肿瘤患者“营养认知-食欲-功能”量表的编制及信效度分析

目的开发综合营养认知、食欲及机体功能等评价进行营养风险筛查的量表,并进行信效度验证。 方法 在文献回顾、患者访谈及项目组讨论的基础上确定量表维度、形成条目池,经过德尔斐专家咨询形成原始量表。选取首都医科大学附属北京世纪坛医院104例肿瘤患者进行调查,检验量表的信效度。 结果 最终形成的肿瘤患者营养认知-食欲-功能（nutrition belief-appetite-function, BAF）评估量表包括营养认知、食欲和功能指标3个维度,共13个条目。项目分析时发现各条目和总分的相关系数均＞0.3,各条目的决断值均达到预设标准,故不考虑删除条目。本量表的分半信度为0.750,各维度的分半信度为0.590～0.847;量表的Cronbachs α系数为0.806,各维度的Cronbachs α系数为0.631～0.866,营养认知和功能维度的系数未达到理想状态;量表的重测信度为0.784,各维度的重测信度为0.588～0.721。量表效度分析方面,各维度与总量表间得分的相关系数为0.539～0.890,均有显著性;结构性因子分析提取2个公因子,累计方差贡献率为56.36%,删除2个条目后得到营养认知和食欲及功能相关的两个维度;量表总分及各维度得分均与NRS 2002的显著正相关。 结论 编制的肿瘤患者BAF评估量表具有较好的信效度,可有效评估肿瘤患者的营养风险。     

恶性肿瘤患者安宁疗护知识问卷的编制及信效度检验

目的：编制恶性肿瘤患者安宁疗护知识问卷，并检测其信效度。方法：参考安宁疗护实践指南及相关文献形成最初版肿瘤患者安宁疗护知识问卷，采取德尔菲两轮专家咨询法，邀请15名专家对问卷的内容效度进行检验，并选取170名肿瘤患者对问卷的信效度进行检验。结果：该问卷的 Cronbanch’s α系数为 0.895，重测信度系数为0.820，内容效度指数I-CVI波动在0.818~1.00，S-CVI为0.910，结构效度KMO值为0.843，Bartlett’s 球形检验结果为P≤0.001，共提取2个公因子，解释变量量为70.036% ，最终保留12个条目。结论：本研究编制的恶性肿瘤患者安宁疗护知识问卷具有较好的信效度，适合评估肿瘤患者对安宁疗护知识的掌握情况。     

肿瘤幸存者癌因性疲劳综合评估量表的编制与初步应用

目的 编制肿瘤幸存者癌因性疲劳综合评估量表,并对评估量表信度、效度进行初步应用。方法 以不愉快症状理论为基础生成量表症状评估核心指标,结合相关文献并通过前期部分肿瘤幸存者的认知访谈内容,初步编制条目池,通过2轮专家咨询,并对出现癌因性疲劳的245例肿瘤幸存者进行量表信度、效度检验。结果 最终修订的肿瘤幸存者癌因性疲劳综合评估量表包括32个条目,探索性因子分析提取8个公因子,累积方差贡献率为70.454%;条目水平内容效度指数为0.827～1.000,量表水平内容效度指数0.924;量表Cronbach′s α系数为0.893,Spearman-Brown分半信度系数为0.796。结论 肿瘤幸存者癌因性疲劳综合评估量表具有较好信度、效度,可作为肿瘤幸存者癌因性疲劳的测评工具。     

口干问卷中文版对鼻咽癌放疗患者评价效度和信度调查

目的 评价口干问卷中文版(XQ-C)对鼻咽癌放疗患者的效度和信度。方法 根据国际生命质量评价项目的标准程序进行XQ-C的制作,对不同放疗阶段的鼻咽癌患者进行问卷调查,对问卷结果进行效度和信度检验,内容效度采用专家评价法,结构效度采用探索性因子分析,区分效度采用非参数检验,信度检验采用克朗巴赫系数(Cronbach′s α)和分半信度进行内部一致性评价。结果回收有效问卷212份,内容效度I-CVI均≥0.80,S-CVI/Ave=0.97,Kendall′s W一致性检验P=0.701;探索性因子分析显示XQ-C为单一维度量表;不同放疗阶段患者的量表评分不同即区分效度良好;信度检验示Cronbach′s α系数=0.951,Guttman分半信度系数为0.940。方法 中文版口干问卷具有良好的效度和信度,可推广用于我国鼻咽癌患者放疗后口腔干燥症的临床诊疗和研究中。     

