Confirmatory factor analysis of a needs assessment tool: Oncology patient distress in Hobart, Tasmania (#274)
The study explored the construct validity of the How Can We Help You and Your Family (HWCH; Loscalzo & Clark, 2007), a 36-item instrument administered to oncology patients which screens for cancer-related distess in physical, practical, social, psychological and spiritual domains distress screening tool for cancer patients.
Subjects were 353 ambulatory oncology patients receiving active treatment at the Royal Hobart Hospital (RHH), Hobart, Tasmania.
Patients consented to their responses being de-identified and used in research. The HCWH tool was reduced to 16 items via an exploratory factor analysis (n=153), which found support for three factors: medical communication (three items) medical consequences (three items), and psychological adjustment (10 items). Items were excluded as certain questions had significant cross-loadings on a number of factors, sub-optimal syntax, and issues of orphanism. A confirmatory factor analysis (CFA) was subsequently conducted (n=200). The data was fitted to the model using the robust weighted least squares (WLSMV) method of estimation. The findings indicate good support for the three-factor model, with three of the four fit indices showing good fit and RMSEA showing acceptable/moderate fit. Further, the items which patients found distressing and the average level of distress were similar to Loscalzo and Clark’s (2007) sample despite differing demographics.
While the original 36-item measure has clinical utility, the present study found support for a 16-item three-factor model to fit the Tasmanian sample. Items were excluded as they did not load reliably well onto the factors and this could be because patients may have perceived some items to be outside the remit of the treating medical team.
- Carlson, L., Waller, A. & Mitchell, A. (2012). Screening for distress in and unmet needs in patients with cancer: Review and recommendations. Journal of Clinical Oncology, 30, 1160-1177.
- Loscalzo, M. & Clark, K. (2007). Problem-related distress in cancer patients drives requests for help: A prospective study. Oncology, 21. 1133-1139.