Are patient-reported outcome measures valid across diverse cancer populations?: A review of psychometric evidence.

Abstract

e23260 Background: Patient-reported outcome (PRO) assessments improve cancer care and health outcomes, including quality of life, patient satisfaction, and survival, and often provide a more accurate reflection of patients’ health status than clinician-reported assessments. Despite increasing use of PROs in oncology research and practice, the extent to which PRO instruments have been systematically evaluated for psychometric performance among underserved populations, such as racial and ethnic minorities, individuals of low socioeconomic status, and rural residents, remains unclear. This systematic review examines existing evidence on the psychometric evaluation of PRO instruments in cancer care among underserved populations. Methods: We examined peer-reviewed studies published in English and conducted in the United States. Three academic databases (i.e., PubMed, Scopus, and Web of Science) were searched for studies assessing PRO instruments among underserved cancer patients. Titles and abstracts were screened, followed by full-text review. Data were systematically extracted on PRO instruments used, study populations, and psychometric evaluations, including comprehension, usability, validity, reliability, and differential item functioning (DIF). Results: A total of 12 studies met inclusion criteria. Findings were generally supportive of widely used instruments, particularly PROMIS measures. Several studies conducted DIF analyses across diverse sociodemographic groups, identifying DIF for select items and domains. While aggregate-level DIF was often small, individual-level DIF by race/ethnicity, education, and language preference was observed, highlighting items that may warrant further evaluation. Studies examining comprehension and usability indicated that literacy was associated with understanding PRO items, whereas age and race were not consistently associated. Few studies examined whether individuals from different racial and ethnic groups interpret PRO items similarly, and limited evidence was found on psychometric evaluation of PRO measures translated into languages other than Spanish. Conclusions: PRO instruments used in cancer care demonstrate overall psychometric support in underserved populations. DIF findings underscore the importance of understanding why items may function differently across groups, including the role of lived experience and cultural context. Additional studies that intentionally evaluate psychometric performance and item comprehension in underserved populations are needed to support equitable interpretation and implementation of PROs in cancer care.