中文版莱斯特咳嗽问卷的改良及验证

背景与目的 患者行肺部手术后常常出现咳嗽,目前尚缺乏专门评估术后咳嗽的工具.本研究对中文版莱斯特咳嗽问卷(Leicester Cough Questionnaire in Mandarin-Chinese,LCQ-MC)改良并进行验证,探讨其临床应用价值.方法 2015年9月-2016年12月四川大学华西医院胸外科单个医疗组共250例行胸腔镜肺部手术的患者参与调查,其中121例患者完成LCQ-MC,129例患者完成简化LCQ-MC,并进行信度和效度检验.结果 新问卷保留LCQ-MC的框架与评分方式,由生理、心理和社会3个维度,共12个条目构成.量表内容效度良好,内容效度指数达到0.83;与日间咳嗽症状积分对比标准效度高(r=-0.578,P<0.001),与夜间咳嗽症状积分和健康调查简表总分(Chinese version of the Medical Outcome Study 36-item Short-Form Healthy Survey,SF-36)对比标准效度中等(r=-0.358,P=0.004;r=0.346,P=0.030),与医院焦虑与抑郁评分总分(Hospital Anxiety and Depression Scale,HADS)对比标准效度较弱(r=-0.241,P=0.046);内部一致性良好,克朗巴赫α系数在0.71-0.84之间;1周后重测信度良好(n=30,r=0.81-0.95).结论 简化版中文版莱斯特咳嗽问卷有良好的信度和效度,可应用于临床.     

QLQ-H&N35量表在鼻咽癌患者生存质量测评中的应用

 目的　对欧洲癌症研究组织（EORTC）头颈癌生存质量问卷（QLQ-H&N35）进行计量心理学考核,以考评量表是否适合于鼻咽癌患者生存质量的测评。方法　收集中山大学肿瘤防治中心的391例鼻咽癌患者的QLQ-H&N35和人口学资料,考核量表的信度、效度、区分度,条目进行项目反应理论（IRT）分析,考察个体分离指数（PSI）、条目阈值参数的排序,进行项目功能差异（DIF）分析。结果　除感觉问题外,各个领域的内部一致性信度和分半系数均大于0.7,所有领域的重测系数都大于0.7,因子分析的结果显示实际的数据跟理论模型一致。不同放疗阶段的患者在大部分领域得分的差异具有统计学意义。整个模型的PSI为0.90,大部分条目的阈值顺序均正常,所有条目在性别、年龄分组上没有一致性DIF和非一致性DIF。结论　QLQ-H&N35是一个具有良好的信度、效度、区分度和计量心理学特征的癌症量表,可操作性强,可用于鼻咽癌患者的生存质量评价。     

宫颈癌患者生命质量评价量表的编制及测评

目的:编制一套适合测评中国宫颈癌患者的生命质量评价量表(quality of life scale for cervical cancer patients,QLS-CCP),并评价其信度和效度.方法:通过文献查阅法、访谈法和专家咨询等方法确定条目池,形成初始量表.采用变异度法、t检验法、相关系数法和逐步回归法对初始量表进行条目筛选,形成最终的测试量表;采用新编制的Q LS-CCP对136例子宫颈癌患者进行调查,并对其信度和效度进行评价.结果:最终QLS-CCP包含躯体功能、心理、社会及与疾病症状4个维度,共32个条目.量表的重测相关系数、Cronbach'α系数和分半信度系数分别为0.96、0.93和0.85.效标效度较好(rs=0.591,P=0.000).因子分析找到4个公因子,可以解释总变异的57.22％,显示量表的结构效度良好,量表结构与理论构想相符,具有较好的区分效度.结论:新编制的QLS-CCP具有良好的信度和效度,可用于中国宫颈癌患者生存质量的测评.     

QLQ-C30用于测评鼻咽癌患者生存质量的计量心理学考核

目的对EORTC QLQ-C30(QLQ-C30)进行计量心理学考核,以考核该量表是否适合于鼻咽癌患者生存质量的评价。方法收集中山大学肿瘤医院的391名鼻咽癌患者的QLQ-C30和人口学资料,采用信度效度理论考核量表的信度、效度、区分度及项目反应理论考核条目的项目功能差异（DIF）。结果除躯体功能和认知功能外,各个领域的Cronbach′s α系数均大于0.7。除认知功能和疲倦外,各个领域的分半系数均大于0.7。所有领域的重测系数都大于0.7。因子分析的结果显示实际的数据跟理论模型一致。不同放疗阶段的患者在大部分领域得分的差别具有统计学意义。项目反应理论结果显示条目在性别、年龄分组上没有一致性DIF和非一致性DIF。结论QLQ-C30是一个具有良好的信度、效度、区分度和计量心理学特征的癌症量表,操作性强,可用于鼻咽癌患者的生存质量评价。     

