(306) Validating the MOST in Goiter and Graves' Disease

Introduction: Existing thyroid-specific validated instruments are limited in that they may introduce an added administrative burden in daily practice, rather than providing clinically relevant information, while quantifying patient-centered outcomes. In this study, we assess the validity of a 4- or 5-item measure for observation or surgery (MOST) which detects the level and types of concerns for patients with Graves’ disease or goiter who present for endocrine surgical evaluation.

Methods: Data were obtained prospectively. Item content originated from qualitative patient comments, assessments of face validity, and direct utility in routine endocrine surgical practice for Graves and goiter patients. 5 items were proposed for further testing in variants in these patients. Assessments of dimensionality, internal consistency, discriminant validity, convergent validity, intra-rater reliability, and responsiveness to change were performed.

Results: Among 239 consecutive patient responses (mean age 54 years (range 24-88), 83% female, 88% goiter, 12% Graves), exploratory factor analysis supported two factors and internal consistency was acceptable (Cronbach alpha 0.7, 95% CI > 0.6). Tested item variant sum scores were able to discriminate between patients who had not yet been counseled by a surgeon and those who already had (difference in means, Cohen d 0.35-0.52, p< 0.01). Convergence with general health scores was moderate (Spearman rho, -0.27 to -0.39, p< 0.01). Intra-rater reliability was high (0.7-1.0). Responsiveness to change was demonstrated (Cohen d 0.38-0.51, p< 0.01).

Conclusions: Assessments of 4-5 item variants of a Measure for Observation or Surgery for Thyroid lesions (MOST) in patients with Graves or goiter yield novel item sets which demonstrate psychometric validity for use in high volume endocrine surgical settings.