title: Classifying the intensity of pediatric cancer treatment protocols: the intensity of treatment rating scale 2.0 (ITR-2).
abstract: BACKGROUND
  To develop and validate a method of classifying the intensity of pediatric oncology treatments using four operationally defined categories of treatment intensity.
  
  
  METHODS
  An earlier version of a rating scale, the intensity of treatment rating (ITR), was revised and validated in two phases. In the Scale Construction phase, three criterion raters revised the ITR items based on consensus and item agreement data from pediatric oncologist raters (N = 15). In the Scale Validation phase, the new ITR-2 items were validated using a second set of pediatric oncologists external to our institution (N = 12). In addition, a third group of raters (N = 16), was employed to assess inter-rater reliabilities for 12 patients at varying levels of treatment intensities.
  
  
  RESULTS
  Agreement between criterion ratings and the median of external raters for all 34 items on the ITR-2 was very high (r = 0.95, range 0.71-0.91). When the ITR-2 was used to rate 12 patient examples, the inter-rater agreement among pediatric oncologists was also very high (median agreement between criterion-rater pairs: r = 0.87; overall relatedness among 16 raters: r(ICC) = 0.83).
  
  
  CONCLUSIONS
  The revised ITR Scale 2.0 (ITR-2) is a valid and reliable scale for classifying the intensity of pediatric oncology treatments.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104-4399, USA.
authors.forename: Branlyn E
authors.initials: BE
authors.lastname: Werba
authors.forename: Wendy
authors.initials: W
authors.lastname: Hobbie
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kazak
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ittenbach
authors.forename: Anne F
authors.initials: AF
authors.lastname: Reilly
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000145:classification*; D002648:Child; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000145:classification; D006801:Humans; D008495:Medical Oncology / Q000379:methods* / Q000592:standards; D009367:Neoplasm Staging; D009369:Neoplasms / Q000175:diagnosis / Q000628:therapy*; D015588:Observer Variation; D012008:Recurrence; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires