The Development Of Cancer Related Fatigue Evaluation Scale

ObjectiveTo develop a standard and brief fatigue measurement scale which consistent with ourcultural background to assess the fatigue status of Chinese cancer patients, and thenvalidity its psychological measurement properties by qualitative research and quantitativestudy. Medical care personnel could make a better understand of cancer related fatigue byusing this assessment scale.Methods1After a widly literatures review in this aspect,we structured the basic frame,thepreliminary item numbers and the dimensions of the measurement scale after referencingthe Piper fatigue Inventroy, Brief fatigue Inventroy.The primary scale contained23items.2After recomposing the scale into semi-open assess tool,130cancer patients from thedepartment of radiation in a three grade hospital were selected to perform the primaryinvestigation.The result was calculated by Spss version19.0. Critical ration (CR) andPerson correlation coefficient were used as the methods to screen items. After eliminatingthe items with low CR or low correlation coefficient, the remainder items were used toperformed a further exploring factor analysis,for one side to selecting items and for anotherto check whether the construct of the scale is coincide with theoretical supposition.3A large number sample of310patients selected from two three grade Hospitals wasused to evaluate the psychological measurement property.Spss19.0and lisrel8.7stasticalsoftware were used to test the reliability and validity for a further way. Reliability was alsoexpressed by Cronbach`α or binary coefficient. Construct validity was verifid byconfirmatory factor analysis and Multidimensional Fatigue Inventory was used as criterionto test the criterion validity.4Based on the result of the retrieved questionnaires, T test or one-way varianceanalysis was used to explore the association among fatigue and weight change,cycle of anti-tumor treatment, age tumor stage, number of children et al.Results1The primary outcomes1.1The content validityOn the base of widely literate research at home and abroad,the primary scale protocolwas formed on the bias of referring the items and dimensionality of Piper fatiguescale,Brief fatigue scale and Multidimensional fatigue scale and the symptoms proposed byChinese traditional doctor such as: consumptive disease,“yin-yang” disharmony et al.Theprotocol contained24items, which divided into4dimensionalities: the general fatigue, themental fatigue,the associated symptoms of fatigue and the influencese caused by fatigue.After patients`interviewing, three items were eliminated, then expert consulting wasperformed to assess its content. The content validity Index (CVI) was used as the standardto represent the opinions of experts. According to the suggestions of experts, we included2additional questions to evaluate the relationship among fatigue status,weight change andanti-tumor treatment for a further step.The CVI was0.87after experimental interview.1.2Item discriminationThe combination of item discrimination, correlation analysis, and factor analysis wereused to selecting items of our scale. The primary outcome showed3items did not meet thestandards of which the correlation coefficient or the factor loading was less than0.3. Aftereliminating these three items, there were20items left.1.3The CredibilityThe Cronbach`α of the total scale was0.811，and Cronbach`α of each dimensionalitywas0.603~0.742, and the binary coefficient was0.799/0.630, indicating a good credibilityof this scale.1.4The construct validityPrincipal component analysis was used to perform the exploring factor analysis. Aftervarimax orthogonal rotation,4common divisors more than1were exacted, with acumulative contribution percentage of50.72%, indicating the structure of this protocol wasjust meet the theoretical supposition. No items were found less than1when exploringfactor analyses was performed after item distinguished.2The large sample investigate2.1The CredibilityThe Cronbach`α of the total scale in the investigating of a large sample was0.818, the coefficient of each dimension was ranged from0.614to0.791, the Binary coefficient were0.820and0.625.The outcoms were similar to the primary investigation.2.2The construct validityConfirmatory factor analysis was performed for a further evaluation,and each of thefit index was as follows: χ2/df=2.3，CFI=0.91，AGFI=0.89，NNFI=0.071，RMSEA=0.06,which was basically conformed with the request.2.3The criterion–related validityThe Multidimensional fatigue scale(MFI) was used as criterion to calculate itscriterion–related validity.The scores of each dimension and total scale were used tocalculated the relevancy with the total score of MFI. The correlation coefficient was rangedform0.157to0.511, all of the dimensions showed a significant correlation.3Relationship between weight change and anti-tumor treatmentThe results showed that the more of weight decrease the severe of fatigue, while thelonger of anti-tumor treatment, the severe of fatigue degree was.4The influence of Socio-demographic factorsThe Socio-demographic factors such as age, living in city or village showed somecorrelation with CRF, while sex, numbers of children didn’t show a significant correlationwith CRF.Conclusions1Our research developed a CRF self-evaluation scale, which contained20items.2The scale has showed a good reliability and validity. It can be used to evaluate thefatigue status of cancer patients.3The structure of CRF self-evaluation was basically conformed with the request ofmetrology.4The additional2questions indicated fatigue score has a negative association withweight change and length of anti-tumor therapy.5Socio-demographic factors indicated that age and living place had some associationwith fatigue, while sex,number of children didn’t show relationship.6Suggestions: Further research is still need to form a more perfect Psychometricproperties of this scale.