食管癌化疗患者生存质量测定量表中文版的研制与考评

目的：应用欧洲癌症研究与治疗组织（EORTC）开发的问卷表QLQ—OES18为蓝本来研制其中文版，并对其进行考评。方法：通过量表的翻译、回译和文化调适制定出中文版的QLQ—OES18，并通过考查133例食管癌患者的生存质量对量表进行评价。对EORTCQLQ—OES18中文版量表主要进行信度、效度和反应度三方面的考评，采用克朗巴赫系数考察内部一致性；计算各个领域及方面间相关系数来分析量表的内容效度；使用配对t检验进行第1、2次测定及第1、3次测定得分均数的比较，考察量表的区分效度。结果：EORTCQLQ—OES18显示出较好的可靠性和良好的鉴别能力，能显示出化疗带来的生存质量改变。各领域内部一致性的信度都在0．61以上；各条目与其领域的相关系数值在0．6以上。结论：QLQ—OES18显示出较好的心理测定学和临床有效性，可推荐其与核心量表QLQ—C30联用，用来评估化疗后食管癌患者的生存质量。     

SF-36中文版健康状况调查表评价鼻咽癌疗后长期存活者适用性研究

目的 评价美国SF-36中文版健康状况调查表用于鼻咽癌疗后长期存活者的适用性.方法 85例鼻咽癌疗后长期存活者通过电话或信访方式完成评价,相关分析、信度分析和因子分析等统计方法用于评价SF-36中文版的信度和效度.结果 分半信度为0.92,各领域克朗巴赫系数α均>0.7,说明信度较好且各领域间有较好区分度.每个条目跟相关领域的相关系数都达到或接近0.5,并且各条目与所属领域相关系数均高于该条目与其他领域的相关系数,说明量表有较好的内容效度和区分效度.量表共提取6个主成分,基本反映了量表8个领域,累计方差贡献率为71.4%.8个领域提取2个公共因子,解释73.3%变异.SF-36中文版判别效度较好,能区分鼻咽癌患者和正常人群的生存质量.结论 SF-36中文版易于完成,具有较好的信度和效度,可应用于鼻咽癌疗后长期存活者生存质量的评价.     

Measurement properties of the English and Chinese versions of the Functional Assessment of Cancer Therapy-Breast (FACT-B) in Asian breast cancer patients

The objective of the study was to examine the measurement properties of and comparability between the English and Chinese versions of the Functional Assessment of Cancer Therapy-Breast (FACT-B) in breast cancer patients in Singapore. This is an observational study of 271 Singaporean breast cancer patients. The known-group validity of FACT-B total score and Trial Outcome Index (TOI) were assessed in relation to performance status, evidence of disease, and treatment status cross-sectionally; responsiveness to change was assessed in relation to change in performance status longitudinally. Internal consistency and test-retest reliability were evaluated by the Cronbach's alpha and intraclass correlation coefficient (ICC), respectively. Multiple regression analyses were performed to compare the scores on the two language versions, adjusting for covariates. The FACT-B total score and TOI demonstrated known-group validity in differentiating patients with different clinical status. They showed high internal consistency and test-retest reliability, with Cronbach's alpha ranging from 0.87 to 0.91 and ICC ranging from 0.82 to 0.89. The English version was responsive to the change in performance status. The Chinese version was shown to be responsive to decline in performance status but the sample size of Chinese-speaking patients who improved in performance status was too small (N = 6) for conclusive analysis about responsiveness to improvement. Two items concerning sexuality had a high item non-response rate (50.2 and 14.4%). No practically significant difference was found in the total score and TOI between the two language versions despite minor differences in two of the 37 items. The English and Chinese versions of the FACT-B are valid, responsive, and reliable instruments in assessing health-related quality of life in breast cancer patients in Singapore. Data collected from the English and Chinese versions can be pooled and either version could be used for bilingual patients.     

