Measuring Attitude and Practice of Physician toward Breaking Bad News to the Breast Cancer Patients: Development and Validation of a Questionnaire

Abstract

Background: Breaking bad news to cancer patients is one of the important responsibilities in the oncology setting. The purpose of this study is develop and validate a new theoretically based tool for measurement of attitude and practice of physicians toward breaking bad news.Methods: The psychometric properties of the scale were established by following the guidelines of Clark and Watson. In the first phase, a literature review was performed to create items; then items were assessed for content validity through individual interview (n = 12) and construct validity was assessed by using factor analysis. Reliability was evaluated by Cronbach’s alpha. Research data was gathered from physicians working in breast cancer setting. Results: A total of 12 expert reviews concluded that a large amount of items of attitude and practice questionnaires were important and essential (Content Validity Ratio > 0.73). The exploratory and confirmatory factor analyses for a sample of physicians (n = 200) indicated a 12-item of attitude scale with three factors: full disclosure, non-disclosure and individual disclosure. Cronbach’s Alpha for the factors returned 0.746, 0.834 and 0.795, respectively. The exploratory and confirmatory factor analyses for a sample of physicians (n = 200) indicated a 20-item of practice scale with six factors: preparation, setting of the interaction, communicate well, use of the “cancer” word, patient’s right to know and close the interview, and summarized. Cronbach’s Alpha for the factors returned 0.765, 0.63, 0.65, 0.793, 0.759 and 0.7, respectively.Conclusions: A resultant 12 items of attitude and 20 items of practice questionnaire were developed to assess how physicians are giving bad news to breast cancer patients. The reliability of the new tools needs to be evaluated for further studies. This new questionnaire will provide researchers and clinicians with a thorough and suitable instrument to measure belief and practice regarding disclosing the truth to breast cancer patients.