title: A revision of the intensity of treatment rating scale: classifying the intensity of pediatric cancer treatment.
abstract: BACKGROUND
  We previously developed a reliable and valid method for classifying the intensity of pediatric cancer treatment. The Intensity of Treatment Rating Scale (ITR-2.0) 1 classifies treatments into four operationally defined levels of intensity and is completed by pediatric oncology specialists based on diagnosis, stage, and treatment data from the medical record. Experience with the ITR-2.0 and recent changes in treatment protocols indicated the need for a minor revision and revalidation.
  
  
  METHODS
  Five criterion raters reviewed the prior items, independently proposing additions and/or changes in the classification of diseases/treatments. Subsequent to a group discussion of the proposed changes, a revised 43-item ITR was evaluated. Pediatric oncologists (n = 47) completed a two-part online questionnaire. Validity of the classifications was determined by the oncologists classifying each disease/treatment into one of the four levels of intensity. Inter-rater reliability was calculated by having each oncologist classify the treatments of 12 sample patients using the new version which we call the ITR-3.
  
  
  RESULTS
  Agreement between median ratings of the 43 items for the pediatric oncologists and the criterion raters was high (r = 0.88). The median of the raters was either identical (81%) with the criterion ratings or discrepant by one level. Inter-rater reliability was very high when using the ITR-3 to classify 12 sample patients, with a median agreement of 0.90 and an intraclass correlation coefficient (r(ICC) = 0.86).
  
  
  CONCLUSIONS
  With these minor modifications and updates, the ITR-3 remains a reliable and valid method for classifying pediatric oncology treatment protocols.
authors.affiliation: Division of Oncology, The Children's Hospital of Philadelphia, Pennsylvania 19104, USA. kazak@email.chop.edu
authors.forename: Anne E
authors.initials: AE
authors.lastname: Kazak
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Hocking
authors.forename: Richard F
authors.initials: RF
authors.lastname: Ittenbach
authors.forename: Anna T
authors.initials: AT
authors.lastname: Meadows
authors.forename: Wendy
authors.initials: W
authors.lastname: Hobbie
authors.forename: Branlyn Werba
authors.initials: BW
authors.lastname: DeRosa
authors.forename: Ann
authors.initials: A
authors.lastname: Leahey
authors.forename: Leslie
authors.initials: L
authors.lastname: Kersun
authors.forename: Anne
authors.initials: A
authors.lastname: Reilly
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000145:classification* / Q000627:therapeutic use*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000188:drug therapy*; D011795:Surveys and Questionnaires