’ assessment of this burden was associated with the patient having a greater number of chronic conditions and drugs, and a higher CIRS score.ConclusionBoth from patients’ and GPs’ perspectives TB appears to be higher in younger patients. Whereas for patients the burden of treatment is associated with socio-economic and psychological factors, GPs’ assessments of this burden are associated with medical factors. Including socio-economic and psychological factors on patients’ self-perception is likely to improve GPs’ assessments of their patients’ burden of treatment thus favoring patient-centered care.

Abstract OT2-10-01: Treatment burden and capacity to manage care among patients with breast cancer

Abstract Patients with breast cancer spend significant time1, effort, and financial resources2 to combat the disease for years after their diagnosis. The large volume of healthcare tasks can cause patients to become overburdened, leading to reduced adherence with care plans and worse outcomes3. On the other hand, certain patient characteristics such as physical resilience, financial well-being, and supportive family environments increase patients' capacity to manage care4. Assessing treatment burden and capacity when prescribing care has been applied to populations such as diabetes patients5. We are investigating this paradigm in treatment of patients with breast cancer. The goal of this preliminary study is to identify significant factors that contribute to treatment burden, capacity to manage care, and outcomes of overburden for patients with breast cancer. Examples of treatment burden, capacity to manage care, and outcomes of overburden in patients with breast cancerTreatment burdenCapacity to manage careOutcomes of overburdenTraveling long distances for careAccess to reliable transportationReduced spending on food, utilities, or other necessitiesPaying for child care during chemotherapyFlexibility in informal caregivers' schedulesMissed appointment with medical oncologistRemembering to take medications with mealsMedical understanding or knowledgeWorse than expected side effectsReporting adverse eventsProficiency with mobile deviceTrip to emergency room Through literature review, interviews with survivors, and expert panels of navigators and providers, we will develop a survey instrument given to patients at the time of diagnosis. The survey will assess patient capacity and help providers give treatment options based on attributes of the patient. Additionally, we will attempt to correlate survey results with treatment burden measures derived from electronic health record data at a population level1. With treatment personalized for patient capacity, patients should be better able to adhere to care plans leading to improved quality of life during treatment and beyond. Acknowledgements: The authors would like to thank Cheryl Jernigan, our patient advocate mentor, for her guidance in this project. We would also like to thank the Susan G. Komen Foundation for their support of this research.

Development and preliminary psychometrics of the exercise therapy burden questionnaire for patients with chronic conditions

Chronic diseases are the leading cause of mortality and disability worldwide. Exercise therapy has been found effective for mortality, disability and well-being in many chronic conditions. Burden of treatment may reduce patient compliance and treatment efficacy. We aimed to develop and validate a self-reporting questionnaire assessing the burden of exercise therapy for patients with chronic conditions. We conducted semi-structured interviews with patients to develop items of the questionnaire. The dimensional structure of the questionnaire was assessed by principal component analysis. Construct validity of the instrument was assessed by exploring convergent validity with the Treatment Burden Questionnaire (TBQ) and divergent validity with pain, self-efficacy, treatment satisfaction and health state. Reliability was assessed with the Cronbach alpha coefficient, a test–retest method using the intraclass correlation coefficient (ICC) and Bland-Altman plotting. A preliminary list of items was developed from semi-structured interviews with 28 patients and reviewed by two expert physicians. Items obtained were reduced. Then, a sample of 163 patients was used to measure the psychometrics of the Exercise Therapy Burden Questionnaire (ETBQ), consisting of 10 items. Principal component analysis extracted one dimension. The Cronbach alpha was 0.86 [0.82–0.89]. Test–retest reliability (n = 24 patients) was good, with ICC 0.93 [0.85–0.97], and Bland–Altman analysis did not reveal a systematic trend. The ETBQ showed expected convergent validity with the TBQ (rs = 0.52) and expected divergent validity with pain (rs = 0.37), self-efficacy (rs = −0.34), treatment satisfaction (rs = −0.49) and perceived health state (rs = −0.28). The ETBQ is the first questionnaire assessing exercise therapy burden in patients with chronic conditions. Its psychometric properties are promising.

Correction to: Reproducibility and Validity of a Questionnaire Measuring Treatment Burden on Patients with Type 2 Diabetes: Diabetic Treatment Burden Questionnaire (DTBQ).

In the original publication, second author's name was incorrectly published as Hiroki Shin. The correct name should read as 'Koki Shin'.

Development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ)

ObjectiveTo develop and validate a new scale to assess treatment burden (the effort of looking after one’s health) for patients with multimorbidity.DesignMixed-methods.SettingUK primary care.ParticipantsContent of the Multimorbidity Treatment Burden Questionnaire...

