【作者】 张琴；

【导师】 李玉丽；

【作者基本信息】 山东大学 ， 护理学， 2023， 硕士

【摘要】 目的:(1)编制癌症患者家庭弹性评估量表(Family Resilience Assessment Scale for Cancer Survivor,FRAS-CS),以形成适应于测量我国癌症患者和家庭照顾者家庭弹性的评估工具,并检验量表的信效度。(2)探讨FRAS-CS用于患者和照顾者共同商讨作答的可行性。(3)对FRAS-CS进行初步应用,评估癌症背景下家庭弹性的疾病及人口学特征。方法:(1)量表编制:经过原作者授权同意后对家庭弹性评估量表(Family Resilience Assessment,FRA)进行汉化,并以家庭弹性框架为基础,结合中国癌症家庭的现实情况,对条目进行适当调整和增删,形成FRAS-CS初始版。邀请4位相关领域专家进行两轮专家函询,综合各专家意见进行适当修改。之后将量表条目顺序随机排序,进行预实验,形成施测版量表。信效度检验的正式调查采用便利抽样法,选取山东省4所三甲医院的多个肿瘤科病房的癌症患者和家属照顾者为调查对象。调查工具包括FRAS-CS施测版、家庭弹性评定量表中文简化版(the Shortened Chinese Version of the Family Resilience Assessment Scale,FRAS-C)、一般资料调查表。信效度调查分为两个样本,样本一共有208例有效样本,用以进行项目分析、探索性因子分析、相容效度检验和信度分析,其中对样本一中的21例样本在首次测量结束后2～4周进行重测,以评估重测信度。样本二共有247例有效样本,用以进行验证性因子分析。项目分析采用临界比值法、相关系数法和题项删除后Cronbach’sα系数进行分析;效度检验以探索性因子分析、验证性因子分析、相容效度进行评价;信度检验以Cronbach’sα系数、折半信度、重测信度进行评价。(2)患者和照顾者共同商讨作答的可行性分析:采用便利抽样法选取50对(样本三)癌症患者及其家庭照顾者为研究对象,用以评估FRAS-CS用于患者和家庭照顾者共同商讨填写的适应性。调查工具为本研究形成的FRAS-CS和一般资料调查表。对患者和照顾者的一般资料和FRAS-CS各条目均分、维度得分情况进行描述性分析,并检验共同填写量表的Cronbach’s α系数。(3)量表初步应用:采用便利抽样法选取癌症患者和/或家庭照顾者参与研究,收集患者单独填写问卷、照顾者单独填写问卷以及患者和照顾者共同商讨填写问卷共113份(样本四)。调查工具为本研究形成的FRAS-CS和一般资料调查表。对患者和照顾者的一般资料进行描述性分析,采用独立样本t检验和单因素方差分析比较人口学因素和疾病相关因素以及填写方式各亚组家庭弹性得分的差异,以初步探讨癌症患者家庭弹性的疾病及人口学特征。结果:(1)量表编制结果:对FRA量表进行汉化后,删除4个原量表条目,重新划分调整3个原条目,新增10个新条目,形成癌症患者家庭弹性评估量表初始版,共包含36个条目,9个维度。两轮专家函询专家的积极系数分别为100%和75%,权威系数为0.92,条目重要性评分均值均为4.00～5.00,重要性评分的变异系数分别为0～0.23和0～0.13。两轮函询后共对10个条目和2个维度的语言进行修改,合并2个维度。之后通过预调查的反馈对条目描述作进一步调整,形成36个条目8个维度的施测版问卷。项目分析时,条目1、4、6、20和26因条目鉴别度和/或同质性较差被删除。探索性因子分析时,删除两个条目,得到最优的六因子模型,六个公因子分别命名为乐观态度、灵活性、家庭和社会支持、有效沟通、超越与精神信仰、合作应对,共可解释65.827%的变异量。验证性因子分析结果显示,修正后模型拟合良好:χ2/df=2.064,RMR=0.043,GFI=0.833,IFI=0.903,CFI=0.902,RMSEA=0.066。与 FRAS-C 的相关系数r=0.419(P<0.01)。总量标的Cronbach’s α系数为0.939,各维度Cronbach’s α系数为0.640～0.880。量表折半信度为 0.914(P<0.01)。量表重测信度为 0.719(P<0.01)。(2)共同商讨作答的可行性分析结果:患者和照顾者共同填写样本中,FRAS-CS的总Cronbach’s α系数为0.951,大于判断标准0.800。各维度Cronbach’s α系数为0.657～0.895,大于判断标准0.600。FRAS-CS在该样本中内部一致性良好,可用于患者和照顾者共同商讨作答。(3)量表初步应用结果:FRAS-CS总分或维度得分在患者年龄、婚姻状况、教育程度、职业类型、疾病类型、医保类型、有无其他疾病、有无共同照顾者、问卷应答方式方面均存在显著的统计学差异(均P<0.05)。结论:(1)癌症患者家庭弹性评估量表(FRAS-CS)包含29个条目,分为6个维度,分别为乐观态度(4个条目)、灵活性(5个条目)、家庭和社会支持(8个条目)、有效沟通(5个条目)、超越与精神信仰(4个条目)、合作应对(3个条目)。该量表各项心理测量学指标良好,可用于测量癌症患者视角、家庭照顾者视角及患者和照顾者一致评价的家庭弹性,从而有助于更精准、全面的评估癌症背景下的家庭弹性水平。(2)患者年龄、婚姻状况、受教育程度、职业类型、疾病类型、医保类型、是否患有其他疾病、是否有共同照顾者、问卷填写方式等因素可能会影响其家庭弹性。更多还原

