A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning

Noelle E. Carlozzi; E. A. Hahn; S. A. Frank; J. S. Perlmutter; N. D. Downing; M. K. McCormack; S. Barton; M. A. Nance; S. G. Schilling; Noelle Carlozzi; Praveen Dayalu; Stephen Schilling; Amy Austin; Matthew Canter; Siera Goodnight; Jennifer Miner; Nicholas Migliore; Jane Paulsen; Nancy Downing; Isabella DeSoriano; Courtney Shadrick; Amanda Miller; Kimberly Quaid; Melissa Wesson; Christopher Ross; Gregory Churchill; Mary Jane Ong; Susan Perlman; Brian Clemente; Aaron Fisher; Gloria Obialisi; Michael Rosco; Michael McCormack; Humberto Marin; Allison Dicke; Joel S. Perlmutter; Stacey Barton; Shineeka Smith; Martha Nance; Pat Ede; Stephen Rao; Anwar Ahmed; Michael Lengen; Lyla Mourany; Christine Reece; Michael Geschwind; Joseph Winer; David Cella; Richard Gershon; Elizabeth Hahn; Hdqlife Site Investigators And Coordinators

doi:10.1007/s00415-017-8677-7

A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning

Noelle E. Carlozzi^*, E. A. Hahn, S. A. Frank, J. S. Perlmutter, N. D. Downing, M. K. McCormack, S. Barton, M. A. Nance, S. G. Schilling, Noelle Carlozzi, Praveen Dayalu, Stephen Schilling, Amy Austin, Matthew Canter, Siera Goodnight, Jennifer Miner, Nicholas Migliore, Jane Paulsen, Nancy Downing, Isabella DeSorianoCourtney Shadrick, Amanda Miller, Kimberly Quaid, Melissa Wesson, Christopher Ross, Gregory Churchill, Mary Jane Ong, Susan Perlman, Brian Clemente, Aaron Fisher, Gloria Obialisi, Michael Rosco, Michael McCormack, Humberto Marin, Allison Dicke, Joel S. Perlmutter, Stacey Barton, Shineeka Smith, Martha Nance, Pat Ede, Stephen Rao, Anwar Ahmed, Michael Lengen, Lyla Mourany, Christine Reece, Michael Geschwind, Joseph Winer, David Cella, Richard Gershon, Elizabeth Hahn, Hdqlife Site Investigators And Coordinators

^*Corresponding author for this work

Medical Social Sciences

Research output: Contribution to journal › Article › peer-review

13 Scopus citations

Abstract

Background: Huntington disease is a fatal inherited neurodegenerative disease. Because the end result of Huntington disease is death due to Huntington disease-related causes, there is a need for better understanding and caring for individuals at their end of life. Aim: The purpose of this study was to develop a new measure to evaluate end of life planning. Design: We conducted qualitative focus groups, solicited expert input, and completed a literature review to develop a 16-item measure to evaluate important aspects of end of life planning for Huntington disease. Item response theory and differential item functioning analyses were utilized to examine the psychometric properties of items; exploratory factor analysis was used to establish meaningful subscales. Participants: Participants included 508 individuals with pre-manifest or manifest Huntington disease. Results: Item response theory supported the retention of all 16 items on the huntington disease quality of life (“HDQLIFE”) end of life planning measure. Exploratory factor analysis supported a four-factor structure: legal planning, financial planning, preferences for hospice care, and preferences for conditions (locations, surroundings, etc.) at the time of death. Although a handful of items exhibited some evidence of differential item functioning, these items were retained due to their relevant clinical content. The final 16-item scale includes an overall total score and four subscale scores that reflect the different end of life planning constructs. Conclusions: The 16-item HDQLIFE end of life planning measure demonstrates adequate psychometric properties; it may be a useful tool for clinicians to clarify patients’ preferences about end of life care.

