Introducing BREAST-Q Computerized Adaptive Testing – short and individualized patient-reported outcome assessment following reconstructive breast surgery

BACKGROUND: BREAST-Q is a widely used patient-reported outcome (PRO) instrument measuring health-related quality-of-life and patient satisfaction in breast surgery. Shorter assessment potentially increases patients' willingness to complete scales, but simply offering a short-form version leads to unacceptable loss in measurement precision. We aimed to develop a computerized adaptive test (CAT) to shorten BREAST-Q's Satisfaction with Breasts scale whilst maintaining reliability of measurement. METHODS: We created a CAT, which repetitively administered questions from the pool of 16 questions, until pre-specified levels of reliability were reached (i.e., standard errors (SE) of 0.32-0.55). In a simulation study, we tested the CAT's feasibility for all potential Satisfaction scores. In a second study using actual patient data, 5000 breast reconstruction patients who had previously completed the full scale were randomly selected from a large database. Their full-scale Satisfaction scores were compared with their CAT-derived scores. RESULTS: In both studies, by applying CAT, the Satisfaction with Breasts scale could be reduced to an average of 10 questions when using the minimum level of measurement precision for individual-patient measurement (SE 0.32), compared to 4 questions when using the minimum precision level for group-based research (SE 0.55). Score estimates were highly correlated between CAT assessment and the full scale (0.91-0.98 in simulation study, 0.89-0.98 in patient data study). CONCLUSIONS: Applying CAT to BREAST-Q's Satisfaction with Breasts scale facilitates reliable assessment with 38% to 75% fewer question than the full version. The novel BREAST-Q CAT version may decrease response burden and help overcome barriers to implementation in routine care. Meetings: Preliminary data was presented at the 23rd Annual Conference of the International Society for Quality of Life (ISOQOL) Research meeting in Denmark in 2016, the Patient Reported Outcome Measures UK conference in the United Kingdom in 2016, and at the bi-annual meeting of the Dutch Society for Plastic Surgery (NVPC) in the Netherlands in 2016. Disclosures: Andrea Pusic, Anne Klassen and Stefan Cano are co-developers of the BREAST-Q, which is owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. They receive a portion of licensing fees (royalty payments) when the BREAST-Q is used in industry sponsored clinical trials. Stefan Cano is co-founder of Modus Outcomes, an outcomes research and consulting firm that provides services to pharmaceutical, medical device, and biotechnology companies. The remaining authors have no financial disclosures. Acknowledgements: Andrea Pusic, Anne Klassen and Stefan Cano are co-developers of the BREAST-Q, which is owned by Memorial Sloan-Kettering Cancer Center and the University of British Columbia. They receive a portion of licensing fees (royalty payments) when the BREAST-Q is used in industry sponsored clinical trials. Stefan Cano is co-founder of Modus Outcomes, an outcomes research and consulting firm that provides services to pharmaceutical, medical device, and biotechnology companies. The remaining authors have no financial disclosures. Corresponding author: Christopher Gibbons, Patient-Reported Outcomes, Value, and Experience (PROVE) Center, Department of Surgery, Brigham and Women's Hospital , 75 Francis Street, Boston, MA 02115, Fax 617-732-6387, E-mail: cgibbons2@bwh.harvard.edu ©2018American Society of Plastic Surgeons

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