Reproducibility and Validity of a Questionnaire Measuring Treatment Burden on Patients with Type 2 Diabetes: Diabetic Treatment Burden Questionnaire (DTBQ).

IntroductionTo measure the burden of pharmacotherapy on patients with type 2 diabetes mellitus (T2DM), we developed the Diabetes Treatment Burden Questionnaire (DTBQ), a patient-administered questionnaire composed of 18 questions, and evaluated its reproducibility and validity.MethodsWe enrolled 240 patients with T2DM under pharmacotherapy over 20 years of age at seven institutes in Japan. Their physicians filled out report forms on patient backgrounds, and the patients answered both the DTBQ and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). For evaluation of reproducibility, 48 of the enrolled subjects completed a 2nd DTBQ at home after leaving the medical institutes.ResultsStatistical analyses were performed for two sets of subjects, the validity analysis set (N = 236) and the reproducibility analysis set (N = 47). Factor analysis found a simple structure in the DTBQ item scores using a three-factor model with varimax rotation; the three subscales were designated as “implementation burden”, “flexibility burden”, and “blood glucose control burden”. All intraclass correlation coefficients for the subscale scores were 0.8 or higher, indicating high reproducibility. Negative correlations were observed between the DTSQ satisfaction score and the DTBQ subscale scores. Moreover, as the dosing frequency of diabetic medicines increased, the DTBQ total score (total burden score) also became higher. Likewise, expected associations were observed between patient backgrounds and DTSQ scores.ConclusionThe DTBQ has adequate reproducibility and validity as a measurement scale for treatment burden on T2DM patients.Trial RegistrationUniversity Hospital Medical Information Network (UMIN) 000026382.FundingEli Lilly Japan.Electronic supplementary materialThe online version of this article (10.1007/s13300-018-0414-4) contains supplementary material, which is available to authorized users.

Development and Preliminary Psychometrics of the Exercise Therapy Burden Questionnaire for patients with chronic conditions

To develop and validate a self-reporting questionnaire assessing the burden of exercise therapy for patients with chronic conditions. The dimensional structure of the questionnaire was assessed by principal component analysis. Construct validity of the instrument was assessed by exploring convergent validity with the Treatment Burden Questionnaire (TBQ) and divergent validity with pain, self-efficacy, treatment satisfaction and health state. Reliability was assessed with the Cronbach alpha coefficient, a test-retest method using the intraclass correlation coefficient (ICC) and Bland-Altman plotting. A preliminary list of items was developed from semi-structured interviews with 28 patients and reviewed by two expert physicians. Items obtained were reduced. Then, a sample of 163 patients was used to measure the psychometrics of the Exercise Therapy Burden Questionnaire (ETBQ), consisting of 10 items. Principal component analysis extracted one dimension. The Cronbach alpha was 0.86 [0.82–0.89]. Test-retest reliability ( n = 24 patients) was good, with ICC 0.93 [0.85–0.97] and Bland-Altman analysis did not reveal a systematic trend. The ETBQ showed expected convergent validity with the TBQ ( rs = 0.52) and expected divergent validity with pain ( rs = 0.37), self-efficacy ( rs = 0.34), treatment satisfaction ( rs = 0.49) and perceived health state ( rs = 0.28). The ETBQ is the first questionnaire assessing exercise therapy burden in patients with chronic conditions. Its psychometric properties are promising.

Development and Preliminary Psychometrics of the Exercise Therapy Burden Questionnaire for Patients With Chronic Conditions

ObjectiveTo develop and validate a self-reporting questionnaire assessing the burden of exercise therapy for patients with chronic conditions. DesignMeasurement properties of an instrument. SettingOutpatient clinics and tertiary care hospital. ParticipantsPatients (N=201) with at least 1 chronic condition and performing exercise therapy. InterventionsNot applicable. Main Outcome MeasuresThe dimensional structure of the questionnaire was assessed by principal component analysis. Construct validity of the instrument was assessed by exploring convergent validity with the Treatment Burden Questionnaire (TBQ) and divergent validity with pain, self-efficacy, treatment satisfaction, and health state. Reliability was assessed with the Cronbach α coefficient, a test-retest method using the intraclass correlation coefficient (ICC), and Bland-Altman plotting. ResultsA preliminary list of items was developed from semistructured interviews with 28 patients and reviewed by 2 expert physicians. Items obtained were reduced. Then a sample of 163 patients was used to measure the psychometrics of the Exercise Therapy Burden Questionnaire (ETBQ), consisting of 10 items. Principal component analysis extracted 1 dimension. The Cronbach α was .86 (.82–.89). Test-retest reliability (n=24 patients) was good with an ICC of .93 (.85–.97), and Bland-Altman analysis did not reveal a systematic trend. The ETBQ showed expected convergent validity with the TBQ (ρ=.52) and expected divergent validity with pain (ρ=.37), self-efficacy (ρ=−.34), treatment satisfaction (ρ=−.49), and perceived health state (ρ=−.28). ConclusionsThe ETBQ is the first questionnaire assessing exercise therapy burden in patients with chronic conditions. Its psychometric properties are promising.

