One of the greatest difficulties experienced by survivors of head and neck cancer (HNCa) relates to verbal communication. However, no existing tools are dedicated towards measuring communication difficulties in everyday life situations, or """"""""communicative participation"""""""". The overarching goal of the proposed investigation is to validate an item bank comprised of carefully calibrated items that define and quantify the construct of communicative participation in HNCa survivors. The first specific aim is to develop and refine a pool of items for measuring communicative participation. In study 1, 15 clinicians experienced treating individuals with HNCa will participation in focus groups. They will evaluate items from an item bank recently developed for individuals with neurogenic communication disorders. As a result, new items may be added or existing items revised in the bank. Fifteen individuals treated for HNCa (oral, oropharynx, hypopharynx, larynx) then will examine items within the bank using cognitive interviewing techniques. Results will ensure clarity of instructions, relevance of items, and response formats for individuals treated for HNCa. The second specific aim is to determine the construct validity of the Communicative Participation Item Bank in HNCa. In study 2, items will be administered to 200+ individuals treated for HNCa. Items that represent a unidimensional trait distributed across difficulty levels will be identified using Item Response Theory (IRT). Results for individuals with HNCa will be compared to those for individuals with neurogenic communication disorders. It is hypothesized that individuals treated for HNCa will demonstrate more interference with communicative participation, but that relevant items and item difficulty levels will be similar across populations. The third specific aim will determine criterion-related validity of the measure of communicative participation by examining relationships with patient-reported QOL. Individuals participating in study 2 also will complete voice-, swallowing-, and HNCa-related QOL measures. Demographic and treatment/disease information will be collected. Univariate and multivariate analyses will determine relationships between communicative participation and QOL well as demographic/treatment factors. It is hypothesized that communicative participation will demonstrate the strongest relationships to QOL. The fourth specific aim is to determine criterion-related validity by examining relationships with traditional speech/voice measures in individuals treated for laryngeal cancer. In study 3, 50 individuals will be audio- recorded and evaluated. Twenty clinicians and 20 na?ve listeners will judge speakers' recordings for intelligibility and acceptability using a standardized instrument and rating scales. Speakers will complete items in the Communicative Participation Item Bank, and voice- and HNCa-related QOL scales. Relationships between patient-reported and traditional measures will be determined; strong relationships are anticipated between communicative participation and QOL, while weak relationships are hypothesized to speech intelligibility. Realization of these aims will help establish the validity of a meaningful HNCa outcome measure. Results from the proposed investigations may increase our understanding of the construct of communicative participation, and may contribute to the development and revision of multidimensional models of rehabilitation. Outcomes from these studies may lead to the development of a validated item bank that may be used in future longitudinal applications to document treatment efficacy in those with head and neck cancer. These approaches may lead to the identification of better treatment methods for many individuals whose physical, social, psychological well-being are impacted by communication disorders. ? ? ? ?
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