| ObjectiveAccording to MDASI-C,development a colorectal cancer module for symptom assessment of patients with colorectal cancer in China,test the reliability and validity of the module.Use MDASI-C and colorectal cancer modules to assess patient's symptoms and demonstrate the feasibility of the colorectal cancer module in clinical nursing.MethodsA pool of common symptom items for colorectal cancer patients was established through literature review,patients interview,panel discussions and recording to existed symptom assessment tools.The expert consultation was used to screen the item pool to form the module(first edition),and it was pre-investigated in 20 people to form the module(pre-test version).183 colorectal cancer patients were sampled by convenient sampling.Project analysis,reliability analysis,validity analysis and feasibility analysis were performed.Thereby forming a colorectal cancer module(official version).Use MDASI-C and colorectal cancer module(official version)in154 patients with colorectal cancer,the structural validity was evaluated by confirmatory factor analysis,and the incidence,severity,and symptom clusters of colorectal cancer patients were evaluated..Results1.Through literature review,patient interviews,group discussions,and recording to existed symptom assessment tools,common symptoms of colorectal cancer patients are divided into“symptoms caused by tumor”,“disease-related symptoms”,“intestinal stoma-related symptoms”and“psychological symptoms”,and initially established 42items of common symptom pool for colorectal cancer patients.2.In the first round of expert consultation,12 experts were involved.According to the CVI,16 symptom items with I-CVI?0.8 were retained.According to the expert opinion,the“lumps”was classified as“ostomy abnormalities”,“in the rush and then heavy”was added.Finally,15 items entered the second round of expert consultation.3.In the second expert consultation,12 items with I-CVI?0.8 were included,and a pre-investigation was made among 20 people to form the colorectal cancer module(pre-test version).4.In the project analysis and reliability and validity evaluation stage,200questionnaires were distributed,200 were recovered and 183 questionnaires were valid,the recovery rate was 100%,the effective rate was 91.5%,and the average response time was 7.8 minutes.The feasibility of the colorectal cancer module was good.Project analysis deletes items:alternation of diarrhea and constipation,abnormal stoma,skin changes around the stoma.Nine items entered the reliability and validity evaluation including:diarrhea,constipation,bloating,changes in stool character,changes in bowel habits,weight loss,urgency,fear,and depression.The I-CVI of the 9-item colorectal cancer module was 0.875?1 and the S-CVI/Ave was 0.958.Exploratory factor analysis extracted three common factors,named“digestion-absorption”,“excretion”and“psychological”,and the cumulative variance contribution rate was 65.299%.Known-group validity showed that patients with different ECOG scores in colorectal cancer had different scores of each item and the total module(p<0.05);the correlation coefficient between each factor and the total module was 0.779?0.919,and the correlation coefficient between each factor was 0.500?0.634,the structural validity was good.The Cronbach'?coefficient of the colorectal cancer module was 0.880,the internal consistency was good.The Spearman correlation coefficient of each item of colorectal cancer module was 0.740?0.997 after two weeks.The Spearman correlation coefficient of the total score was 0.948,the test reliability was good.5.During the exploration of the symptom clusters,183 patients were followed up by telephone,and 154 patients were successfully collected.The recovery rate was 84.1%and the effective rate was 100%.Confirmatory factor analysis confirmed that the3-factor model fits well(~2/df=1.134,RMSEA=0.03,SRMR=0.0413,GFI=0.966,NFI=0.945,IFI=0.993,CFI=0.993,TLI=0.989),which proved that the colorectal cancer module(official version)has good structural validity again.Statistics show that the incidence of symptoms in patients with colorectal cancer was 14.3%?86.4%,and the incidence of symptomatic troubles was 63.6%?85.7%.Exploratory factor analysis yielded five symptom clusters:“digestive-respiratory symptom clusters”,“emotional symptom clusters”,“pain related symptoms clusters”,“colorectal cancer specific symptom clusters”and“disease symptom clusters”.ConclusionsThe self-developed colorectal cancer module has high feasibility and good reliability and validity.It can provide tools for symptom assessment and management in clinical nursing,and identify the symptoms of colorectal cancer patients comprehensively and effectively. |
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