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    A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation.

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    Date
    2004-05-06
    Authors
    Dolor, RJ
    Edwards, R
    Hauch, O
    Hedner, E
    Marple, CB
    Matchar, David Bruce
    Samsa, Gregory P
    Wiklund, I
    Wygant, G
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    Abstract
    BACKGROUND: Anticoagulation can reduce quality of life, and different models of anticoagulation management might have different impacts on satisfaction with this component of medical care. Yet, to our knowledge, there are no scales measuring quality of life and satisfaction with anticoagulation that can be generalized across different models of anticoagulation management. We describe the development and preliminary validation of such an instrument - the Duke Anticoagulation Satisfaction Scale (DASS). METHODS: The DASS is a 25-item scale addressing the (a) negative impacts of anticoagulation (limitations, hassles and burdens); and (b) positive impacts of anticoagulation (confidence, reassurance, satisfaction). Each item has 7 possible responses. The DASS was administered to 262 patients currently receiving oral anticoagulation. Scales measuring generic quality of life, satisfaction with medical care, and tendency to provide socially desirable responses were also administered. Statistical analysis included assessment of item variability, internal consistency (Cronbach's alpha), scale structure (factor analysis), and correlations between the DASS and demographic variables, clinical characteristics, and scores on the above scales. A follow-up study of 105 additional patients assessed test-retest reliability. RESULTS: 220 subjects answered all items. Ceiling and floor effects were modest, and 25 of the 27 proposed items grouped into 2 factors (positive impacts, negative impacts, this latter factor being potentially subdivided into limitations versus hassles and burdens). Each factor had a high degree of internal consistency (Cronbach's alpha 0.78-0.91). The limitations and hassles factors consistently correlated with the SF-36 scales measuring generic quality of life, while the positive psychological impact scale correlated with age and time on anticoagulation. The intra-class correlation coefficient for test-retest reliability was 0.80. CONCLUSIONS: The DASS has demonstrated reasonable psychometric properties to date. Further validation is ongoing. To the degree that dissatisfaction with anticoagulation leads to decreased adherence, poorer INR control, and poor clinical outcomes, the DASS has the potential to help identify reasons for dissatisfaction (and positive satisfaction), and thus help to develop interventions to break this cycle. As an instrument designed to be applicable across multiple models of anticoagulation management, the DASS could be crucial in the scientific comparison between those models of care.
    Type
    Journal article
    Subject
    Administration, Oral
    Aged
    Anticoagulants
    Cost of Illness
    Female
    Focus Groups
    Hematologic Tests
    Humans
    Long-Term Care
    Male
    Middle Aged
    Outpatients
    Patient Compliance
    Patient Satisfaction
    Psychometrics
    Quality of Life
    Sickness Impact Profile
    Warfarin
    Permalink
    http://hdl.handle.net/10161/11676
    Published Version (Please cite this version)
    10.1186/1477-7525-2-22
    Publication Info
    Dolor, RJ; Edwards, R; Hauch, O; Hedner, E; Marple, CB; Matchar, David Bruce; ... Wygant, G (2004). A new instrument for measuring anticoagulation-related quality of life: development and preliminary validation. Health Qual Life Outcomes, 2. pp. 22. 10.1186/1477-7525-2-22. Retrieved from http://hdl.handle.net/10161/11676.
    This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
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    Scholars@Duke

    Matchar

    David Bruce Matchar

    Professor of Medicine
    My research relates to clinical practice improvement - from the development of clinical policies to their implementation in real world clinical settings. Most recently my major content focus has been cerebrovascular disease. Other major clinical areas in which I work include the range of disabling neurological conditions, cardiovascular disease, and cancer prevention. Notable features of my work are: (1) reliance on analytic strategies such as meta-analysis, simulation, decision analy
    Samsa

    Gregory P. Samsa

    Associate Professor of Biostatistics and Bioinformatics
    Greg Samsa is an applied statistician whose primary interests are in study design, instrument development, information synthesis, practice improvement, effective communication of statistical results, and teaching. He is a believer in the power of statistical thinking, as broadly defined.
    Alphabetical list of authors with Scholars@Duke profiles.
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