title: A systematic review of patient-reported measures of burden of treatment in three chronic diseases.
abstract: BACKGROUND
  Burden of treatment refers to the workload of health care and its impact on patient functioning and well-being. There are a number of patient-reported measures that assess burden of treatment in single diseases or in specific treatment contexts. A review of such measures could help identify content for a general measure of treatment burden that could be used with patients dealing with multiple chronic conditions. We reviewed the content and psychometric properties of patient-reported measures that assess aspects of treatment burden in three chronic diseases, ie, diabetes, chronic kidney disease, and heart failure.
  
  
  METHODS
  We searched Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, and EBSCO CINAHL through November 2011. Abstracts were independently reviewed by two people, with disagreements adjudicated by a third person. Retrieved articles were reviewed to confirm relevance, with patient-reported measures scrutinized to determine consistency with the definition of burden of treatment. Descriptive information and psychometric properties were extracted.
  
  
  RESULTS
  A total of 5686 abstracts were identified from the database searches. After abstract review, 359 full-text articles were retrieved, of which 76 met our inclusion criteria. An additional 22 articles were identified from the references of included articles. From the 98 studies, 57 patient-reported measures of treatment burden (full measures or components within measures) were identified. Most were multi-item scales (89%) and assessed treatment burden in diabetes (82%). Only 15 measures were developed using direct patient input and had demonstrable evidence of reliability, scale structure, and multiple forms of validity; six of these demonstrated evidence of sensitivity to change. We identified 12 content domains common across measures and disease types.
  
  
  CONCLUSIONS
  Available measures of treatment burden in single diseases can inform derivation of a patient-centered measure of the construct in patients with multiple chronic conditions. Patients should take part in developing the measure to ensure salience and relevance.
authors.affiliation: Division of Heath Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Eton
authors.forename: Tarig A
authors.initials: TA
authors.lastname: Elraiyah
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Yost
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Ridgeway
authors.forename: Anna
authors.initials: A
authors.lastname: Johnson
authors.forename: Jason S
authors.initials: JS
authors.lastname: Egginton
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Mullan
authors.forename: Mohammad Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
keywords: patient-centered; patient-reported outcomes; psychometric properties; questionnaire; self-management; treatment burden