Development and validation of an instrument to assess treatment adherence for each individual drug taken by a patient

ObjectiveTo develop and validate an instrument to assess adherence to each individual drug taken by patients undergoing long-term treatment.DesignMulticentre prospective observational validation study.SettingSix general practitioners' clinics and 6 university hospitals...

Adaptation and validation of the Treatment Burden Questionnaire (TBQ) in English using an internet platform.

BackgroundTreatment burden refers to the workload imposed by healthcare on patients, and the effect this has on quality of life. The Treatment Burden Questionnaire (TBQ) aims to assess treatment burden in different condition and treatment contexts. Here, we aimed to evaluate the validity and reliability of an English version of the TBQ, a scale that was originally developed in French.MethodsThe TBQ was translated into English by a forward-backward translation method. Wording and possible missing items were assessed during a pretest involving 200 patients with chronic conditions. Measurement properties of the instrument were assessed online with a patient network, using the PatientsLikeMe website. Dimensional structure of the questionnaire was assessed by factor analysis. Construct validity was assessed by associating TBQ global score wıth clinical variables, adherence to medication assessed by Morisky’s Medication Adherence Scale (MMAS-8), quality of life (QOL) assessed by the PatientsLikeMe Quality of Life Scale (PLMQOL), and patients’ confidence in their knowledge of their conditions and treatments. Reliability was determined by a test–retest method.ResultsIn total, 610 patients with chronic conditions, mainly from the USA, UK, Canada, Australia, or New Zealand, completed the TBQ between September and October 2013. The English TBQ showed a unidimensional structure with Cronbach α of 0.90. The TBQ global score was negatively correlated with the PLMQOL score (rs = −0.50; p < 0.0001). Low rather than moderate or high adherence to medication was associated with high TBQ score (mean [SD] TBQ score 61.8 [30.5] vs. 37.7 [27.5]; P < 0.0001). The treatment burden was higher for patients who had insufficient knowledge compared with those who had sufficient knowledge about their treatments (mean ± SD TBQ score 62.3 ± 31.3 vs. 47.8 ± 30.4; P < 0.0001) and conditions (63.0 ± 31.6 vs. 49.3 ± 30.7; P < 0.0001). The intraclass correlation coefficient for the retest (n = 282) was 0.77 (95% CI 0.70 to 0.82).ConclusionsWe found that the English TBQ is a reliable instrument in this population, and provide evidence supporting the construct validity for its use to assess treatment burden for patients with one or more chronic conditions in English-speaking countries.

Development and description of measurement properties of an instrument to assess treatment burden among patients with multiple chronic conditions

BackgroundPatients experience an increasing treatment burden related to everything they do to take care of their health: visits to the doctor, medical tests, treatment management and lifestyle changes. This treatment burden could affect treatment adherence, quality of life and outcomes. We aimed to develop and validate an instrument for measuring treatment burden for patients with multiple chronic conditions.MethodsItems were derived from a literature review and qualitative semistructured interviews with patients. The instrument was then validated in a sample of patients with chronic conditions recruited in hospitals and general practitioner clinics in France. Factor analysis was used to examine the questionnaire structure. Construct validity was studied by the relationships between the instrument's global score, the Treatment Satisfaction Questionnaire for Medication (TSQM) scores and the complexity of treatment as assessed by patients and physicians. Agreement between patients and physicians was appraised. Reliability was determined by a test-retest method.ResultsA sample of 502 patients completed the Treatment Burden Questionnaire (TBQ), which consisted of 7 items (2 of which had 4 subitems) defined after 22 interviews with patients. The questionnaire showed a unidimensional structure. The Cronbach's α was 0.89. The instrument's global score was negatively correlated with TSQM scores (rs = -0.41 to -0.53) and positively correlated with the complexity of treatment (rs = 0.16 to 0.40). Agreement between patients and physicians (n = 396) was weak (intraclass correlation coefficient 0.38 (95% confidence interval 0.29 to 0.47)). Reliability of the retest (n = 211 patients) was 0.76 (0.67 to 0.83).ConclusionsThis study provides the first valid and reliable instrument assessing the treatment burden for patients across any disease or treatment context. This instrument could help in the development of treatment strategies that are both efficient and acceptable for patients.