Development And Application Of Self-perceived Discrimination Scale In Patients With Malignant Tumor

Objectives:1.The purpose of this study is to use the grounded theory to explore the causes and manifestations of self-perceived discrimination among patients with cervical cancer,lung cancer and colorectal cancer ostomy under the background of China.2.To develop the self-perceived discrimination specific scales for cervical cancer,lung cancer,and colorectal cancer ostomy patients.3.In this study,the European organization for the research and treatment of cancer Quality of Life Questionnare-Core 30(EORTC QLQ-C30)was used to evaluate the patients’ quality of life,analyze the correlation between the quality of life and the degree of self-perceived discrimination,and compare the degree of self-perceived discrimination among patients in different subgroups.Methods:1.Semi-structured interview:semi-structured interview was conducted for patients with different types of cancer by searching relevant literature,constructing interview outline and including patients according to inclusion/exclusion criteria.2.Qualitative study:"Information saturation method" was used to determine the sample size.All participants received face-to-face,one-to-one semi-structured interviews,which were conducted on open question outlines.The data were encoded by a qualitative analysis software(Nvivo 11 plus).3.Scale development:Through the formation of a research group,the analysis of interview data,and the combination of previous literature theory and practical clinical experience,the scale item pool was constructed.Relevant experts were invited for two rounds of expert consultation to score the relevance of items and form the initial scale.Finally,patients were invited to conduct cognitive interviews to conduct qualitative analysis on the contents of the items and adjust the way of expression to form the initial version of the scale.4.Scale verification:A questionnaire(Patient basic information table;Cancer Self-Perceived Discrimination Scale(CSPDS),CSPDS-CC18,CSPDS-LC10 and CSPDS-CC012;EORTC QLQ-C30)was constructed to invite patients to conduct a large sample survey.Based on the classical measurement theory,the reliability and validity of the Scales were tested respectively.In this study,the homogeneity test method was used for item analysis,internal consistency coefficient(Cronbach’s alpha coefficient)and split half reliability were used to measure the reliability,and content validity(content validity index,I-CVI)and structure validity(exploratory factor analysis)were used to evaluate the scale validity.The acceptance of the scale was evaluated according to the completion rate and the completion time.5.Scale application:This study used Single factor variance to test and compare the self-perceived discrimination scores among different groups of patients,used Pearson correlation analysis to explore the correlation between self-perceived discrimination and quality of life in patients with cervical cancer,colorectal cancer stomy and lung cancer.Results:1.Qualitative research:A total of 27 patients with colorectal cancer,35 patients with lung cancer,and 30 patients with cervical cancer were included in the study.Patients showed the sense of self-perceived discrimination,among which the self-perceived discrimination of lung cancer and colorectal cancer stomy patients was manifested through three main themes(stigma,self-denial,and social avoidance).Cervical cancer patients,on the other hand,manifest the self-perceived discrimination through four main themes:stigma,self-denial,sexual shame,and social avoidance.2.Scale development:In this study,a total of 18 items of self-perceived discrimination specific scale for cervical cancer patients were established,including four subscales:decreased sexual attraction,stigma,self-denial and sexual shame.10 items were established for lung cancer patients,including two subscales:objective stigma and subjective stigma.A total of 12 items for colorectal cancer stomy patients,including three subscales of dung bag shame,stigma and sexual avoidance.3.Scale verification:The total initial scale scores of the three cancer types and the total CSPDS score had good correlation(P<0.05).The initial scales of the three cancer types had good reliability(CSPDS-CC18,Cronbach’s α value was 0.938,and the split-half reliability was 0.817.CSPDS-LC10:Cronbach’s α value was 0.792,and the split-half reliability was 0.739.CSPDS-CC012:Cronbach’s α value was 0.890,split-half reliability was 0.871),good validity(content validity:I-CVI of all the items was>0.86;Structural validity:KMO values were 0.886,0.780,and 0.754,respectively.Significances of Bartlett’ spherical test were P<0.001.Four common factors were extracted from CSPDS-CC18 through factor analysis,and the cumulative variance contribution rate was 70.938.CSPDS-LC10:two common factors,cumulative variance contribution rate is 51.610;CSPDS-CC012:three common factors,cumulative variance contribution rate was 70.988.)The scale had high acceptability(effective rate was 94.46%.The average time to fill in the scale was(21.34±3.06)minutes).4.Scale application:among patients with cervical cancer,the lower the education level,the higher the scale score and the stronger the sense of self-perceived discrimination(P<0.05).Among patients with lung cancer,the lower the education level and the longer duration of illness,the stronger the sense of discrimination(P<0.05).Among colorectal cancer patients with colostomy,female patients had a higher sense of self-perceived discrimination than male patients,and patients without fixed occupation had a stronger sense of self-perceived discrimination(P<0.05).According to Pearson correlation analysis of the correlation between the strength of self-perceived discrimination and the quality of life,the correlation coefficients of CSPDS-CC18,CSPDS-LC10 and CSPDS-CC012 were:0.238,0.190,0.206(P<0.05),indicating a positive correlation that the higher the score of self-perceived discrimination,the higher the QLQ-C30 scores,the worse the quality of life.Conclusions:1.Through the qualitative analysis results,cervical cancer patients,lung cancer patients,colorectal cancer stomy patients showed the sense of self-perceived discrimination.2.CSPDS-CC18,CSPDS-LC10,CSPDS-CCO12 developed in this study have good reliability and validity,can be used to quantitatively evaluate the degree of discrimination perceived by patients,which is the same as the results of qualitative studies.3.According to qualitative analysis,the stronger the self-perceived discrimination of patients with cervical cancer,lung cancer and colorectal cancer with stoma,the worse their quality of life.