Validation of the simplified Chinese version of EORTC QLQ-C30 from the measurements of five types of inpatients with cancer

Background: European Organization for Research and Treatment quality of life (QOL) questionnaire (QLQ-C30) has been used frequently and many language versions have been developed, including the simplified Chinese version. It is important to study psychometric properties of the simplified Chinese version from the clinical standpoint.Patients and methods: The simplified Chinese version of the QLQ-C30 was used in a longitudinal study of 600 patients with five types of cancer: lung, breast, head and neck, colorectal, and stomach. The psychometric properties of the scale were evaluated by indicators of validity and reliability coefficients such as Cronbach's α and Pearson's correlation coefficient r, standardized response mean (SRM), correlational analysis, t-tests, and structural equation models.Results: Correlation and structural equation model analyses confirmed good construct validity with root mean square error of approximation 0.054, standardized root mean square residual 0.037, non-normed fit index 0.972, and comparative fit index 0.980. The α coefficients for all domains are >0.7 except for cognitive functioning (0.49). The test–retest reliability coefficients for most domains are >0.80 except for appetite loss (0.77) and diarrhea (0.75). The QOL score changes after treatments were of statistical significance with higher or moderate SRM in most domains.Conclusion: The simplified Chinese version of QLQ-C30 has good validity, reliability, and responsiveness and can be used to measure QOL for Chinese cancer patients.     

Reliability and Validity of the Brief Illness Perception Questionnaire in Bahasa Malaysia for Patients with Cancer

Objective: The main purpose of this study was to identify the psychometric properties and validate   the Bahasa Malaysia version of the Brief Illness Perception Questionnaire among patients with cancer. Methods: A total of 129 newly diagnosed patients with cancer were consecutively sampled. Reliability and validity of the questionnaire were tested using translation validity, test-retest reliability, Principal Component Analysis, Cronbach’s alpha coefficient for domains and item-total correlation. Results: The questionnaire indicates excellent test-retest reliability. The Principal Component Analysis (PCA) revealed that Kaiser-Meyer-Olkin (KMO) is 0.60 for the two-factor structure of the Brief Illness Perception Questionnaire of the Bahasa Malaysia version which consists of cognitive illness representation and emotional illness representation. Conclusion: The Brief Illness Perception Questionnaire in the Bahasa Malaysia version is a useful tool to use among patients with cancer in Malaysia context despite moderate psychometric properties. This is based on the premise that the questionnaire can be used as a quick tool to assess illness perceptions among Malaysian with cancer in routine oncology practice.     

Psychometric properties of the Chinese version of the FACT-L for measuring quality of life in patients with lung cancer

A Simplified Chinese version of the FACT-L was evaluated using responses from 181 patients with lung cancer in China by assessing the construct, discriminative and criterion-related validity, internal consistency, test-retest reliability, and responsiveness as measured by score changes of the scales. Correlation and factor analysis among domains and items showed good construct validity, correlation analysis of domain scores between FACT-L and Quality of Life Instruments for Cancer Patients-Lung cancer (QLICP-LU) displayed good criterion-related validity, and comparison of two age groups demonstrated discriminative validity. Test-retest reliability and Internal consistency coefficients for all domains were greater than 0.75 with the exception of the domain of additional concerns (alpha=0.56). Score changes over time were statistically significant in the overall scale and all domains: standardized response mean (SRM) for physical well-being is 1.56, social/ family well-being 0.70, emotional well-being 0.93, and functioning well-being 1.51. Therefore, the Simplified Chinese version of FACT-L can be used to measure quality of life (QOL) for Chinese patients with lung cancer with good validity, reliability, and responsiveness.     

Psychometric properties of the simplified Chinese version of the EORTC QLQ-BR53 for measuring quality of life for breast cancer patients

A Simplified Chinese version of the EORTC QLQ-BR53 was evaluated using responses from 233 patients with breast cancer in China by assessing the construct and criterion-related validity, internal consistency and test–retest reliability, and responsiveness as measured by score changes of the scales. Internal consistency reliability measured by Cronbach’s coefficient α is greater than 0.75 for most multi-item scales except cognitive functioning (0.41) and breast symptoms (0.71). Test–retest reliability coefficients for all domains are greater than 0.80 with the exception of physical functioning (0.65), social functioning (0.75), appetite loss (0.75), diarrhea (0.72), and body image (0.72). Correlation and factor analysis among domains and items showed good construct validity for both QLQ-C30 and QLQ-BR23. Score changes over time were observed in most domains except emotional functioning, global health status/QOL, dyspnoea, constipation, diarrhea, financial difficulties, sexual functioning, sexual enjoyment, and breast symptoms. Therefore, the Simplified Chinese version of QLQ-BR53 shows reasonable validity, reliability, and responsiveness and can be used to measure QOL for Chinese patients with breast cancer.     

