The Effectiveness Satisfaction Questionnaire for COPD (ESQ-COPD) previously developed by us based on classical test theory has proven to have some limitations. The combination use of classical test theory and item response theory may achieve complementary advantages, which may be a theoretical basis and methodological support for the development or revision of instruments.
To develop a modified ESQ-COPD (mESQ-COPD) based on the combination of disease and syndrome, and to evaluate its psychometric properties.
By predefining basic characteristics of the instrument, normalizing the essential concepts and terminologies, revising the conceptual framework, generating an item pool, and reviewing the items, the draft of the mESQ-COPD was developed by our revision group. Then the draft was improved to be a mESQ-COPD by screening items based on the results of a pretest conducted during October 2017 to February 2018 with a convenience sample of 265 stable COPD patients from the respiratory clinic of 10 grade A tertiary hospitals in China, in combination with item screening using the classical test theory and item response theory. After that, the psychometric properties of the mESQ-COPD were tested using an onsite investigation carried out in a convenience sample of 365 stable COPD patients from the respiratory clinic of six grade A tertiary hospitals in China from November 2018 to February 2019.
The final mESQ-COPD includes four domains (clinical symptoms, capabilities for work and life, ability of environmental adaptation, and therapeutic effect) and 19 items. The Cronbach's α of the questionnaire was 0.949, and that of the four domains was 0.943, 0.869, 0.829, and 0.767, respectively. The correlation coefficient between the domain of clinical symptoms, capabilities for work and life, ability of environmental adaptation, or therapeutic effect and its component items ranged from 0.667 to 0.798, 0.855 to 0.882, 0.795 to 0.907, or 0.857 to 0.934, respectively. Confirmatory factor analysis showed that the comparative fit index, incremental fit index, non-normed fit index, standardized root mean square residual, and root mean square error of approximation measuring the construct validity of the mESQ-COPD were 0.94, 0.94, 0.93, 0.07, and 0.16, respectively. The correlation coefficients of the mESQ-COPD and its domains with COPD assessment test ranged from 0.371 to 0.538, while those of the mESQ-COPD and its domains with the modified Medical Research Council scale ranged from 0.329 to 0.564. The differences in the total score and domain scores of the mESQ-COPD between mild/moderate and severe/extremely severe COPD patients were both statistically significant (P<0.01). The acceptance rate of the mESQ-COPD was 99.5%, and the completion rate was 99.2%, with a mean completion time of (6.13±4.59) min.
The 19-item mESQ-COPD (consists of four domains: clinical symptoms, ability of work and life, capability for environmental adaptation, and therapeutic effect) has good reliability, validity, and applicability, which could be used to support the efficacy evaluation in COPD.
Palliative care improves the quality of life of patients with cancer. The development and utilization of palliative care needs screening tools can help health care providers rapidly, accurately, and scientifically identify cancer patients with palliative care needs and enable health care providers to provide them with palliative care related services in a more timely manner. Currently, the literature on screening tools for palliative care needs in China is less common.
To hance the palliative care needs screening tool (PCST) and test its validity in hospitalized cancer patients.
The PCST was bidirectionally translated following the Brislin translational model. Cultural commissioning of the Chinese version of PCST through expert panel meetings and pre survey. A total of 173 cancer patients admitted to the Department of oncology, biotherapeutics, interventional, and integrative medicine of the Third Affiliated Hospital of Navy Military Medical University were selected for the study from December 2020 to May 2021 using convenience sampling, and the general information questionnaire, Chinese version of PCST were used for this investigation. The critical ratio method and correlation of the item-total scores were used for item analysis, and the content validity of the scale was assessed by expert scoring. To evaluate the validity of known-groups, the palliative care needs screening results of patients with different characteristics were compared. Cronbach's α Coefficient and Guttman compromise coefficient were used to evaluate the internal consistency of the scale. Pearson correlation was used to evaluate the inter rater reliability and test-retest reliability of the scale.
The Chinese version of the PCST includes 10 items, with scores ranging from 0 to 14 points. The CR values of entries ranged from 0.621 to 8.820, and all entries except entries 1 and 8 achieved significant values (P<0.05). The correlation coefficients between the scores of the individual entries and the total score of the scale ranged from 0.161 to 0.795 (P<0.05), and all entries except entries 8 achieved values greater than 0.200. The mean content validity index was 0. 943 at the scale level, and ranged from 0.429 to 1.000 at the entry level. Cronbach's α for the scale was 0.612, and the Guttman halving coefficient was 0.538. The inter rater reliability coefficient was 0.967 (P<0.001) and the test-retest reliability coefficient was 0.960 (P<0.001). Taking a score of 5 as the cutoff for palliative care needs screening, 35.3% (61/173) of the 173 inpatient cancer patients who completed screening required palliative care support. The needs for palliative care in hospitalized cancer patients varied significantly across patients by age groups, number of children, length of illness, number of cancer symptoms, number of visits for cancer in past 6 months, nutritional status and self-care ability (P<0.05) .
The Chinese version of PCST has good reliability, simplicity and understanding, and it can be used to screen and evaluate the need for palliative care in hospitalized cancer patients in China.
