Cross-cultural Adaptation And Validation The Home-based Version Of The Problem And Needs In Palliative Care Questionnaire

Purpose1.To modify and develop the Home-based version of Problems and Needs in Palliative Care Questionnaire(home-based version of PNPC).2.To analyze reliability and validity of home-based version of PNPC in patients with advanced cancer,to provide a useful instrument for measuring the needs of palliative home care in Chinese advanced cancer patients.Methods1.The phenomenological research method in qualitative research was adopted.This qualitative study was conducted using semi-structured interviews with patients with advanced cancer.Participants(n=15)were recruited from two public hospitals in Guangdong Province,and were selected using purposive sampling from October 2019 to March 2020.The data was analyzed by thematic analysis and NVivo 12.0.2.The first version of the questionnaire was developed based on the PNPC questionnaire,the interview results of patients with advanced cancer and the cross-cultural adaptation.Four hundred and fifty-seven participants were enrolled in seven public hospitals in Guangdong Province,and were selected using convenient sampling from May 2020 to September 2020.All participants were invited to complete a general questionnaire,the home-based version of PNPC and The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30(EORTC QLQ-C30)by themselves.The data analysis was performed with SPSS 23.0 and Amos 24.0.Items were screened and selected through item analysis.The Cronbach’s α coefficient,split-half reliability,test-retest reliability,content validity,construct validity and convergent validity were used to evaluate the reliability and validity of the home-based version of PNPC.Results1.This qualitative study was conducted using semi-structured interviews with fifteen patients with advanced cancer.Four themes were identified: physical need;complex experience of the intersection of positive and negative psychological;social supported need and spiritual need;Patients need to manage their symptoms(especially cancer pain),prolong life as long as possible,reconstruct their attitudes to adapt to their roles,be socially supported,be respected,maintain spiritual peace,and obtain more information about illness and home care.2.The home-based version of the PNPC questionnaire consists of 36 items on seven dimensions(daily activity ability,physical symptoms,social issues,psychological issues,spiritual issues,financial problems,and the home self-care).The home-based version of the PNPC questionnaire is divided into two subscales: “problem part” and “need-for-care part”.3.The CR value of each item in the home-based version of PNPC was greater than 3.00,which was statistically significant(P<0.001).The item-scale correlation coefficient ranged from 0.329 to 0.731.The Scale-Content Validity Index was 0.984,and the Item-Content Validity Index ranged from 0.857 to 1.00.The exploratory factor analysis extracted seven factors,which accounted for a total of 71.01% and 70.88% variance for the “problem part”and “need-for-care part”,respectively.Confirmatory factor analysis showed that the seven common factors had good fitting degree.The Chi-square divided by degrees of freedom(χ2/df)was 1.239 and 1.225,the Goodness of Fit Index(GFI)was 0.923 and 0.964,the Comparative Fit Index(CFI)was 0.966 and 0.967,the Tucker-Lewis Index(TLI)was 0.962 and 0.964,the Root Mean-square Residual(RMR)was 0.016,and the root mean squared error of approximation(RMSEA)was 0.032 and 0.031,respectively.The home-based version of the PNPC questionnaire was positively correlated with the majority of the sub-scores(positive correlations)and total scores(negative correlations)of EORTC QLQ-C30,both of which were statistically significant(P<0.001).2.The Cronbach’sα coefficient of the total scale was 0.967,the split-half reliability of the total scale was 0.819,the test-retest reliability of the total scale was 0.852.The Cronbach’sα coefficient for the “problem part” subscale of the home-based version of PNPC was 0.931,and the Cronbach’sα coefficient for seven dimensions ranged from 0.688 to 0.907.The Cronbach’sα coefficient for the“need-of-care”subscale of the home-based version of PNPC was 0.944,and the Cronbach’s α coefficient for seven dimensions ranged from 0.737 to 0.923.ConclusionPatients with advanced cancer have physical,psychological,social and spiritual needs for palliative home care,especially in physical pain,psychological support and financial support are the primary concerns of our participants.The home-based version of PNPC is a valid and reliable instrument to evaluate the need among patients with advanced cancer in China.