MGA3A New Paradigm for Assessing Health-Related Quality of Life: A Social-Clinical Model

The objectives of this study were to confirm the factorial validity of a health-related quality of life (HRQL) instrument (Functional Assessment of Cancer Therapy), establish equivalence of the HRQL instrument across three racial/ethnic groups, and examine the impact of social and clinical factors on HRQL in diverse cancer patients.METHODS: Data used in this study were supplied by three Eastern Cooperative Oncology Group (ECOG) data collection sites. A total of 911 patients with complete data were included in the cross-sectional analyses. This study includes seven exogenous (observed) variables (age, socio-economic status, living arrangement, gender, race/ethnicity, disease stage, and performance status) and one exogenous latent variable (spiritual beliefs). The multivariate analyses include exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. RESULTS: The construct validity of a commonly used HRQL instrument has been demonstrated in this study sample. The results indicate that HRQL is a multidimensional construct, which is composed of the dimensions of physical well-being, social well-being, emotional well-being, and functional well-being. The HRQL measurement model is universally applicable, irrespective of race and/or ethnicity, and the factor loadings are the same across the three groups. The findings indicate that one's “spiritual beliefs,” a social factor, is the most significant determinant of HRQL followed by a clinical attribute, performance status. CONCLUSION: HRQL assessment plays a crucial role in health services research and clinical practice. It is hoped that this research has furthered the discussion on the social and clinical determinants of HRQL. The application of a HRQL instrument using confirmatory factor analysis in multiple racial/ethnic groups in this study has demonstrated a new methodological approach to validation research.