Abstract P4-11-14: Content validation and modification of the treatment satisfaction questionnaire for medication (TSQM) for breast cancer
Authors: DeBusk KPA , Maddux LM , Turner-Bowker DM , Krupnick RN , Skolas KL , Patel SL , Petersen JA 
Published: May 2016

Abstract
Background
With the growing number of treatment options for metastatic breast cancer, patient (pt) perspective on treatment and treatment satisfaction is increasingly important to assess. A literature search was conducted to identify commonly utilized measures of pt preference. The Treatment Satisfaction Questionnaire for Medication (TSQM) was identified as the most comprehensive measure to assess patient-reported treatment effectiveness, side effects, convenience, and overall satisfaction with medication for a wide variety of medical conditions. The broad nature of the TSQM allows for assessment of treatment satisfaction across indications; however it has not been evaluated for specific use in populations of cancer patients. We assessed the content validity of the TSQM v1.4® with previously treated breast cancer (BC) patients to determine if any modifications were necessary to ensure relevance in this population.
Methods
This non-interventional, cross-sectional qualitative study used individual semi-structured cognitive interviews to: (1) assess content of the TSQM and relevance for BC, and (2) identify necessary modifications as based on patient interviews. 15 BC pts with a mix of receptor types [hormone receptor positive (HR+), HER2+, triple negative (TNBC)], age &gt; 18 yrs and currently receiving or recently completed first-, second-, or third-line therapy for Stage IIIA to IV were included to ensure applicability across BC. Pts meeting inclusion/exclusion criteria were identified through database review and recruited. Interviews were conducted in three waves of five pts and necessary modifications were made to the TSQM after each wave. Interviews were audio recorded and transcribed.
Results
Mean age of participants was 53 years; 6 patients were HR+/HER2+, 2 patients were HR+/HER2-, 2 patients were HR-/HER2+, 5 patients were TNBC. Pts reported that the three items comprising the effectiveness scale were not relevant in BC and are difficult to answer. Specifically, pts felt the first item ('ability of medication to treat/prevent condition') would be highly dependent on scan results, and indicated that the term 'prevent' is not relevant to the experience of BC pts with a metastatic diagnosis. With the second item ('relieves symptoms'), most pts reported that they did not experience symptoms related to their cancer and thus were unsure how to respond. Pts were confused by the term 'symptoms' and interpreted it as 'side effects from treatment' rather than disease-related. For the third item ('time it takes medication to start working'), pts noted the only way to definitively know if a cancer medication has started working is with scan results, and they would not be able to assess this.
Pts found the remaining TSQM items to be relevant, clear, and easy to understand, and offered a few suggestions for improvement that can be evaluated in future research.
Conclusion
BC pts did not find the TSQM effectiveness scale items relevant to the assessment of their treatment experience, and as a result these items were eliminated in the modified TSQM for Breast Cancer (TSQM-BC). The TSQM-BC is content valid for use in breast cancer studies. Psychometric performance of this version of the TSQM-BC will be evaluated in future research.
Citation Format: DeBusk KPA, Maddux LM, Turner-Bowker DM, Krupnick RN, Skolas KL, Patel SL, Petersen JA. Content validation and modification of the treatment satisfaction questionnaire for medication (TSQM) for breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-11-14.