【Abstract】 Objectives:(1)To develop the Family Resilience Assessment Scale for Cancer Survivors(FRAS-CS),which aimed to form an assessment tool that can be adapted to the responses of cancer survivors and family caregivers in China.Furthermore,to analyze the reliability and validity of the scale.(2)To explore the feasibility of using the scale for patients and caregivers co-discussion responses.(3)To conduct a preliminary application of the FRAS-CS and assess the disease and sociodemographic characteristics of the family resilience in the context of cancer.Methods:(1)Development of the scale:Firstly,the translation of the FRA was carried out with the permission of the author,Dr.Duncan Lane.Then,based on the Walsh Family Resilience Framework and considering of the realities of Chinese cancer families,the items were appropriately adjusted to form the initial version of the FRAS-CS.Four experts in related fields were invited to conduct two rounds of expert consultation.The scale was modified appropriately according to the comments of each expert.Furthermore,the scale items were randomly ordered.A pre-survey was then conducted to form the test version of FRAS-CS.The formal survey for reliability and validity test used a convenience sample of cancer survivors and family caregivers from several oncology wards in four tertiary hospitals in Shandong Province.The survey instruments included the test version of the FRAS-CS,the Shortened Chinese Version of the Family Resilience Assessment Scale(FRAS-C),and the general information questionnaire.Two samples were used for the reliability and validity analysis.Sample one with 208 valid samples was used for item analysis,exploratory factor analysis,compatible validity and reliability analysis.21 samples from Sample one were retested 2 to 4 weeks after the first measurement to assess retest reliability.While sample two with 247 valid samples was used for confirmatory factor analysis.Specifically,item analysis was conducted using the critical ratio method,the correlation coefficient method and the Cronbach’s a coefficient after item deletion.Validity analysis was evaluated by exploratory factor analysis,confirmatory factor analysis,compatible validity.The reliability analysis was evaluated by Cronbach’s a coefficient,split-half reliability,and retest reliability.(2)Feasibility analysis of survivors and caregivers co-discussion responses:A convenience sampling method was used to invite fifty dyads of cancer survivors and their caregivers(Sample three)to participate in this study that assessed the suitability of the FRAS-CS for patient and caregiver co-discussion.The survey instruments included the FRAS-CS and the general information questionnaire.The data was analyzed using descriptive statistics and Cronbach’s a coefficients.(3)Preliminary application of the scale:A convenience sampling method was used to invite cancer survivors and/or family caregivers to participate in this part of the study.A total of 113 valid questionnaires were collected from survivors alone,caregivers alone and survivors-caregivers dyad respectively.The survey instruments included the FRAS-CS scale and the general information questionnaire.The data was analyzed using t-tests and one-way ANOVA to explore the factors influencing family resilience.Results:(1)Results of the scale development:After translation of the FRA scale,four original scale items were deleted,three original items were reclassified and adjusted,and 10 new items were added to develop the initial version of FRAS-CS.The initial version of the scale contains a total of 36 items with 9 dimensions.In the two rounds of consultation,the positive coefficient of experts was 100%and 75%respectively,the authority coefficient was 0.92,the mean importance rating of the items was 4.00～5.00,and the coefficient of variation of the importance rating was 0～0.23 and 0～0.13 respectively.10 items and 2 dimensions were revised after the two rounds of consultation,and 2 dimensions were combined.Further adjustments were then made to the item descriptions based on feedback from the pre-survey,which yielded the test version of the FRAS-CS with 8 dimensions.In the item analysis,items 1,4,6,20 and 26 were deleted due to poor identification and/or homogeneity of the items.In the exploratory factor analysis,two items were deleted to obtain the optimal six-factor model.The six common factors were named Positive Outlook,Flexibility,Family and Social Support,Effective Communication,Transcendence and Spirituality,and Cooperative Coping,which in total explained 65.827%of the variance.The results of the confirmatory factor analysis showed that the modified model was well fitted:χ2/df=2.064,RMR=0.043,GFI=0.833,IFI=0.903,CFI=0.902,RMSEA=0.066.The correlation coefficient between the test version of the scale and FRAS-C was 0.419(P<0.01).The Cronbach’s a coefficient for the total scale was 0.939 and the Cronbach’s α coefficients for the dimensions ranged from 0.640 to 0.880.The scale split-half reliability was 0.914(P<0.01).The scale retest reliability was 0.719(P<0.01).(2)Results of feasibility analysis of survivors and caregivers co-discussion responses:In the sample of survivors and caregivers co-discussion responses,the total scale Cronbach’s a coefficient was 0.951,which was greater than the criterion 0.800;the Cronbach’s αcoefficients for the dimensions ranged from 0.657 to 0.895,which was greater than the criterion 0.600.The FRAS-CS has excellent internal consistency in this sample and can be applied to measure consistent family resilience responses of survivors and caregivers.(3)Results of preliminary application of the scale:Family resilience total or dimension scores were statistically different in terms of patients age,marital status,education level,type of occupation,type of disease,type of health insurance,the presence or absence of other illnesses,the presence or absence of other caregivers,and questionnaire response mode(all p<0.05).Conclusions:(1)The Family Resilience Assessment Scale for Cancer Survivors(FRAS-CS)has 29 items divided into six dimensions:Positive Outlook(4 items),Flexibility(5 items),Family and Social Support(8 items),Effective Communication(5 items),Transcendence and Spirituality(4 items),and Cooperative Coping(3 items).The FRAS-CS has excellent psychometric properties and can be used to measure family resilience from the cancer survivors perspective,the family caregiver perspective and patient-caregiver dyad responses,thereby contributing to a more accurate and comprehensive assessment of the level of household resilience in the context of cancer.(2)Patient age,marital status,education level,type of occupation,type of disease,type of health insurance,the presence or absence of other illnesses,the presence or absence of other caregivers,and questionnaire response mode could affect family resilience.更多还原