Original language	English (US)
Pages (from-to)	98-107
Number of pages	10
Journal	Journal of Neurology
Volume	265
Issue number	1
DOIs	https://doi.org/10.1007/s00415-017-8677-7
State	Published - Jan 1 2018

Funding

Conflicts of interest Carlozzi, N. E. currently has research Grants from the NIH; she is also supported by Grant funding from the NIH and CHDI. She provides patient-reported outcome measurement selection and application consultation for Teva Pharmaceuticals. She declares no conflicts of interest. Hahn, E. A. currently has research Grants from the NIH; she is also supported by Grant funding from the NIH and PCORI, and by research contracts from Merck and EMMES; she declares no conflicts of interest. Frank, S. receives salary support from the Huntington Study Group for a study sponsored by Auspex Pharmaceuticals. There is no conflict of interest. Perlmutter, J. S. currently has funding from the NIH, HDSA, CHDI, and APDA. He has received honoraria from the University of Rochester, American Academy of Neurology, Movement Disorders Society, Toronto Western Hospital, St. Luke’s Hospital in St Louis, Emory University, Penn State, Alberta innovates, Indiana Neurological Society, Parkinson Disease Foundation, Columbia University, St. Louis University, Harvard University and the University of Michigan; he declares no conflicts of interest. Downing, N. R. declares no conflicts of interest. McCormack, M. K. currently has Grants from the NJ Department of Health; he declares no conflicts of interest. Barton, S. K. is supported by grant funding from the Huntington Disease Society of America, CHDI Foundation and the NIH. She declares no conflicts of interest. Nance, M. A. declares no conflicts of interest. Schilling, S. G. has a research Grant from NSF. He also is supported by Grant funding from NIH. He declares no conflicts of interest. Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (R01NS077946) and the National Center for Advancing Translational Sciences (UL1TR000433). In addition, a portion of this study sample was collected in conjunction with the Predict-HD study. The Predict-HD data were supported by the NIH, National Institute of Neurological Disorders and Stroke (R01NS040068), the NIH, Center for Inherited Disease Research (provided support for sample phenotyping), and the CHDI Foundation (award to the University of Iowa). We thank the University of Iowa, the Investigators and Coordinators of this study, the study participants, the National Research Roster for Huntington Disease Patients and Families, the Huntington Study Group, and the Huntington Disease Society of America. We acknowledge the assistance of Jeffrey D. Long, Hans J. Johnson, Jeremy H. Bockholt, Roland Zschiegner, and Jane S. Paulsen. We also acknowledge Roger Albin, Kelvin Chou, and Henry Paulsen for the assistance with participant recruitment. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. HDQLIFE Site Investigators and Coordinators: Noelle Carlozzi, Praveen Dayalu, Stephen Schilling, Amy Austin, Matthew Canter, Siera Goodnight, Jennifer Miner, Nicholas Migliore (University of Michigan, Ann Arbor, MI); Jane Paulsen, Nancy Downing, Isabella DeSoriano, Courtney Shadrick, Amanda Miller (University of Iowa, Iowa City, IA); Kimberly Quaid, Melissa Wesson (Indiana University, Indianapolis, IN); Christopher Ross, Gregory Churchill, Mary Jane Ong (Johns Hopkins University, Baltimore, MD); Susan Perlman, Brian Clemente, Aaron Fisher, Gloria Obialisi, Michael Rosco (University of California Los Angeles, Los Angeles, CA); Michael McCormack, Humberto Marin, Allison Dicke (Rutgers University, Piscataway, NJ); Joel S. Perlmutter, Stacey Barton, Shineeka Smith (Washington University, St. Louis, MO); Martha Nance, Pat Ede (Struthers Parkinson’s Center); Stephen Rao, Anwar Ahmed, Michael Lengen, Lyla Mourany, Christine Reece, (Cleveland Clinic Foundation, Cleveland, OH); Michael Geschwind, Joseph Winer (University of California-San Francisco, San Francisco, CA), David Cella, Richard Gershon, Elizabeth Hahn, Jin-Shei Lai (Northwestern University, Chicago, IL). Acknowledgments Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurologi-cal Disorders and Stroke (R01NS077946) and the National Center for Advancing Translational Sciences (UL1TR000433). In addition, a por-tion of this study sample was collected in conjunction with the Predict-HD study. The Predict-HD data were supported by the NIH, National 56 Institute of Neurological Disorders and Stroke (R01NS040068), the NIH, Center for Inherited Disease Research (provided support for 57 sample phenotyping), and the CHDI Foundation (award to the Uni-58 versity of Iowa). We thank the University of Iowa, the Investigators This overall reliability of the HDQLIFE planning measure was very good, and subdomain scores ranged from adequate to very good. The reliability of Preferences for Care and Financial Planning subdomains were slightly lower than recommended for a new measure [45, 46], so additional consideration when using these scales is appropriate. Regardless, construct validity of these four factors was supported by EFA. There is evidence that individuals with HD often do not discuss their EOL thoughts or wishes with physicians.2Thus, this study provides preliminary support for the reliability and validity of this new measure that can be used to foster productive and meaningful discussions about this sensitive topic in conjunction with established clinical guidelines of EOL care [2].

