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Open Access Research

The psychological context of quality of life: a psychometric analysis of a novel idiographic measure of bladder cancer patients' personal goals and concerns prior to surgery

Bradley Andrew Morganstern1*, Bernard Bochner2, Guido Dalbagni2, Ahmad Shabsigh3 and Bruce Rapkin4

Author Affiliations

1 Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, New York, 10461, USA

2 Department of Urology and the Genitourinary Oncology Service, Sidney Kimmel Center for Prostate & Urologic Cancers, Memorial Sloan- Kettering Cancer Center, New York, New York, USA

3 Department of Urology, Ohio State's Center for Advanced Robotic Surgery, Ohio State University Medical Center, Columbus, OH, USA

4 Department of Epidemiology and Population Health, Albert Einstein College of Medicine of Yeshiva University, Bronx, New York, USA

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Health and Quality of Life Outcomes 2011, 9:10  doi:10.1186/1477-7525-9-10

Published: 15 February 2011

Abstract

Background

Over the past two decades, there has been an increasing focus on quality of life outcomes in urological diseases. Patient-reported outcomes research has relied on structured assessments that constrain interpretation of the impact of disease and treatments. In this study, we present content analysis and psychometric evaluation of the Quality of Life Appraisal Profile. Our evaluation of this measure is a prelude to a prospective comparison of quality of life outcomes of reconstructive procedures after cystectomy.

Methods

Fifty patients with bladder cancer were interviewed prior to surgery using the Quality of Life Appraisal Profile. Patients also completed the EORTC QLQ-C30 and demographics. Analysis included content coding of personal goal statements generated by the Appraisal Profile, examination of the relationship of goal attainment to content, and association of goal-based measures with QLQ-C30 scales.

Results

Patients reported an average of 10 personal goals, reflecting motivational themes of achievement, problem solving, avoidance of problems, maintaining desired circumstances, letting go of roles and responsibilities, acceptance of undesirable situations, and attaining milestones. 503 goal statements were coded using 40 different content categories. Progress toward goal attainment was positively correlated with relationships and activities goals, but negatively correlated with health concerns. Associations among goal measures provided evidence for construct validity. Goal content also differed according to age, gender, employment, and marital status, lending further support for construct validity. QLQ-C30 functioning and symptom scales were correlated with goal content, but not with progress toward goal attainment, suggesting that patients may calibrate progress ratings relative to their specific goals. Alternately, progress may reflect a unique aspect of quality of life untapped by more standard scales.

Conclusions

The Brief Quality of Life Appraisal Profile was associated with measures of motivation, goal content and progress, as well as relationships with demographic and standard quality of life measures. This measure identifies novel concerns and issues in treating patients with bladder cancer, necessary for a more comprehensive evaluations of their health-related quality of life.