Development And Preliminary Application Of The Family Resilience Assessment Scale For Cancer Survivors

Objectives:(1)To develop the Family Resilience Assessment Scale for Cancer Survivors(FRAS-CS),which aimed to form an assessment tool that can be adapted to the responses of cancer survivors and family caregivers in China.Furthermore,to analyze the reliability and validity of the scale.(2)To explore the feasibility of using the scale for patients and caregivers co-discussion responses.(3)To conduct a preliminary application of the FRAS-CS and assess the disease and sociodemographic characteristics of the family resilience in the context of cancer.Methods:(1)Development of the scale:Firstly,the translation of the FRA was carried out with the permission of the author,Dr.Duncan Lane.Then,based on the Walsh Family Resilience Framework and considering of the realities of Chinese cancer families,the items were appropriately adjusted to form the initial version of the FRAS-CS.Four experts in related fields were invited to conduct two rounds of expert consultation.The scale was modified appropriately according to the comments of each expert.Furthermore,the scale items were randomly ordered.A pre-survey was then conducted to form the test version of FRAS-CS.The formal survey for reliability and validity test used a convenience sample of cancer survivors and family caregivers from several oncology wards in four tertiary hospitals in Shandong Province.The survey instruments included the test version of the FRAS-CS,the Shortened Chinese Version of the Family Resilience Assessment Scale(FRAS-C),and the general information questionnaire.Two samples were used for the reliability and validity analysis.Sample one with 208 valid samples was used for item analysis,exploratory factor analysis,compatible validity and reliability analysis.21 samples from Sample one were retested 2 to 4 weeks after the first measurement to assess retest reliability.While sample two with 247 valid samples was used for confirmatory factor analysis.Specifically,item analysis was conducted using the critical ratio method,the correlation coefficient method and the Cronbach’s a coefficient after item deletion.Validity analysis was evaluated by exploratory factor analysis,confirmatory factor analysis,compatible validity.The reliability analysis was evaluated by Cronbach’s a coefficient,split-half reliability,and retest reliability.(2)Feasibility analysis of survivors and caregivers co-discussion responses:A convenience sampling method was used to invite fifty dyads of cancer survivors and their caregivers(Sample three)to participate in this study that assessed the suitability of the FRAS-CS for patient and caregiver co-discussion.The survey instruments included the FRAS-CS and the general information questionnaire.The data was analyzed using descriptive statistics and Cronbach’s a coefficients.(3)Preliminary application of the scale:A convenience sampling method was used to invite cancer survivors and/or family caregivers to participate in this part of the study.A total of 113 valid questionnaires were collected from survivors alone,caregivers alone and survivors-caregivers dyad respectively.The survey instruments included the FRAS-CS scale and the general information questionnaire.The data was analyzed using t-tests and one-way ANOVA to explore the factors influencing family resilience.Results:(1)Results of the scale development:After translation of the FRA scale,four original scale items were deleted,three original items were reclassified and adjusted,and 10 new items were added to develop the initial version of FRAS-CS.The initial version of the scale contains a total of 36 items with 9 dimensions.In the two rounds of consultation,the positive coefficient of experts was 100%and 75%respectively,the authority coefficient was 0.92,the mean importance rating of the items was 4.00～5.00,and the coefficient of variation of the importance rating was 0～0.23 and 0～0.13 respectively.10 items and 2 dimensions were revised after the two rounds of consultation,and 2 dimensions were combined.Further adjustments were then made to the item descriptions based on feedback from the pre-survey,which yielded the test version of the FRAS-CS with 8 dimensions.In the item analysis,items 1,4,6,20 and 26 were deleted due to poor identification and/or homogeneity of the items.In the exploratory factor analysis,two items were deleted to obtain the optimal six-factor model.The six common factors were named Positive Outlook,Flexibility,Family and Social Support,Effective Communication,Transcendence and Spirituality,and Cooperative Coping,which in total explained 65.827%of the variance.The results of the confirmatory factor analysis showed that the modified model was well fitted:χ2/df=2.064,RMR=0.043,GFI=0.833,IFI=0.903,CFI=0.902,RMSEA=0.066.The correlation coefficient between the test version of the scale and FRAS-C was 0.419(P<0.01).The Cronbach’s a coefficient for the total scale was 0.939 and the Cronbach’s α coefficients for the dimensions ranged from 0.640 to 0.880.The scale split-half reliability was 0.914(P<0.01).The scale retest reliability was 0.719(P<0.01).(2)Results of feasibility analysis of survivors and caregivers co-discussion responses:In the sample of survivors and caregivers co-discussion responses,the total scale Cronbach’s a coefficient was 0.951,which was greater than the criterion 0.800;the Cronbach’s αcoefficients for the dimensions ranged from 0.657 to 0.895,which was greater than the criterion 0.600.The FRAS-CS has excellent internal consistency in this sample and can be applied to measure consistent family resilience responses of survivors and caregivers.(3)Results of preliminary application of the scale:Family resilience total or dimension scores were statistically different in terms of patients age,marital status,education level,type of occupation,type of disease,type of health insurance,the presence or absence of other illnesses,the presence or absence of other caregivers,and questionnaire response mode(all p<0.05).Conclusions:(1)The Family Resilience Assessment Scale for Cancer Survivors(FRAS-CS)has 29 items divided into six dimensions:Positive Outlook(4 items),Flexibility(5 items),Family and Social Support(8 items),Effective Communication(5 items),Transcendence and Spirituality(4 items),and Cooperative Coping(3 items).The FRAS-CS has excellent psychometric properties and can be used to measure family resilience from the cancer survivors perspective,the family caregiver perspective and patient-caregiver dyad responses,thereby contributing to a more accurate and comprehensive assessment of the level of household resilience in the context of cancer.(2)Patient age,marital status,education level,type of occupation,type of disease,type of health insurance,the presence or absence of other illnesses,the presence or absence of other caregivers,and questionnaire response mode could affect family resilience.