An analysis of the construct validity and responsiveness of the ICECAP-SCM capability wellbeing measure in a palliative care hospice setting

Gareth Myring, Paul Mitchell, W.George Kernohan, Sonja J McIlfatrick, Sarah Cudmore, Anne Finucane, Lisa Graham-Wisener, Alistair Hewison, Louise Jones, Joanne Elizabeth Jordan, Laurie Mc Kibben, Deborah Muldrew, Shazia Zafar, Joanna Coast

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For outcome measures to be useful in health and care decision-making, they need to have certain psychometric properties. The ICECAP-Supportive Care Measure (ICECAP-SCM), a seven attribute measure (1. Choice, 2. Love and affection, 3. Physical suffering, 4. Emotional suffering, 5. Dignity, 6. Being supported, 7. Preparation) developed for use in economic evaluation of end-of-life interventions, has face validity and is feasible to use. This study aimed to assess the construct validity and responsiveness of the ICECAP-SCM in hospice inpatient and outpatient settings. A secondary analysis of data collated from two studies, one focusing on palliative care day services and the other on constipation management, undertaken in the same national hospice organisation across three UK hospices, was conducted. Other quality of life and wellbeing outcome measures used were the EQ-5D-5L, McGill Quality of Life Questionnaire - Expanded (MQOL-E), Patient Health Questionnaire-2 (PHQ-2) and Palliative Outcomes Scale Symptom list (POS-S). The construct validity of the ICECAP-SCM was assessed, following hypotheses generation, by calculating correlations between: (i) its domains and the domains of other outcome measures, (ii) its summary score and the other measures' domains, (iii) its summary score and the summary scores of the other measures. The responsiveness of the ICECAP-SCM was assessed using anchor-based methods to understand change over time. Statistical analysis consisted of Spearman and Pearson correlations for construct validity and paired t-tests for the responsiveness analysis. Sixty-eight participants were included in the baseline analysis. Five strong correlations were found with ICECAP-SCM attributes and items on the other measures: four with the Emotional suffering attribute (Anxiety/depression on EQ-5D-5L, Psychological and Burden on MQOL-E and Feeling down, depressed or hopeless on PHQ-2), and one with Physical suffering (Weakness or lack of energy on POS-S). ICECAP-SCM attributes and scores were most strongly associated with the MQOL-E measure (0.73 correlation coefficient between summary scores). The responsiveness analysis (n = 36) showed the ICECAP-SCM score was responsive to change when anchored to changes on the MQOL-E over time (p
Original languageEnglish
Article number121(2022)
JournalBMC Palliative Care
Publication statusPublished (in print/issue) - 8 Jul 2022

Bibliographical note

Funding Information:
We would like to thank participants at the International Health Economics Association (iHEA) 2021 Congress, where an earlier version of this research was presented. The methods used in this study were carried out in accordance with relevant guidelines, the COSMIN study design checklist for patient reported outcome measurement instruments, and regulations.

Funding Information:
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Funding was provided by the Marie Curie Research Grants Scheme [A17114, A20993]. PM and JC were supported by a Wellcome Trust Investigator Award in the analysis and drafting of this manuscript (205284/Z/16/Z).

Publisher Copyright:
© 2022, The Author(s).


  • Palliative care
  • patient reported outcome measures
  • economic evaluation
  • psychometrics
  • quality of life
  • hospice care
  • Patient reported outcome measures
  • Reproducibility of Results
  • Humans
  • Palliative Care
  • Psychometrics
  • Hospices
  • Quality of life
  • Pain
  • Economic evaluation
  • Hospice care
  • Surveys and Questionnaires
  • Quality of Life - psychology


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