Keywords

End of life
HDQLIFE
HDQLIFE Site Investigators and Coordinators
Health-related quality of life
Huntington disease
Patient-reported outcome (PRO)

ASJC Scopus subject areas

Clinical Neurology
Neurology

Access to Document

10.1007/s00415-017-8677-7

Cite this

Carlozzi, N. E., Hahn, E. A., Frank, S. A., Perlmutter, J. S., Downing, N. D., McCormack, M. K., Barton, S., Nance, M. A., Schilling, S. G., Carlozzi, N., Dayalu, P., Schilling, S., Austin, A., Canter, M., Goodnight, S., Miner, J., Migliore, N., Paulsen, J., Downing, N., ... Hdqlife Site Investigators And Coordinators (2018). A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning. Journal of Neurology, 265(1), 98-107. https://doi.org/10.1007/s00415-017-8677-7

@article{dc2222fea8224c32b5d0a510202953d0,

title = "A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning",

abstract = "Background: Huntington disease is a fatal inherited neurodegenerative disease. Because the end result of Huntington disease is death due to Huntington disease-related causes, there is a need for better understanding and caring for individuals at their end of life. Aim: The purpose of this study was to develop a new measure to evaluate end of life planning. Design: We conducted qualitative focus groups, solicited expert input, and completed a literature review to develop a 16-item measure to evaluate important aspects of end of life planning for Huntington disease. Item response theory and differential item functioning analyses were utilized to examine the psychometric properties of items; exploratory factor analysis was used to establish meaningful subscales. Participants: Participants included 508 individuals with pre-manifest or manifest Huntington disease. Results: Item response theory supported the retention of all 16 items on the huntington disease quality of life (“HDQLIFE”) end of life planning measure. Exploratory factor analysis supported a four-factor structure: legal planning, financial planning, preferences for hospice care, and preferences for conditions (locations, surroundings, etc.) at the time of death. Although a handful of items exhibited some evidence of differential item functioning, these items were retained due to their relevant clinical content. The final 16-item scale includes an overall total score and four subscale scores that reflect the different end of life planning constructs. Conclusions: The 16-item HDQLIFE end of life planning measure demonstrates adequate psychometric properties; it may be a useful tool for clinicians to clarify patients{\textquoteright} preferences about end of life care.",

keywords = "End of life, HDQLIFE, HDQLIFE Site Investigators and Coordinators, Health-related quality of life, Huntington disease, Patient-reported outcome (PRO)",

author = "Carlozzi, {Noelle E.} and Hahn, {E. A.} and Frank, {S. A.} and Perlmutter, {J. S.} and Downing, {N. D.} and McCormack, {M. K.} and S. Barton and Nance, {M. A.} and Schilling, {S. G.} and Noelle Carlozzi and Praveen Dayalu and Stephen Schilling and Amy Austin and Matthew Canter and Siera Goodnight and Jennifer Miner and Nicholas Migliore and Jane Paulsen and Nancy Downing and Isabella DeSoriano and Courtney Shadrick and Amanda Miller and Kimberly Quaid and Melissa Wesson and Christopher Ross and Gregory Churchill and Ong, {Mary Jane} and Susan Perlman and Brian Clemente and Aaron Fisher and Gloria Obialisi and Michael Rosco and Michael McCormack and Humberto Marin and Allison Dicke and Perlmutter, {Joel S.} and Stacey Barton and Shineeka Smith and Martha Nance and Pat Ede and Stephen Rao and Anwar Ahmed and Michael Lengen and Lyla Mourany and Christine Reece and Michael Geschwind and Joseph Winer and David Cella and Richard Gershon and Elizabeth Hahn and {Hdqlife Site Investigators And Coordinators}",

