Development And Validation Of Resilience Scale Specific To Cancer (RS-SC) In Chinese Patients With Cancer Diagnosis

ObjectiveTo develop and validate Resilience Scale Specific to Cancer(RS-SC)in Chinese patients with cancer diagnosis based on the theory of TCM and Shift-Persist Model,and to provide an effective tool for medical staffs to measure patients' resilience level and other psychosocial functions.MethodsDraft the items pool based on the on the theory of TCM and Shift-Persist Model and determine the initial scale using literature analysis and experts interviews.Provide 240 initial scales for the cancer patients from The First Affiliated Hospital of Guangzhou University of Chinese Medicine,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou Medical University Cancer Center,and Sun Yat-sen University Cancer Center in order to determine the formal scale by analyzing the data.Then,provide 550 patients with the formal scale and CD-RISC(Connor-Davidson Resilience Scale)and retest 80 of them after 2-4 weeks.Data will be analyzed for validity and reliability using Exploratory Factor Analysis(EFA)?Confirmatory Factor Analysis(CFA)?Parallel Analysis and Velicer Partial Correlation Coefficient.At last,RS-SC,SSRS(Social Support Rating's Scale),SAS(Self-Rating Anxiety Scale),SDS(Self-Rating Depression Scale),QLQ-C30(Quality of Life Questionnaire-core 30),MCMQ(Medical Coping Modes Questionnaire)combined were provided for 150 patients to test the relationships between resilience level an d other psychosocial functions.ResultsA initial scale of 38 items was retained after deleting 13 items due to low level of relevance to the scale by the invited experts.In the item analysis,13 items also were deleted due to low Critical Ratio value or skewed distribution and finally we got a 25-item RS-SC(The formal one).In the EFA,5 factor were recommended by the software and our hypothesis theory combined,and the factors were Benefit Finding?Support and Coping?Generic Elements ? Hope for The Future,and Meaning for Existence,accounting for 64.72% variance of resilience.The Parallel Analysis recommend 5 factors for the scale and Velicer Partial Correlation Coefficient suggested 4 or 5 factors for the scale.In the CFA,a two order-five factor model was confirmed and the indicators for model were as follows: Chi-Square=102.256,P<0.001,RMSEA=0.012,RMR=0.036,NFI=0.841,GFI=0.912,TLI=0.927,IFI=0.914,CFI=0.901,RFI=0.878,indicating a good fitness.The associated coefficient among the five factors were 0.18-0.43,and the correlations between the five factors and the total score varied from 0.40-0.61.In addition,the associations between CD-RISC(including its factors)and RS-SC(including its factors)varied from 0.14-0.61.The Cronbach ? of the scale and its factors ranged from 0.77-0.91 and retest reliability of RS-SC(including its factors)were between 0.82 and 0.89.It determined that a higher level of resilience was associated with a lower risk of anxiety(second vs.first quartile,OR=0.69,95%CI=0.37-1.30,P=0.2240;third vs.first quartile,OR=0.57,95%CI=0.31-1.05,P=0.0472;fourth vs.first quartile,OR=0.53,95%CI=0.29-0.97,P=0.0228),depression(second vs.first quartile,OR=0.66,95%CI=0.30-1.43,P=0.2684;third vs.first quartile,OR=0.47,95%CI=0.23-1.00,P=0.0270;fourth vs.first quartile,OR=0.37,95%CI=0.18-0.77,P=0.0016),and emotional distress(anxiety and depression combined,second vs.first quartile,OR=0.76,95%CI=0.34-1.70,P=0.4865;third vs.first quartile,OR=0.60,95%CI=0.28-1.31,P=0.1739;fourth vs.first quartile,OR=0.39,95%CI=0.19-0.82,P=0.0038).Two sets of regression analyses were performed to test the mediation hypothesis that resilience affects the associations between the QOL and anxiety and depression.The QOL was first regressed on demographics,and only the Stage of Cancer,Time since Diagnosis,and Type of Cancer impacted the interpretation of the results;thus,these variables were included in the final models as covariates.Second,the QOL was regressed on emotional distress(anxiety or depression)with a significant association(?=-0.37,SE=0.97,p=.004 for anxiety;?=-0.42,SE=0.68,p=.001 for depression).A third regression was subsequently conducted that indicated emotional distress was significantly associated with resilience(?=-0.38,SE=1.21,p<.001 for anxiety;?=-0.47,SE=0.93,p<.001 for depression).Finally,the QOL was regressed on emotional distress and resilience in the regression analyses,which indicated a stronger indirect effect on depression compared with anxiety.The associations between the QOL and anxiety decreased from-0.37 to-0.19;however,the Sobel test indicated the buffering effect of resilience was not significant(Sobel value=1.426,p=.154).However,the Sobel test indicated that resilience was a significant partial mediator between depression and QOL(Sobel value=2.194,p=.028).The relationships between depression and QOL decreased from-0.42 to-0.17 when the variable of resilience and other covariates were included in the logistic regression.ROC Curve and Youden Index combined indicated the cut-off of 70.5 for RS-SC and the specificity and sensitivity for emotional distress were 0.578 and 0.905.ConclusionThe 25-item RS-SC has good psychometrics properties,consisted by five factors including Benefit Finding?Support and Coping?Generic Elements?Hope for The Future,and Meaning for Existence,accounting for 64.72% variances of resilience.The present study suggests that psychological resilience is positively associated with QOL and comprise a robust buffer between depression and QOL in cancer patients.However,the effect of buffering is also affected by tumor type,time since first cancer diagnosis and clinical stage of cancer.The cut-off of RS-SC is 70.5 and it is a high sensitive tool to recognize cancer patients with emotional distress.The concept of resilience is promising in cancer care,and psychosocial interventions to enhance resilience might provide useful approaches to solve psychological distress and improve QOL among Chinese patients with cancer.