Psychometric Analysis of a Persian Version of the EuropeanOrganization for Research and Treatment of Cancer OG25 Quality of Life Questionnaire in Oesophagogastric Cancer Patients

Background: Health-related quality of life (HRQL) is a fundamental outcome in oncology patients and qualityof life (QOL) assessment requires clinically relevant questionnaires. The purpose of this study was translationand definition of measurement properties and the clinical validity of Quality of Life Questionnaire (QLQ) -OG25module in Persian patients with oesophagus, oesophagogastric junction (OGJ) or gastric cancers. Materials andMethods: The translation procedure followed European Organization for Research and Treatment of Cancer(EORTC) guidelines. Both EORTC QLQ-OG25 and a core questionnaire (EORTC QLQ-C30) were administeredto patients with oesophagus (150), OG junction (93) and gastric (32) cancer undergoing multi-modal treatments.Convergent and discriminant validity, Cronbach’s alpha coefficient and known-groups comparisons were used toexamine reliability and validity. Results: In all, 275 patients (mean age 62 years) completed both questionnaires.Compliance rate was high and the questionnaire module was well accepted. We found good reliability for multiitemsubscales of QLQ-OG25 (Cronbach’s alpha coefficients 0.76-0.89). About 73% had TNM staging and scalesdistinguished between clinically distinct groups of patients. However, patients in palliative group experiencedcompromised functional status and worse treatment-associated symptoms than those in the potentially curativegroup. Test-retest scores were consistent. Multi-trait scaling analysis demonstrated good convergent anddiscriminant validity. Conclusions: Overall, the Persian version of QLQ-OG25 demonstrated psychometricand clinical validity that supports its application as a supplement to the original tool (EORTC QLQ-C30) whenassessing HRQL in patients with upper-gastrointestinal (GI) cancer both in curative and palliative phases.     

Utilization of a Scored Patient-Generated Subjective Global Assessment in Detecting a Malnourished Status in Gynecologic Cancer Patients

Purpose: To assess the prevalence of malnutrition in gynecologic cancer patients using the Scored Patient- Generated Subjective Global Assessment (PG-SGA) questionnaire. Materials and Methods: A total of 97 gynecologic cancer patients who never had any treatment but were planned for surgery were enrolled. The patients were asked to complete the scored PG-SGA form before the treatment was started. Attending physicians were also asked to complete other information in the PG-SGA form. Total scores were calculated and the patients were classified into 3 nutritional status levels. Results: Mean age was 54 years. Postoperative diagnoses were endometrial cancer in 42 cases (43.2%), ovarian cancer in 29 cases (29.9%), and cervical cancer in 26 cases (26.8%). Mean PG-SGA score was 5.24.7. Malnutrition (PG-SGA B and C) was found in 52 patients (53.6%, 95% CI 43.7% - 63.2%). Preoperative BMI, hemoglobin, serum albumin, and cancer stage were not significantly associated with nutritional status. Malnutrition was significantly more common among patients diagnosed with ovarian cancer, compared to other types of cancer (79.3% vs. 42.6%, p 0.004). Conclusions: Prevalence of malnutrition among gynecologic cancer patients was 53.5%, according to the scored PG-SGA. Malnutrition was significantly more common among patients with ovarian cancer.     

食管癌化疗患者生存质量测定量表中文版的研制与考评

目的:应用欧洲癌症研究与治疗组织(EORTC)开发的问卷表QLQ-OES18为蓝本来研制其中文版,并对其进行考评。方法:通过量表的翻译、回译和文化调适制定出中文版的QLQ-OES18,并通过考查133例食管癌患者的生存质量对量表进行评价。对EORTCQLQ-OES18中文版量表主要进行信度、效度和反应度三方面的考评,采用克朗巴赫系数考察内部一致性;计算各个领域及方面间相关系数来分析量表的内容效度;使用配对t检验进行第1、2次测定及第1、3次测定得分均数的比较,考察量表的区分效度。结果:EORTCQLQ-OES18显示出较好的可靠性和良好的鉴别能力,能显示出化疗带来的生存质量改变。各领域内部一致性的信度都在0.61以上;各条目与其领域的相关系数值在0.6以上。结论:QLQ-OES18显示出较好的心理测定学和临床有效性,可推荐其与核心量表QLQ-C30联用,用来评估化疗后食管癌患者的生存质量。