Reliability and validity testing of the MD Anderson Symptom Inventory-Heart Failure (MDASI-HF): An evaluative instrument for symptom identification in cancer patients with concurrent heart failure

Abstract

<p>The purpose of this study was to evaluate the psychometric properties of the MD Anderson Symptom Inventory- Heart Failure (MDASI-HF), an evaluative instrument for symptom assessment in cancer patients with concurrent heart failure (HF). One hundred and fifty six patients (male=88, female=68) with a diagnosis of cancer and HF receiving care in a major cancer center participated in the study. The mean age was 63.3 &plusmn; 13.2 years (range 23-97 years). The majority of the subjects (60.3%, n=94) had solid tumors, while 39.7% (n=62) had hematological cancers. All of the participants had concurrent HF, 65% (n=102) with systolic dysfunction (EF&lt;40%), while 34.6% (n=54) had diastolic dysfunction (EF&gt;40%). Using a descriptive, cross-sectional design, the subjects completed the 24-item symptom assessment and a six item interference MDASI-HF instrument. A cardiologist's assessment of the patient's symptoms using the New York Heart Association (NYHA) classification, and an oncologist's assessment using the Eastern Cooperative Oncology Group (ECOG) performance status were recorded simultaneously with the patient's completion of the MDASI-HF instrument. Internal consistency reliability showed a Cronbach's &alpha; = .92 (21 symptoms), &alpha; = .89 (13 core symptoms), &alpha; = .83 (8 HF symptoms), and &alpha; = .92 (interference items). Criterion validity indicated moderate correlation scores with the ECOG performance status with r = .622, .548, and .645 for the 13 core items, 8 HF items, and six interference items respectively; and the NYHA classification with r = .622 (13 core items), r = .590 (8 HF items) and r = .588 (6 interference items). All correlations were statistically significant at p = .01. Construct validity determination using factor analysis revealed the MDASI-HF measured four constructs: (1) general symptom severity factor, (2) gastrointestinal factor, (3) covert heart failure factor and (4) overt heart failure factor. Based on the findings of this study, the MDASI-HF is a valid and reliable instrument for the assessment of symptoms in cancer patients with concurrent HF. The instrument can be used to identify symptom occurrence and enhance the provider's understanding of the prevalence and severity of symptoms from the patient's perspective that will assist in managing the complex condition of cancer and concurrent heart failure.</p>