Development of the Short Treatment Burden Questionnaire (STBQ) including a Global Treatment Burden Question (GTBQ): Cognitive interviews with adults living with multimorbidity

Background:
A short patient reported outcome measure (PROM) could help identify people experiencing high treatment burden.

Objectives:
To develop the Short Treatment Burden Questionnaire (STBQ), a novel PROM comprising a Global Treatment Burden Question (GTBQ) and items to identify areas of difficulty; improve its understandability and face validity; and explore patient views on using it in clinical practice.

Methods:
Prototype development drew on the validated Multimorbidity Treatment Burden Questionnaire (MTBQ) and a single-item global measure. Adults, aged 18–65, living with multimorbidity were recruited from English general practices. Three rounds of cognitive interviews, with think-aloud and prompts, were conducted (July–October 2023). After each round, data were analysed, suggested changes and uncertainties discussed and modifications made. Public contributors were involved throughout.

Results:
Participants (n = 15) were predominantly female (67%) and White British (87%). Issues were identified with the layout, instructions, and order and wording of response options, with some aspects interpreted in unintended ways. The number of issues and consequent changes reduced with each round of interviews. Participants highlighted potential benefits of using the STBQ in clinical practice, including encouraging patients to mention things they may not otherwise bring up. They suggested the STBQ could inform both individual patient care and practice-level service improvement.

Conclusions:
Robust qualitative methods were used to develop a novel PROM for use in clinical practice and research. The STBQ demonstrated face validity and was relatively easy to use. Further work has been undertaken to validate the GTBQ. Guidance will outline how the STBQ could support patient care.