DESCRIPTION (provided by applicant): One of the greatest difficulties experienced by survivors of head and neck cancer (HNC) relates to verbal communication. However, standard HNC outcome measures do not capture how individuals communicate in everyday life situations, or "communicative participation". Recently, our research team began to address this critical gap through initial validation of a tool that measures communicative participation: the Communicative Participation Item Bank (CPIB). Yet, before becoming a gold standard measure for treatment efficacy research, an outcome measure must be able to detect changes in function over time. Clinicians must also know what the smallest difference is in scores that patients perceive as meaningful. Finally, measures must not only be precise but also time-effective, and could be addressed with computer-based administration. Thus, the first specific aim of the proposed study is to further establish the psychometric properties of the CPIB. This will be accomplished by: a) examining the sensitivity of the CPIB by comparing those undergoing standard HNC treatments over time with those in a stable/no treatment status; b) estimating the unit of clinically meaningful change; and c) determining relationships between scores from static short-forms with those from computerized adaptive testing (CAT). To accomplish aim 1, two groups of subjects will complete the CPIB and standard HNC outcome measures in a longitudinal study. The Treatment Group will include HNC patients currently in treatment; the Chronic Group will include individuals who are at least 5 years HNC post-treatment. It is predicted that CPIB scores will decrease over the first 3 months, but will improve and stabilize by 12 months in the Treatment group; CPIB scores will remain stable in the Chronic group. Using anchor-, distribution-based, and qualitative approaches, and clinically meaningful change scores on the CPIB will be determined. Finally, it is hypothesized that there will be strong correlations between CPIB scores derived from static and CAT-based formats. The ability to quantify communicative participation is important because it allows us to identify contributing variables whose strength may change over time. Thus, the second specific aim is to determine significant predictors of communicative participation. Treatment group subjects will provide demographics, disease/treatment-related information and psychosocial measures. It is hypothesized that CPIB will have multiple predictors, and that psychosocial factors will become stronger predictors over time. In a second study, a subgroup will complete standard speech measures to determine how traditional measures of speech predict CPIB over time. The approach is innovative because it represents a substantive departure from the status quo in HNC outcome measurement. By identifying which variables contribute to communicative participation over time, results of this study will make a significant impact on future interventio approaches based on these variables. Realization of these aims will further establish the validity of a meaningful outcome measure, identify targets for future rehabilitation, and contribute to models of functioning and disability in HNC survivors.
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