Abstract
ABSTRACTBackground:Most gynecological cancer survivors outlive the acute stage, and many reach permanent survival. However, the fear of cancer recurrence (FCR) is stressful and affects quality of life.Purpose:This study was designed to validate a Chinese version of the Assessment of Survivor Concerns (ASC) questionnaire in terms of its ability to assess FCR in gynecological cancer survivors.Methods:A two-stage study procedure was employed. The first stage involved the translation of the ASC questionnaire from English into Chinese using the methods proposed by Guillemin, which include translation, back-translation, consensus meetings, and a trial of potential users. In the second stage, a pilot study was completed with 37 gynecological cancer survivors followed by a psychometric property study with 287 gynecological cancer survivors. Construct validity was determined using confirmatory factor analysis (CFA) with structural equation modeling. Convergent validity was determined using composite reliability and the average variance extracted values of the ASC model. Discriminant validity was determined by comparing the model fitness of the ASC model against the model fitness of a one-construct model. Concurrent criterion validity was assessed using the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30 as the auxiliary instrument. Reliability was determined by measuring the internal consistency reliability using Cronbach's α in addition to the 3-week test–retest reliability with a 95% confidence interval of the intraclass correlation coefficient.Results:The process of translation and back-translation was performed to ensure the conceptual equivalence of the Chinese version with the original ASC questionnaire. For CFA, the fit indices of the ASC model (χ2 = 9.87, p > .05; root mean square error of approximation = .03. comparative fit index = 1, nonnormed fit index = 1) indicated appropriate model fitness. For convergent validity, the composite reliability and average variance extracted values of the ASC model were satisfactory. For discriminant validity, the model fitness of the ASC model was significantly improved over the one-construct model. For concurrent criterion validity, the ASC scores correlated negatively with the scores of the global quality of life and the five functions (physical, role, cognition, emotions, and social) of the European Organization for Research and Treatment of Cancer's Quality-of-Life Questionnaire Core 30, as hypothesized. For reliability, the Cronbach's α and the 95% confidence interval of intraclass correlation coefficient for the ASC model were .91 and [.18, .68], respectively.Conclusions/Implications for Practice:The Chinese version of the ASC questionnaire is a valid and reliable instrument that is suitable for assessing FCR in gynecological cancer survivors in clinical and research settings.
Highlights
Advances in the early detection and treatment of cancer have increased the chances of survival of patients with cancer significantly
The model fitness of the Assessment of Survivor Concerns (ASC) model was significantly improved over the one-construct model
This study completed a translation and cultural adaptation of the ASC questionnaire from its original English version into Chinese and validated the translated version using a sample of 287 gynecological cancer survivors
Summary
Advances in the early detection and treatment of cancer have increased the chances of survival of patients with cancer significantly. One of the most disturbing emotional responses and prevalent unmet psychosocial needs of cancer survivorship is fear of cancer recurrence (FCR; Simard et al, 2013). FCR has been recently defined as referring to “fear, worry, or concern relating to the possibility that cancer will come back or progress” (Lebel et al, 2016). With an incidence rate of 22%–87%, FCR may cause functionally impaired behaviors such as escapist behavior or recurrent symptoms and may further develop into anxiety disorder, posttraumatic stress. Most gynecological cancer survivors outlive the acute stage, and many reach permanent survival. The fear of cancer recurrence (FCR) is stressful and affects quality of life. Purpose: This study was designed to validate a Chinese version of the Assessment of Survivor Concerns (ASC) questionnaire in terms of its ability to assess FCR in gynecological cancer survivors
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