note = "Funding Information: Conflicts of interest Carlozzi, N. E. currently has research Grants from the NIH; she is also supported by Grant funding from the NIH and CHDI. She provides patient-reported outcome measurement selection and application consultation for Teva Pharmaceuticals. She declares no conflicts of interest. Hahn, E. A. currently has research Grants from the NIH; she is also supported by Grant funding from the NIH and PCORI, and by research contracts from Merck and EMMES; she declares no conflicts of interest. Frank, S. receives salary support from the Huntington Study Group for a study sponsored by Auspex Pharmaceuticals. There is no conflict of interest. Perlmutter, J. S. currently has funding from the NIH, HDSA, CHDI, and APDA. He has received honoraria from the University of Rochester, American Academy of Neurology, Movement Disorders Society, Toronto Western Hospital, St. Luke{\textquoteright}s Hospital in St Louis, Emory University, Penn State, Alberta innovates, Indiana Neurological Society, Parkinson Disease Foundation, Columbia University, St. Louis University, Harvard University and the University of Michigan; he declares no conflicts of interest. Downing, N. R. declares no conflicts of interest. McCormack, M. K. currently has Grants from the NJ Department of Health; he declares no conflicts of interest. Barton, S. K. is supported by grant funding from the Huntington Disease Society of America, CHDI Foundation and the NIH. She declares no conflicts of interest. Nance, M. A. declares no conflicts of interest. Schilling, S. G. has a research Grant from NSF. He also is supported by Grant funding from NIH. He declares no conflicts of interest. Funding Information: Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (R01NS077946) and the National Center for Advancing Translational Sciences (UL1TR000433). In addition, a portion of this study sample was collected in conjunction with the Predict-HD study. The Predict-HD data were supported by the NIH, National Institute of Neurological Disorders and Stroke (R01NS040068), the NIH, Center for Inherited Disease Research (provided support for sample phenotyping), and the CHDI Foundation (award to the University of Iowa). We thank the University of Iowa, the Investigators and Coordinators of this study, the study participants, the National Research Roster for Huntington Disease Patients and Families, the Huntington Study Group, and the Huntington Disease Society of America. We acknowledge the assistance of Jeffrey D. Long, Hans J. Johnson, Jeremy H. Bockholt, Roland Zschiegner, and Jane S. Paulsen. We also acknowledge Roger Albin, Kelvin Chou, and Henry Paulsen for the assistance with participant recruitment. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. HDQLIFE Site Investigators and Coordinators: Noelle Carlozzi, Praveen Dayalu, Stephen Schilling, Amy Austin, Matthew Canter, Siera Goodnight, Jennifer Miner, Nicholas Migliore (University of Michigan, Ann Arbor, MI); Jane Paulsen, Nancy Downing, Isabella DeSoriano, Courtney Shadrick, Amanda Miller (University of Iowa, Iowa City, IA); Kimberly Quaid, Melissa Wesson (Indiana University, Indianapolis, IN); Christopher Ross, Gregory Churchill, Mary Jane Ong (Johns Hopkins University, Baltimore, MD); Susan Perlman, Brian Clemente, Aaron Fisher, Gloria Obialisi, Michael Rosco (University of California Los Angeles, Los Angeles, CA); Michael McCormack, Humberto Marin, Allison Dicke (Rutgers University, Piscataway, NJ); Joel S. Perlmutter, Stacey Barton, Shineeka Smith (Washington University, St. Louis, MO); Martha Nance, Pat Ede (Struthers Parkinson{\textquoteright}s Center); Stephen Rao, Anwar Ahmed, Michael Lengen, Lyla Mourany, Christine Reece, (Cleveland Clinic Foundation, Cleveland, OH); Michael Geschwind, Joseph Winer (University of California-San Francisco, San Francisco, CA), David Cella, Richard Gershon, Elizabeth Hahn, Jin-Shei Lai (Northwestern University, Chicago, IL). Funding Information: Acknowledgments Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurologi-cal Disorders and Stroke (R01NS077946) and the National Center for Advancing Translational Sciences (UL1TR000433). In addition, a por-tion of this study sample was collected in conjunction with the Predict-HD study. The Predict-HD data were supported by the NIH, National 56 Institute of Neurological Disorders and Stroke (R01NS040068), the NIH, Center for Inherited Disease Research (provided support for 57 sample phenotyping), and the CHDI Foundation (award to the Uni-58 versity of Iowa). We thank the University of Iowa, the Investigators Funding Information: This overall reliability of the HDQLIFE planning measure was very good, and subdomain scores ranged from adequate to very good. The reliability of Preferences for Care and Financial Planning subdomains were slightly lower than recommended for a new measure [45, 46], so additional consideration when using these scales is appropriate. Regardless, construct validity of these four factors was supported by EFA. There is evidence that individuals with HD often do not discuss their EOL thoughts or wishes with physicians.2Thus, this study provides preliminary support for the reliability and validity of this new measure that can be used to foster productive and meaningful discussions about this sensitive topic in conjunction with established clinical guidelines of EOL care [2]. Publisher Copyright: {\textcopyright} 2017, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2018",

