German cross-cultural adaptation of the Health Utilities Index and its application to a sample of childhood cancer survivors

Steady progress in developing effective treatments for childhood cancer and other severe pediatric diseases has established the need to consider the n ature and frequency of late physical and psychological effects. The Health Utilities Index Mark 2 and Mark 3 (HUI2/3) systems were developed by Feeny, Furlong, Torrance et al. in Canada. These systems are generic multi-attrib ute measures of a person's health status and health-related quality of life . The first German version of the Canadian HUI2/3 questionnaire was created in our clinic, following recommended guidelines for cross-cultural adaptat ion of health-related quality of life measures. The usefulness of the resul tant version was investigated using a sample of 142 patients who presented to our oncological outpatients' department for a routine health care visit after completion of treatment. The 15 items of the HUI2/3-questionnaire wer e answered independently by three groups of assessors - nurses, physicians, and parents or patients. Two additional questions covered ratings of the s everity of treatment effects and the specification of these effects. The qu estionnaire was both easy to use and acceptable to the assessors. Percentag e agreement between observers about levels for individual attributes ranged from 56% to 100%, with the lowest agreement on the subjective attributes o f emotion, pain and cognition. These results are in accordance with previou s studies using the original instrument. HUI2 global utility scores were si gnificantly related to ratings of treatment sequelae, giving support to the discriminant validity of the measure. Conclusion The German version of HUI2/3 is a useful instrument with general ly high inter-observer agreement and good suitability for outcome measureme nt in childhood cancer patients. Further research is needed to assess the u sefulness of the instrument in other clinical populations and its sensitivi ty in longitudinal studies.