The patient experience with fatigue and content validity of a measure to assess fatigue severity: qualitative research in patients with ankylosing spondylitis (AS)

Abstract Background Ankylosing spondylitis (AS) is an autoimmune disorder characterized by inflammation of the spine and large joints. Fatigue is a common symptom that many AS patients find significantly impacts their health-related quality of life. The Worst Fatigue – Numeric Rating Scale (WF-NRS) assesses the severity of this symptom during the previous 24-hour period. The objective of this study was to perform qualitative research to support the development and content validity of the WF-NRS. Methods Patients with AS were recruited from clinical sites in the U.S. for a qualitative study which first entailed concept elicitation interviews to gain understanding of the patients’ experience with AS and fatigue. Subsequently, cognitive debriefing interviews were undertaken to assess the understandability, clarity, and appropriateness from the patient’s perspective, of the content of a measure of fatigue severity. Results Thirteen patients with AS participated in concept elicitation interviews and cognitive debriefing of the Brief Fatigue Inventory (BFI) fatigue severity subscale. The WF-NRS was developed from the worst fatigue item of the BFI as patients generally reported it to be understandable and covered an important concept, the completion instructions were modified, but the response scale remained as it was familiar and readily completed, and the recall period was appropriate. Conclusions Patient responses resulted in the development of and supported the content validity of the WF-NRS. Further quantitative evaluation of the WF-NRS is warranted in order to assess its psychometric properties and confirm its usefulness as a clinical trial tool. </jats:sec

The Burden of Inflammatory Bowel Disease: A Patient-Reported Qualitative Analysis and Development of a Conceptual Model

Background The aim of this study was to describe the impacts of inflammatory bowel disease (IBD) from the patients’ perspective, and to inform the development of a conceptual model. Methods Focus groups and one-on-one interviews were undertaken in adult patients with IBD. Transcripts from the focus groups and interviews were analyzed to identify themes and links between themes, assisted by qualitative data software MaxQDA. Themes from the qualitative research were supplemented with those reported in the literature and concepts included in IBD-specific patient-reported outcome (PRO) measures. Results Twenty-seven patients participated. Key physical symptoms included pain, bowel-related symptoms such as frequency, urgency, incontinence, diarrhea, passing blood, and systemic symptoms such as weight loss and fatigue. Participants described continuing and variable symptom experiences. IBD symptoms caused immediate disruption of activities but also had ongoing impacts on daily activities, including dietary restrictions, lifestyle changes, and maintaining close proximity to a toilet. More distal impacts included interference with work, school, parenting, social and leisure activities, relationships, and psychological well-being. The inconvenience of rectal medications, refrigerated biologics, and medication refills emerged as novel burdens not identified in existing PRO measures. Conclusions IBD symptoms cause immediate disruption in activities, but patients may continue to experience some symptoms on a chronic basis. The conceptual model presented here may be useful for identifying target concepts for measurement in future studies in IBD

Patient Preferences for Chronic Myeloid Leukemia Medication Regimen Attributes and their Potential Impact on Adherence: Results from a Multi-national Conjoint Study

**Background:** Tyrosine kinase inhibitors (TKIs) have significantly improved survival for patients with chronic myeloid leukemia (CML) but require long-term administration and non-adherence due to regimen requirements has been reported. **Objectives:** This study sought to identify how much patients value more convenient regimens and the potential impact that regimen may have on medication adherence. **Methods:** This cross-sectional, six-country study utilized a web-based discrete conjoint experiment (DCE) survey in which participants selected between hypothetical treatments that differed on three attributes: meal requirements/restrictions, frequency of administration, and monthly co-pay, to quantify willingness to pay. Attribute percent importance ratings were derived from a multinomial logit model, and utilities were summed for each product profile to determine the most preferred regimen profile. Additional survey questions asked about attributes perceived to affect adherence and the ease and convenience of participants’ current regimen. **Results:** A total of 318 patients completed the survey; median age 53 years (range 18-87); 43.7% male. Four participants were excluded from the conjoint analysis due to illogical responses. The most important regimen attribute driving preferences was the meal requirement/restriction, which was almost twice as important as dose frequency. The majority of participants preferred the profile of a once a day dosing taken with or without a meal, and estimates of willingness-to-pay helped to quantify this preference. In terms of adherence, the majority of participants perceived that having to fast before and after taking medication would be the most likely reason for missing a dose. **Conclusions:** The results suggest that patients value the convenience of CML treatments and perceive certain regimen characteristics, particularly meal requirements or restrictions, as likely to affect adherence. It is important for healthcare providers to be aware of the potential impact of treatment convenience on non-adherence and communicate closely with patients to decrease this potential