month = jan,

day = "1",

doi = "10.1007/s00415-017-8677-7",

language = "English (US)",

volume = "265",

pages = "98--107",

journal = "Journal of Neurology",

issn = "0340-5354",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "1",

}

Carlozzi, NE, Hahn, EA, Frank, SA, Perlmutter, JS, Downing, ND, McCormack, MK, Barton, S, Nance, MA, Schilling, SG, Carlozzi, N, Dayalu, P, Schilling, S, Austin, A, Canter, M, Goodnight, S, Miner, J, Migliore, N, Paulsen, J, Downing, N, DeSoriano, I, Shadrick, C, Miller, A, Quaid, K, Wesson, M, Ross, C, Churchill, G, Ong, MJ, Perlman, S, Clemente, B, Fisher, A, Obialisi, G, Rosco, M, McCormack, M, Marin, H, Dicke, A, Perlmutter, JS, Barton, S, Smith, S, Nance, M, Ede, P, Rao, S, Ahmed, A, Lengen, M, Mourany, L, Reece, C, Geschwind, M, Winer, J, Cella, D , Gershon, R , Hahn, E & Hdqlife Site Investigators And Coordinators 2018, 'A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning', Journal of Neurology, vol. 265, no. 1, pp. 98-107. https://doi.org/10.1007/s00415-017-8677-7

TY - JOUR

T1 - A new measure for end of life planning, preparation, and preferences in Huntington disease

T2 - HDQLIFE end of life planning

AU - Carlozzi, Noelle E.

AU - Hahn, E. A.

AU - Frank, S. A.

AU - Perlmutter, J. S.

AU - Downing, N. D.

AU - McCormack, M. K.

AU - Barton, S.

AU - Nance, M. A.

AU - Schilling, S. G.

AU - Carlozzi, Noelle

AU - Dayalu, Praveen

AU - Schilling, Stephen

AU - Austin, Amy

AU - Canter, Matthew

AU - Goodnight, Siera

AU - Miner, Jennifer

AU - Migliore, Nicholas

AU - Paulsen, Jane

AU - Downing, Nancy

AU - DeSoriano, Isabella

AU - Shadrick, Courtney

AU - Miller, Amanda

AU - Quaid, Kimberly

AU - Wesson, Melissa

AU - Ross, Christopher

AU - Churchill, Gregory

AU - Ong, Mary Jane

AU - Perlman, Susan

AU - Clemente, Brian

AU - Fisher, Aaron

AU - Obialisi, Gloria

AU - Rosco, Michael

AU - McCormack, Michael

AU - Marin, Humberto

AU - Dicke, Allison

AU - Perlmutter, Joel S.

