Development Of Cancer Patients’ Nursing Professional Social Support Needs Scale And Its Application

Objectives 1. Exploring the connotation of nursing professional social support needs; 2.Developing a culturally appropriate Nursing Professional Social Support Needs Scale(short for NPSSNS)(including general module and specific modules of lung cancer and breast cancer) and validating its reliability and validity; 3. Investigating the situation of nursing professional social support needs, acquisition, and their possible factors, aiming at providing evidence of nurses’ fulfilling the specific nursing professional social support, managing and meeting cancer patients’ needs.Methods A qualitative study was conducted in the first phase. We recruited 32 health care personnel to take part in our focus group interviews(Dec., 2012-Jan., 2013), and22 different types of cancer patients to join in our in-depth interviews with purposive sampling to deeper understand the connotation of nursing professional social support needs(Jun., 2013-Sep., 2013). Content analysis of the data was performed to refine the themes and sub-themes.The development and evaluation of the scale were implemented in the second phase(Oct., 2013-May, 2014). The item pool was established on the basis of literature review,qualitative interviews, the guideline of Oncology Nurse Navigator Core Competencies,the existing needs assessment instruments. After assessing the content validity by a panel of two rounds of expert consultations, a pilot study by inviting 10 cancer patients to read and screen the draft, we formed the primary version of the scale. A convenience sample of 328 different types of cancer patients was enrolled to complete the primary scale, with the method of item reduction and other psychometric properties testing, wedeveloped the clinical version of NPSSNS.A cross-sectional survey design was used in the third phase(Jun., 2014-Jan., 2015). The instruments of a self-design general demographic questionnaire, NPSSNS(general module and specific modules of lung cancer and breast cancer), Psychological Distress Thermometer(short for DT) and Hospital Anxiety and Depression Scale(short for HADS) were measured in 390 different types of cancer patients. In addition, we conducted the SCNS-SF34 to validate the criterion-related validity of the NPSSNS.Results The initial phase--deeper understanding and enriching the connotation of nursing professional social support needs from health care personnel’s and cancer patients’ perspectives.1.From the perception regarding nursing professional social support needs among cancer patients, health care personnel indicated it should include informational,emotional/psychological, and technical needs; the mobilization of social resources; and palliative care during certain stages. While cancer patients emphasized that they had the need of information, technology, psychology and care coordination and communication during their hospitalization.2.From the actual acquisition of the nursing professional social support given by clinical nurses, health care personnel thought that the needs especially related to the mobilization of social resources and palliative care were still unmet. However, there were still some unmet needs(especially related to psychological and care coordination needs) or partially met needs(such as the need for information and for symptom management) from the cancer patients’ point of view.3.From the key reasons for the gap between the identified needs and the actual acquisitions, in health care personnel’s opinion, the reasons for the deficiencies includedboth subjective and objective aspects, such as the patients’ lack of awareness of how to search for professional support, a shortage of professional staff, and the lack of a culturally appropriate assessment tool. While from the perspective of cancer patients,both patient and nurse aspects could explain the disparities, such as patients’ lack of awareness of how to search for professional assistance and their reluctance to express their needs and nurses’ lack of active communication with patients, their inability to provide specific support, and their limited resources for coordination. Patients also recommended that nurses should actively communicate with patients, understand their needs, and be empowered to use the available medical resources.The second phase--forming the item pool and primary version of the scale and validating the reliability and validity of the clinical version.1.We formed a 187 optional item pool(included 137 general items, 31 breast cancer and19 lung cancer specific modules).2.With the method of a pilot study and expert’s content validity, we acquired the primary version of NPSSNS(75-item general module, the 11-item lung cancer and the26-item breast cancer specific modules).3.With the item screening, exploratory factor analysis(EFA), we got the clinical version of NPSSNS(58-item general module, the 10-item lung cancer and the 25-item breast cancer specific modules).4.In the general module, the reliability results showed that the total scale’s Cronbach’s αcoefficient was 0.962, the Guttman Spilt-Half coefficient was 0.867. Cronbach’s αcoefficients of different domains ranged from 0.851 to 0.946, and the Guttman Spilt-Half coefficient varied from 0.715 to 0.920. In specific module of lung cancer, it’stotal Cronbach’s α coefficient was 0.852. And the Guttman Spilt-Half coefficient was0.880. In specific module of breast cancer, the total Cronbach’s α and Guttman Spilt-Half coefficients were respectively 0.855, 0.719.5.Results of validity showed that the content and construct validity of the NPSSNS met the screening criteria. The factor loading of informational needs domain was0.503~0.701; technical needs domain was 0.464~0.680; psychological needs domain was 0.556~0.841; care coordination and communication needs domain was0.459~0.735.The third phase--describing the scale application and retesting the reliability and validity of the general module(the clinical version of the scale).1. We did the reliability and validity test of the general module of the scale(clinical version) again. The results of reliability indicated the total scale’s Cronbach’s αcoefficient was 0.959. The Guttman Spilt-Half coefficient was 0.857. Cronbach’s αcoefficients of different domains ranged from 0.868 to 0.917, and the Guttman Spilt-Half coefficient varied from 0.761 to 0.872. The EFA results showed that the factor loading of the total 49 items reached the screening criteria. And we extracted four common factors, the cumulative common variance explained 51.284% of the total variance. Additionally, it had good criterion-related validity of the general module(r=0.750). The convergent validity revealed that there existed a positively significant correlation among nursing professional social support needs and psychological distress,anxiety and depression(P<0.01).2.The univariate analysis results revealed that no matter the scores of nursing professional social support needs or the acquisition, there existed statistical significance among the demographic variables(marriage, education level, place of residence,average income of per month, caregivers), and the disease-related variables(cancer sites,disease stage, ever used and the existing treatment methods).3.In the general module, there existed a significant difference between nursing professional social support needs and the acquisition(3.23±0.73 vs 2.31±0.81); as well as in the specific module of lung cancer(2.62±0.90 vs 1.95±0.99) and specific module of breast cancer(3.02±0.77 vs 1.83±0.78).Conclusion 1.The study developed the NPSSNS(a general module and two specific modules).2.The results of reliability and validity of the scale were basically satisfied the requirements of psychometric properties. Further research with confirmatory factor analysis is suggested in the future for validation of this new scale.3.There existed evident discrepancies between nursing professional social support needs and the acquisition. Nurses should take specific measures to meet and manage cancer patients’ nursing professional social support needs.