Evaluation of measurement equivalence of the Family Satisfaction with the End-of-Life Care in an ethnically diverse cohort: Tests of differential item functioning

Abstract

Background The Family Satisfaction with End-of-Life Care is an internationally used measure of satisfaction with cancer care. However, the Family Satisfaction with End-of-Life Care has not been studied for equivalence of item endorsement across different socio-demographic groups using differential item functioning. Aims The aims of this secondary data analysis were (1) to examine potential differential item functioning in the family satisfaction item set with respect to type of caregiver, race, and patient age, gender, and education and (2) to provide parameters and documentation of differential item functioning for an item bank. Design A mixed qualitative and quantitative analysis was conducted. A priori hypotheses regarding potential group differences in item response were established. Item response theory and Wald tests were used for the analyses of differential item functioning, accompanied by magnitude and impact measures. Results Very little significant differential item functioning was observed for patient's age and gender. For race, 13 items showed differential item functioning after multiple comparison adjustment, 10 with non-uniform differential item functioning. No items evidenced differential item functioning of high magnitude, and the impact was negligible. For education, 5 items evidenced uniform differential item functioning after adjustment, none of high magnitude. Differential item functioning impact was trivial. One item evidenced differential item functioning for the caregiver relationship variable. Conclusion Differential item functioning was observed primarily for race and education. No differential item functioning of high magnitude was observed for any item, and the overall impact of differential item functioning was negligible. One item, satisfaction with “the patient's pain relief,” might be singled out for further study, given that this item was both hypothesized and observed to show differential item functioning for race and education.

Evaluation of measurement equivalence of the Family Satisfaction with the End-of-Life Care (FAMCARE): Tests of differential item functioning between Hispanic and non-Hispanic White caregivers

“…Although there is no literature on the FAMCARE in a sample of Hispanic caregivers to persons with ADRD, earlier work on ethnically diverse caregivers may have informed the hypotheses. In contrast to the findings reported here, in an earlier paper on DIF in the FAMCARE (Teresi et al, 2015), Black responders reported less satisfaction with their care, conditional on the trait.…”

“…However, in an earlier study a similar item, "Satisfaction with the patient's pain relief" was found to show DIF for the comparison of Blacks and White non-Hispanics. In that study, it was found that conditional on the satisfaction level, caregivers of Black patients were less satisfied with pain relief (Teresi et al, 2015), a finding corresponding to findings of racial and ethnic disparities in pain treatment identified by Green et al (2003). It is possible that the content experts posited the presence of an unmeasured secondary extraneous factor such as personal experiences that may have influenced responses to satisfaction items.…”

“…A study of measurement equivalence comparing Black with White non-Hispanic caregivers of patients with cancer found that 13 items evidenced differential item functioning (DIF), a type of item bias; however, none of high magnitude (Teresi et al, 2015). Moreover, the scale-level impact was negligible.…”

Psychometric Properties of a Spanish-Language Version of a Short-Form FAMCARE: Applications to Caregivers of Patients With Alzheimer’s Disease and Related Dementias

“…Earlier psychometric studies of the FAMCARE identified varying factor structures. One study using IRT examined the performance of items in terms of information and differential item functioning between Black and White subsamples (Teresi et al, 2015). Because of overlapping category response functions identified in the prior analyses, the response categories were collapsed from five into three: very satisfied responses coded as 2, satisfied coded as 1, and indecision or dissatisfaction coded as 0.…”

The Spectrum of Caregiving in Palliative Care for Serious, Advanced, Rare Diseases: Key Issues and Research Directions

“…Areas of difference included patient's pain relief, information provided about prognosis, referrals to specialists, the way treatments were performed, inclusion of the family in treatment decisions, and information given about tests. 46 Research can address gaps through development and testing of culturally adapted models of care. For example, in a study of African Americans coping with cancer, participants reported that an interactive communication intervention which facilitated Afrocentric coping skills such as relying on faith, promoting fictive kin support, highlighting positives, and encouraging flexibility in family roles resulted in significantly improved family member communication and satisfaction.…”