AU - Barton, Stacey

AU - Smith, Shineeka

AU - Nance, Martha

AU - Ede, Pat

AU - Rao, Stephen

AU - Ahmed, Anwar

AU - Lengen, Michael

AU - Mourany, Lyla

AU - Reece, Christine

AU - Geschwind, Michael

AU - Winer, Joseph

AU - Cella, David

AU - Gershon, Richard

AU - Hahn, Elizabeth

AU - Hdqlife Site Investigators And Coordinators

N1 - Funding Information: Conflicts of interest Carlozzi, N. E. currently has research Grants from the NIH; she is also supported by Grant funding from the NIH and CHDI. She provides patient-reported outcome measurement selection and application consultation for Teva Pharmaceuticals. She declares no conflicts of interest. Hahn, E. A. currently has research Grants from the NIH; she is also supported by Grant funding from the NIH and PCORI, and by research contracts from Merck and EMMES; she declares no conflicts of interest. Frank, S. receives salary support from the Huntington Study Group for a study sponsored by Auspex Pharmaceuticals. There is no conflict of interest. Perlmutter, J. S. currently has funding from the NIH, HDSA, CHDI, and APDA. He has received honoraria from the University of Rochester, American Academy of Neurology, Movement Disorders Society, Toronto Western Hospital, St. Luke’s Hospital in St Louis, Emory University, Penn State, Alberta innovates, Indiana Neurological Society, Parkinson Disease Foundation, Columbia University, St. Louis University, Harvard University and the University of Michigan; he declares no conflicts of interest. Downing, N. R. declares no conflicts of interest. McCormack, M. K. currently has Grants from the NJ Department of Health; he declares no conflicts of interest. Barton, S. K. is supported by grant funding from the Huntington Disease Society of America, CHDI Foundation and the NIH. She declares no conflicts of interest. Nance, M. A. declares no conflicts of interest. Schilling, S. G. has a research Grant from NSF. He also is supported by Grant funding from NIH. He declares no conflicts of interest. Funding Information: Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurological Disorders and Stroke (R01NS077946) and the National Center for Advancing Translational Sciences (UL1TR000433). In addition, a portion of this study sample was collected in conjunction with the Predict-HD study. The Predict-HD data were supported by the NIH, National Institute of Neurological Disorders and Stroke (R01NS040068), the NIH, Center for Inherited Disease Research (provided support for sample phenotyping), and the CHDI Foundation (award to the University of Iowa). We thank the University of Iowa, the Investigators and Coordinators of this study, the study participants, the National Research Roster for Huntington Disease Patients and Families, the Huntington Study Group, and the Huntington Disease Society of America. We acknowledge the assistance of Jeffrey D. Long, Hans J. Johnson, Jeremy H. Bockholt, Roland Zschiegner, and Jane S. Paulsen. We also acknowledge Roger Albin, Kelvin Chou, and Henry Paulsen for the assistance with participant recruitment. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. HDQLIFE Site Investigators and Coordinators: Noelle Carlozzi, Praveen Dayalu, Stephen Schilling, Amy Austin, Matthew Canter, Siera Goodnight, Jennifer Miner, Nicholas Migliore (University of Michigan, Ann Arbor, MI); Jane Paulsen, Nancy Downing, Isabella DeSoriano, Courtney Shadrick, Amanda Miller (University of Iowa, Iowa City, IA); Kimberly Quaid, Melissa Wesson (Indiana University, Indianapolis, IN); Christopher Ross, Gregory Churchill, Mary Jane Ong (Johns Hopkins University, Baltimore, MD); Susan Perlman, Brian Clemente, Aaron Fisher, Gloria Obialisi, Michael Rosco (University of California Los Angeles, Los Angeles, CA); Michael McCormack, Humberto Marin, Allison Dicke (Rutgers University, Piscataway, NJ); Joel S. Perlmutter, Stacey Barton, Shineeka Smith (Washington University, St. Louis, MO); Martha Nance, Pat Ede (Struthers Parkinson’s Center); Stephen Rao, Anwar Ahmed, Michael Lengen, Lyla Mourany, Christine Reece, (Cleveland Clinic Foundation, Cleveland, OH); Michael Geschwind, Joseph Winer (University of California-San Francisco, San Francisco, CA), David Cella, Richard Gershon, Elizabeth Hahn, Jin-Shei Lai (Northwestern University, Chicago, IL). Funding Information: Acknowledgments Work on this manuscript was supported by the National Institutes of Health (NIH), National Institute of Neurologi-cal Disorders and Stroke (R01NS077946) and the National Center for Advancing Translational Sciences (UL1TR000433). In addition, a por-tion of this study sample was collected in conjunction with the Predict-HD study. The Predict-HD data were supported by the NIH, National 56 Institute of Neurological Disorders and Stroke (R01NS040068), the NIH, Center for Inherited Disease Research (provided support for 57 sample phenotyping), and the CHDI Foundation (award to the Uni-58 versity of Iowa). We thank the University of Iowa, the Investigators Funding Information: This overall reliability of the HDQLIFE planning measure was very good, and subdomain scores ranged from adequate to very good. The reliability of Preferences for Care and Financial Planning subdomains were slightly lower than recommended for a new measure [45, 46], so additional consideration when using these scales is appropriate. Regardless, construct validity of these four factors was supported by EFA. There is evidence that individuals with HD often do not discuss their EOL thoughts or wishes with physicians.2Thus, this study provides preliminary support for the reliability and validity of this new measure that can be used to foster productive and meaningful discussions about this sensitive topic in conjunction with established clinical guidelines of EOL care [2]. Publisher Copyright: © 2017, Springer-Verlag GmbH Germany, part of Springer Nature.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Huntington disease is a fatal inherited neurodegenerative disease. Because the end result of Huntington disease is death due to Huntington disease-related causes, there is a need for better understanding and caring for individuals at their end of life. Aim: The purpose of this study was to develop a new measure to evaluate end of life planning. Design: We conducted qualitative focus groups, solicited expert input, and completed a literature review to develop a 16-item measure to evaluate important aspects of end of life planning for Huntington disease. Item response theory and differential item functioning analyses were utilized to examine the psychometric properties of items; exploratory factor analysis was used to establish meaningful subscales. Participants: Participants included 508 individuals with pre-manifest or manifest Huntington disease. Results: Item response theory supported the retention of all 16 items on the huntington disease quality of life (“HDQLIFE”) end of life planning measure. Exploratory factor analysis supported a four-factor structure: legal planning, financial planning, preferences for hospice care, and preferences for conditions (locations, surroundings, etc.) at the time of death. Although a handful of items exhibited some evidence of differential item functioning, these items were retained due to their relevant clinical content. The final 16-item scale includes an overall total score and four subscale scores that reflect the different end of life planning constructs. Conclusions: The 16-item HDQLIFE end of life planning measure demonstrates adequate psychometric properties; it may be a useful tool for clinicians to clarify patients’ preferences about end of life care.

