Evaluating the “Good Death” Concept from Iranian Bereaved Family

Table 2
Spearman Correlation Coefficients between Changes in BPI-SF Worst Pain Rating and Changes in Potential
Anchors
ANCHOR
BASELINE TO WEEK 5
ASSESSMENT INTERVAL
BASELINE TO WEEK 13 BASELINE TO WEEK 25
BPI-SF Current Pain rating 0.234* (n � 1,814) 0.275* (n � 1,730) 0.647* (n� 1,562)
EQ-5D Index score �0.286* (n � 1,742) �0.331* (n � 1,667) �0.391* (n� 1,507)
EQ-5D Pain item 0.359* (n � 1,774) 0.383* (n � 1,696) 0.423* (n� 1,543)
ECOG Performance scale — 0.162* (n � 1,702) 0.164* (n � 1,542)
FACT-B Overall QOL �0.131* (n � 1,783) �0.155* (n � 1,705) �0.195* (n � 1,543)
FACT-B TOI �0.252* (n � 1,740) �0.318* (n � 1,665) �0.351* (n� 1,514)
FACT-G Physical Well-Being �0.339* (n � 1,795) �0.381* (n � 1,715) �0.420* (n� 1,554)
FACT-G Social/Family Well-Being �0.026 (n � 1,785) �0.018 (n � 1,705) �0.048 (n � 1,550)
FACT-G Emotional Well-Being �0.151* (n � 1,788) �0.176* (n � 1,713) �0.188* (n � 1,552)
FACT-G Functional Well-Being �0.138* (n � 1,790) �0.199* (n � 1,710) �0.227* (n � 1,551)
FACT-G total score �0.255* (n � 1,760) �0.288* (n � 1,687) �0.329* (n� 1,522)
* P � .001.
Bolded correlations represent the highest correlations with anchors where correlation r � 0.300.
Spearman correlation coefficients between changes in BPI-SF worst pain rating and changes in each of the 11 potential anchors that were considered are provided. The data are displayed
for three intervals of time including baseline to week 5, baseline to week 13, and baseline to week 25. Using a cut point of r � 0.300, only those correlations that are bolded meet the criteria
of acceptability.
(80.9%). Average pain scores at baseline were 2.45 � 2.51, with
a full range of scores (0–10) being used. Clinical results from the
study have been presented previously. 22
ANCHOR-BASED ANALYSIS
Spearman correlations between changes in the BPI-SF
worst pain item and changes in potential anchors are presented
in Table 2. For all potential anchors, the highest
correlations with the BPI-SF worst pain rating were obtained
at the baseline to week 25 interval. All potential anchors
correlated significantly (P � 0.001) with the BPI-SF worst
pain rating with the exception of the FACT-G Social/Family
Well-Being scale. However, correlations were low (�0.30) for
several potential anchors: ECOG Performance Status,
FACT-B Overall QOL item, FACT-G Emotional Well-Being,
and FACT-G Functional Well-Being. Therefore, the
week 25 interval and the following anchors were selected for
the MID analysis: BPI-SF current pain rating, EQ-5D Index
score, EQ-5D Pain item, FACT-B TOI, FACT-G Physical
Well-Being, and FACT-G total score. Correlation coefficients
between the changes in the selected anchors and
changes in the BPI-SF worst pain ratings range from
0.329–0.647.
Mean changes in the BPI-SF worst pain rating that correspond
to a one-category change in anchors from baseline to
week 25 are presented in Table 3. BPI-SF current pain ratings
�5 and EQ-5D Index scores �0.40 were excluded from their
respective analysis due to small sample sizes. A one-category
increase in the anchor scores was associated with an absolute
value of change in the BPI-SF worst pain item ranging from
0.26–2.42. A one-category decrease in the anchor score was
associated with an absolute value of change in the BPI-SF
worst pain item ranging from 0.56–3.16. Changes associated
Mathias et al
Table 3
Range of Mean Changes in BPI-SF Worst Pain Rating
from Baseline to Week 25 by Anchors
ONE CATEGORY
ANCHOR
A ONE CATEGORY
INCREASE IN DECREASE IN
ANCHOR
ANCHOR
BPI-SF Current Pain rating 0.26–1.04 �0.89 to �1.66
EQ 5D Index score �2.42 to �1.40 0.56–1.63
EQ 5D Pain item 1.71–1.98 �3.16 to �2.56
FACT-B TOI �2.22 to �0.51 �0.56 to 0.77
FACT-G Physical Well-Being �1.61 to �0.16 �0.79 to 0.46
FACT-G total �1.31 to �0.12 �0.97 to 0.57
a One category (increase or decrease) represents 0.20 points for EQ-5D Index score, one
point for BPI-SF current pain rating and EQ-5D pain item, three points for FACT-G Physical
Well-Being, and six points for FACT-G total and FACT-B TOI.
The range of mean changes in BPI-SF worst pain ratings (using the interval from baseline
to week 25) for the six anchors that met the correlation criteria in Table 2 are provided.
Mean changes are displayed for one-category increases and one-category decreases in
anchor.
with improvement and worsening in anchors were not symmetrical,
nor was there a consistent trend across anchors. For
example, for the EQ-5D pain item, the magnitude of
change in BPI-SF worst pain was greater for a one-category
increase in the anchor than for a one-category decrease in
the anchor. In contrast, for the EQ-5D Index score, the
magnitude of change in BPI-SF worst pain was greater for
a one-category decrease in the anchor than for a onecategory
increase in the anchor.
The regression of changes in anchors on changes in the
BPI-SF worst pain item is shown in Table 4. Changes in each
anchor are significantly (P � 0.05) associated with changes in
BPI-SF worst pain rating. A one-point increase in BPI-SF
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