Preliminary validation of a brief PROM assessing psychological distress in patients with malignant mesothelioma: The mesothelioma psychological distress tool-Patients

Our plain-English summary of Preliminary validation of a brief PROM assessing psychological distress in patients with malignant mesothelioma: The mesothelioma psychological distress tool-Patients, by F. Guglielmucci, M. Bonafede, D. Azzolina, et al (Frontiers in Psychology, 2022).

The study

• Authors: F. Guglielmucci, M. Bonafede, D. Azzolina, A. Marinaccio, I.G. Franzoi, E. Migliore, C. Mensi, E. Chellini, E. Romeo, F. Grosso, A. Granieri
• Journal: Frontiers in Psychology
• Published: 2022;13:974982
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: Psychological suffering in malignant mesothelioma (MM) differs from that in other cancers because of its occupational etiology, and we aimed to develop specific patient-reported outcome measures to assess it.

Methods: We used a multi-method prospective observational multicentric study (N = 149), and a preliminary questionnaire validation was performed through a Bayesian approach.

Results: Item analysis showed a good internal consistency and reliability (Cronbach alpha = 0.79 [95% CI = 0.74-0.93]. Twenty of the 41 initial items were selected as posterior 95% highest density interval factor loading standardized effect size fell outside of the region of practical equivalence. Bayesian exploratory factor analysis showed a two-factor structure: (1) Trauma-related reactions (TR, 13 items) and (2) Claim for justice (CJ, 7 items), confirmed by the Bayesian confirmatory factor analysis. Latent factors were poorly correlated (Posterior median: 0.13; 95% CI = -0.079 to 0.323). The 90% root mean square error of approximation posterior median was 0.04 [90% CI = 0.03-0.58]; the 90% chi-square posterior median was 242 [90% CI = 209-287].

Conclusion: Psychological suffering in MM patients implies negative cognitive, emotional, and somatic reactions related to the traumatic impact of the disease and the need to obtain justice through economic compensation. Our findings provide preliminary evidence that the Mesothelioma Psychological Distress Tool-Patients could be a promising and reliable instrument to assess MM patients' psychological distress.

Copyright © 2022 Guglielmucci, Bonafede, Azzolina, Marinaccio, Franzoi, Migliore, Mensi, Chellini, Romeo, Grosso and Granieri.

In plain English

This Italian study built a questionnaire, the Mesothelioma Psychological Distress Tool—Patients (MPDT-P), to measure psychological distress in people with malignant mesothelioma, and gave it a first statistical check. Patients came through the Italian National Mesothelioma Registry in Tuscany, Piedmont, Lombardy and Lazio. Of 707 individuals recruited, 149 took part. Median age was 71 among the 136 with age recorded, and 73 of 135 with gender recorded (54%) were men. The article did not report measuring or analysing asbestos exposure. Using Bayesian statistical methods, the authors kept 20 of 41 draft questions. These fell into two groups: trauma-related reactions (13 items) and claims for justice (7 items, covering anger, betrayal and the wish for economic compensation). The two groups were only weakly related (0.13, 95% CI -0.079 to 0.323). Internal consistency for the final 20 items was 0.83 (95% CI 0.77 to 0.86). The authors concluded that the tool could be a promising and reliable instrument, but called their evidence preliminary. They noted a small sample, a low response rate, no outside-measure comparison, and that both factor analyses used the same data.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective observational multicentric questionnaire-development and preliminary validation study, analysed with Bayesian item analysis and exploratory and confirmatory factor analysis
• Who was studied: Patients with malignant mesothelioma recruited through the Italian National Mesothelioma Registry (ReNaM) regional centres in Tuscany, Piedmont, Lombardy and Lazio (interviewer training March–June 2018). 707 individuals were recruited and 149 took part. Median age was 71 years among the 136 with age recorded. 73 of 135 with gender recorded (54%) were male. The article does not say whether the mesothelioma was pleural or peritoneal.
• Exposure: The article did not report any measurement or analysis of asbestos exposure, and no fiber types, jobs or doses are reported. Participants had malignant mesothelioma, which the article describes as a cancer related to asbestos exposure. They were recruited through a registry that investigates how patients were exposed to asbestos.
• Main results:
  • Initial 41-item questionnaire: Cronbach alpha (internal consistency) posterior median 0.79 [95% CI 0.74–0.93]
  • 20 items were retained. 13 loaded on the first factor and 7 on the second; the authors labelled these Trauma-Related Reactions and Claims for Justice.
  • The second factor reflected anger and betrayal at exposure to a harmful pollutant and the desire for economic compensation
  • The two factors were poorly correlated in the confirmatory analysis: posterior median 0.13 [95% CI −0.079 to 0.323]
  • Final 20-item questionnaire: Cronbach alpha 0.83 [95% CI 0.77–0.86]; first factor 0.84 [95% CI 0.80–0.87]; second factor 0.82 [95% CI 0.78–0.86]
  • Model fit: 95% probability that the RMSEA was below the 0.06 threshold; RMSEA posterior median 0.04 [90% CI 0.03–0.58, as printed]
• The authors' conclusion: The authors concluded that their findings provide preliminary evidence that the MPDT-P could be a promising and reliable instrument to assess psychological distress in malignant mesothelioma patients.
• Limitations the authors state:
  • Small sample by common statistical guidelines. The authors note it was about 20% of malignant mesothelioma cases in the regions involved.
  • No external-criterion validity assessment
  • Exploratory and confirmatory analyses were run on the same data. Splitting the sample to derive and validate the model was not done because of the sample size.
  • Further research, including test–retest reliability and other samples, is needed to assess generalizability
  • Low response rate, attributed to patients' critical health status

Topics

Medical terms in this study, explained in our Lexicon: Malignant Mesothelioma, Mesothelioma, Etiology.

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