AB - Background: Huntington disease is a fatal inherited neurodegenerative disease. Because the end result of Huntington disease is death due to Huntington disease-related causes, there is a need for better understanding and caring for individuals at their end of life. Aim: The purpose of this study was to develop a new measure to evaluate end of life planning. Design: We conducted qualitative focus groups, solicited expert input, and completed a literature review to develop a 16-item measure to evaluate important aspects of end of life planning for Huntington disease. Item response theory and differential item functioning analyses were utilized to examine the psychometric properties of items; exploratory factor analysis was used to establish meaningful subscales. Participants: Participants included 508 individuals with pre-manifest or manifest Huntington disease. Results: Item response theory supported the retention of all 16 items on the huntington disease quality of life (“HDQLIFE”) end of life planning measure. Exploratory factor analysis supported a four-factor structure: legal planning, financial planning, preferences for hospice care, and preferences for conditions (locations, surroundings, etc.) at the time of death. Although a handful of items exhibited some evidence of differential item functioning, these items were retained due to their relevant clinical content. The final 16-item scale includes an overall total score and four subscale scores that reflect the different end of life planning constructs. Conclusions: The 16-item HDQLIFE end of life planning measure demonstrates adequate psychometric properties; it may be a useful tool for clinicians to clarify patients’ preferences about end of life care.

KW - End of life

KW - HDQLIFE

KW - HDQLIFE Site Investigators and Coordinators

KW - Health-related quality of life

KW - Huntington disease

KW - Patient-reported outcome (PRO)

UR - http://www.scopus.com/inward/record.url?scp=85034063065&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85034063065&partnerID=8YFLogxK

U2 - 10.1007/s00415-017-8677-7

DO - 10.1007/s00415-017-8677-7

M3 - Article

C2 - 29143208

AN - SCOPUS:85034063065

SN - 0340-5354

VL - 265

SP - 98

EP - 107

JO - Journal of Neurology

JF - Journal of Neurology

IS - 1

ER -

A new measure for end of life planning, preparation, and preferences in Huntington disease: HDQLIFE end of life planning

Abstract

Funding

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this