| Objectives:1.To explore the cognitive experience of economic pressure of kidney transplant patients on their own physiology,psychology and family,and to provide reference for the compilation of economic toxicity assessment scale.2.The economic toxicity scale for kidney transplantation patients suitable for Chinese national conditions was developed and the reliability and validity were tested preliminarily.Methods:1.Qualitative research:Literature review was conducted,interview outline was drawn up,and a total of 16 outpatient and inpatient kidney transplant patients from a third-class A hospital in Jinan City from January to February 2022 were selected for semi-structured interviews,themes were extracted,and reference suggestions were provided for the establishment of the scale item pool.2.Establishment of entry pool:The initial entry pool was constructed through qualitative interview,literature review,brainstorming and group discussion.3.Delphi method:20 experts in the field of kidney transplantation from nursing,medical and transplant liaison officers and affiliated colleges were invited to evaluate the scale items.4.Reliability and validity test:Convenience sampling method was used to select 261 cases of outpatient reexamination and inpatient kidney transplantation patients from a third-class A hospital in Jinan City from March to October 2022,and various methods were used to test the reliability and validity of the scale.Results:1.A total of 16 kidney transplant patients were interviewed in this study.Through semi-structured interviews,five themes were summarized,namely cognitive experience of disease,cognitive experience of economic stress,social support,psychological self-adjustment and current situation of economic stress.Among them,the cognitive experience of disease includes two sub-themes:after transplantation,it can prolong life and improve life quality more than dialysis;Knowledge of diseases can affect the life span of transplanted kidney,reduce complications and reduce economic burden.2.Based on qualitative interview and literature review and group discussion,the draft scale formed in this study contains 3 first-level indicators:material capital,social capital and human capital,and 6 second-level indicators:Positive "economic expenditures"(such as health-related economic expenditures as a percentage of household income),negative"financial resources"(such as selling property or depleting savings),psychosocial responses(such as concerns about the current financial situation;The impact of financial distress on the emotional health and social context of individuals and families),seeking support(e.g.,seeking financial assistance),treatment and care coping(e.g.,reduced prescription medication,treatment nonadherence),lifestyle coping(e.g.,reduced leisure activities，hard work,etc.),and tertiary indicators,a total of 44 items.3.The positive coefficients of the two rounds of correspondence consultation with experts were 100%and 95%respectively,and the authoritative coefficients were 0.888 and 0.824.The importance values of the two rounds were 2.80 and 3.38 respectively.The coefficients of variation were 0.27 and 0.19,respectively.The full score rates of entries were 55.83%and 56.46%,respectively.According to the expert letter consultation results,there are 4 items in a round of consultation.For two or more of the above three boundary values,they are deleted after group discussion and 1 item is added.Another 7 groups of items are considered to be merged and 1 item is modified.After two rounds of expert letter consultation,one item was deleted and one item was modified to form an initial scale with 33 items in 6 dimensions.4.In the analysis of project mean and standard deviation,questions I4 and I7 will be deleted if standard deviation is lower than 1.with a total of 31 items.5.The horizontal content validity(S-CVI)of the scale was 0.945,and all correspondent-consulted experts had a high degree of agreement on the scale content.Item level content validity(I-CVI)fluctuated between 0.80 and 1.00,indicating that the content validity of 31 items was high.In exploratory factor analysis,KMO value was 0.879,and the absolute value of factor loading ranged from 0.587 to 0.920,so all items were retained.The final interpretation rate of the six factors was 70.475%,higher than the critical standard of 60%,and the interpretation rate met the requirements.The six common factors were named as positive "economic expenditure",negative "financial resources",psychosocial response,support seeking,treatment and nursing coping,and lifestyle coping,and finally formed the final version of the economic toxicity scale for kidney transplant patients with 6 dimensions and 31 items.The model fit index obtained by confirmatory factor analysis was χ2/df=1.483,CFI=0.924，TLI=0.916,RMSEA=0.061,SRMR=0.059,and the model had a good fit.6.Cronbach’s a coefficient of the total scale was 0.910,and that of the subscale was 0.698～0.943.The half coefficient of the total scale is 0.706,and the half coefficient of the subscale is 0.558～0.926.The total retest reliability coefficient is 0.948,and the six dimensions are 0.732～0.942 respectively.The scale has good reliability.Conclusions:1.The economic burden of kidney transplantation patients is heavy and the pressure is great.At present,there is no objective evaluation tool to evaluate the economic toxicity caused by the economic pressure of kidney transplantation patients.Patients have a series of problems caused by the economic burden,so medical institutions should evaluate the economic toxicity of kidney transplantation patients,identify patients at risk of economic toxicity,and provide preventive intervention measures for patients.Reduce economic toxic hazards.2.This study completed the compilation of the economic toxicity scale for kidney transplant patients,which finally included 31 items from 6 dimensions including positive"economic expenditure",negative "financial resources",psychosocial response,support seeking,treatment and nursing coping,and lifestyle coping.After preliminary reliability and validity test,the scale has good reliability and validity,and can be used as an objective tool to evaluate the economic toxicity of kidney transplantation patients. |
