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Automated Collection of Quality-of-Life Data: A Comparison of Paper and Computer Touch-Screen Questionnaires

From the Imperial Cancer Research Fund Cancer Medicine Research Unit, St James's University Hospital; Research School of Medicine, Centre for Cancer Research, University of Leeds; Northern and Yorkshire Cancer Registry and Information Service; and Northern and Yorkshire Clinical Trials and Research Unit, Leeds, UK; Department of Psychology and Imperial Cancer Research Fund Medical Oncology Unit, Western General Hospital, Edinburgh, UK; and Information and Statistics Division, National Health Service in Scotland, Edinburgh, UK.

Address reprint requests to G. Velikova, MD, Imperial Cancer Research Fund Cancer Medicine Research Unit, St James's University Hospital, Beckett Street, Leeds LS97TF, UK.

PURPOSE: To evaluate alternative automated methods of collecting data on quality of life (QOL) in cancer patients. After initial evaluation of a range of technologies, we compared computer touch-screen questionnaires with paper questionnaires scanned by optical reading systems in terms of patients' acceptance, data quality, and reliability.

PATIENTS AND METHODS: In a randomized cross-over trial, 149 cancer patients completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30, version 2.0 (EORTC QLQ-C30), and the Hospital Anxiety and Depression Scale (HADS) on paper and on a touch screen. In a further test-retest study, 81 patients completed the electronic version of the questionnaires twice, with a time interval of 3 hours between questionnaires.

RESULTS: Fifty-two percent of the patients preferred the touch screen to paper; 24% had no preference. The quality of the data collected with the touch-screen system was good, with no missed responses. At the group level, the differences between scores obtained with the two modes of administration of the instruments were small, suggesting equivalence for most of the QOL scales, with the possible exception of the emotional, fatigue, and nausea/vomiting scales and the appetite item, where patients tended to give more positive responses on the touch screen. At the individual patient level, the agreement was good, with a kappa coefficient from 0.57 to 0.77 and percent global agreement from 61% to 97%. The electronic questionnaire had good test-retest reliability, with correlation coefficients between the two administrations from 0.78 to 0.95, kappa coefficients of agreement from 0.55 to 0.90, and percent global agreement from 56% to 100%.

CONCLUSION: Computer touch-screen QOL questionnaires were well accepted by cancer patients, with good data quality and reliability.

The views expressed in this article are those of the authors and not necessarily those of the National Health Service Executive.

The software was designed by A.B.S., who can be contacted for further information at the correspondence address.

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