Reliability And Validity Of The Chinese Version Of Concern About Recurrence Scale And Its Preliminary Application In Breast Cancer Patients

Objective1.To translate the Concern About Recurrence Scale(CARS)into Chinese and to test its reliability and validity in Chinese breast cancer patients.2.Using the Chinese version of the Concern About Recurrence Scale(CARS)to explore the current statue of fear of cancer recurrence in breast cancer survivors and analyze its influencing factors.Methods1.Get the authorization of the original scale by E-mail,according to the Brislin translation principle to translate the English version into Chinese.During October 2017 to May 2018,a total of 426 breast cancer patients were recruited in Zhejiang Cancer Hospital by convenience sampling method and investigated by socio-demographic questionnaire,Concerns About Recurrence Scale(Chinese Version),Functional Assessment of Cancer Therapy Breast and Self-Rating Anxiety Scale to test reliability and validity of the instrument.Item analysis was used to select items.The validity analysis includes content validity,construct validity and convergent validity.Reliability was evaluated by internal consistency,spilt-half reliability and test-retest reliability.2.From June 2018 to September 2018,251 breast cancer patients were investigated using socio-demographic questionnaire,Concerns About Recurrence Scale(Chinese Version),Social Support Rating Scale(SSRS),Medical Coping Modes Questionnaire(MCMQ).According to the records,SPSS 21.0 was used to analyze the statistical results.The general information of patients was analyzed by statistical description;Using univariate analysis to compare the fear of cancer recurrence in different groups and the correlation between fear of cancer recurrence,social support and coping style were assessed by Pearson correlation coefficient.The influencing factors of fear of cancer recurrence were analyzed by multiple linear regression.Results1.The introduction of Chinese CARS: After translating CARS into Chinese,the investigator amended it taking the cultural background in China into consideration.The Chinese version of CARS consists of 29 items which was divided into five dimensions.According to the results of item-analysis,all items of the Chinese version of CARS between low score group and high score group have statistical significance(P<0.05).The correlation coefficients between the 29 items and total score of the scale were 0.418~0.736(P<0.05).The Scale-level Content Validity Index was 0.962 and the Item-level Content Validity Index ranged from 0.833 to 1.Exploratory factor analysis extracted four factors,which explained 60.358% of the total variance,and each item had high factor loading quantity in its dimensions(>0.40).The score of Chinese version CARS was negatively correlated with the score of FACT-B(r=-0.664,P<0.001)and positively correlated with the score of SAS(r=0.444,P < 0.001),which indicated good convergent validity.The Cronbach's ? for the CARS scale was 0.947 and the Cronbach's ? for five dimensions ranged from 0.764 to 0.911.The spilt-half reliability was 0.885 for the overall scale and 0.745~0.922 for the five dimensions.The test-retest reliability was 0.944 for the overall scale and.857~0.917 for the five dimensions.2.The application of Chinese CARS: The overall fear of cancer recurrence for breast patients was54.67±25.66,each dimension scores were: overall fears 14.53±6.54,womanhood worries9.02±6.88,death worries 5.54±3.27,health worries 21.16±9.53 and role worries 4.30±3.01;Single factor analysis indicated that differences of fear of cancer recurrence between ages,degree of education,financial burdens,relapse statues and diagnosis time were statistically significant(P< 0.05);The Pearson correlation analysis showed that avoidance,confronce coping style and social support were negatively correlated with fear of cancer recurrence in breast cancer patients and the resignation coping style was positively correlated with the fear of cancer recurrence in breast cancer patients(P<0.05);Multiple linear regression analysis indicated that age,financial burdens,relapse statues,objective support,subjective support,avoidance and resignation coping style were the major factors of the fear of cancer rucurrence in breast cancer patients,explaining57.8% of the total variation.Conclusion1.The translation and cultural adaption of CARS into Chinese was successful.The Chinese version of CARS had suitable factor structure and psychometric properties for fear of cancer recurrence for breast cancer patients in China.2.Breast cancer patients had middle level of fear of cancer recurrence in our country,which was influenced by various factors.Age,financial burdens,relapse statues,social support and coping styles are the main factors of fear of recurrence.Therefore,In order to reduce the level of fear of cancer recurrence and improve their quality of life,health care workers should given more attention to the high-risk patients of fear of cancer recurrence,guiding them make full use of social supports and adopt effective coping styles.