Table 5 Key notes from item generation expert panel meeting (September 2013)
From: Development of the chronic obstructive pulmonary disease morning symptom diary (COPD-MSD)
Notes/Group Decisions |
|---|
• It is difficult for subjects to link nighttime awakenings to symptoms, thus do not ask subjects to report number of awakenings related to symptoms; one advisor suggested adding a proxy item to capture nighttime awakenings (“How rested did you feel this morning?”) – this item would be in addition to a question regarding how tired or fatigued the subject felt |
• All symptom concepts, including those with relatively low subject endorsement (e.g., headaches, exhaustion/tiredness), should be included; advisors agreed to err on side of inclusivity in the early stages of instrument development. It was noted items that perform poorly would drop out in the future based on psychometric assessments |
• Wheeze was debated at length among advisors with some noting it was a difficult symptom to measure, however advisors agreed to include wheeze for now with potential for deleting later |
• Although unclear if “chest congestion” was viewed by subjects as a distinct symptom from phlegm or other chest symptoms (i.e., tightness, discomfort), include as separate item for now |
• For those miscellaneous symptoms that were mentioned infrequently (n < 5) and were not clearly related to COPD (e.g., back pain), advisors agreed to exclude from COPD-MSD |
• Shortness of breath (but not other symptoms) should be measured in the context of performing activities, however need to select activities that are relatively universal; advisors recommended reviewing literature and exploring this with subjects in cognitive interviews |
• Advisors concluded a Likert scale would be best suited for the COPD-MSD items |
• Key questions or themes to explore during cognitive interview phase: |
o Explore subject language used around the “tiredness/exhaustion” concept as well as how subjects describe and define “chest congestion” (i.e., is chest congestion different from chest tightness and chest discomfort?) |
o Explore what morning activities are universal or common to all subjects |
• For recall period, ask about morning timeframe in general, do not limit or narrow to a specific hour within the morning period |