Katz M R, Irish J C, Devins G M, Rodin G M, Gullane P J
Department of Psychiatry and Psychosocial Oncology Program, the Toronto Hospital General Division, 200 Elizabeth Street, Eaton Wing 8-228, Toronto, Ontario, Canada M5G 2C4.
Head Neck. 2000 Mar;22(2):132-41. doi: 10.1002/(sici)1097-0347(200003)22:2<132::aid-hed4>3.0.co;2-k.
Facial disfigurement is considered to be one of the most distressing aspects of head and neck cancer and its treatment, but it has been the focus of little systematic study. Existing studies have yielded conflicting results about the psychosocial impact of disfigurement. No studies to date have examined disfigurement using a valid and reliable observer-rated measure. The purpose of the current study was to examine the validity (convergent and discriminant) and the inter-rater reliability of a novel nine-point observer-rated disfigurement scale.
The sample consisted of 74 ambulatory head and neck cancer patients more than 6 months post treatment. Ratings of disfigurement were assigned independently by surgical and nonsurgical raters. Validity was assessed by comparing the association between disfigurement ratings and sociodemographic and illness treatment variables. Reliability was assessed by examining the concordance between the surgical and nonsurgical ratings.
Disfigurement ratings were not associated with several sociodemographic variables, supporting the discriminant validity of the scale. Disfigurement was significantly related to a diagnosis of oral cancer, a history of adjunctive radiation, the type of surgical procedure performed, the degree of physical dysfunction, and the presence of postoperative complications. Observer ratings of disfigurement were significantly related to patient ratings of disfigurement. These findings support the convergent validity of the disfigurement scale. Inter-rater reliability of the scale was high (intraclass correlation coefficient =.91).
The study provides preliminary evidence for the validity and inter-rater reliability of a novel nine point observer-rated disfigurement scale that may be useful in evaluating the impact of disfigurement on quality of life in head and neck cancer.
面部毁容被认为是头颈癌及其治疗中最令人痛苦的方面之一，但一直很少成为系统研究的焦点。现有研究在毁容对心理社会的影响方面得出了相互矛盾的结果。迄今为止，尚无研究使用有效且可靠的观察者评定量表来评估毁容情况。本研究的目的是检验一种新型的九点观察者评定毁容量表的效度（聚合效度和区分效度）以及评分者间信度。
样本包括74名治疗后6个月以上的非卧床头颈癌患者。手术和非手术评分者分别独立给出毁容评分。通过比较毁容评分与社会人口统计学和疾病治疗变量之间的关联来评估效度。通过检查手术和非手术评分之间的一致性来评估信度。
毁容评分与几个社会人口统计学变量无关，支持了该量表的区分效度。毁容与口腔癌诊断、辅助放疗史、所进行的手术类型、身体功能障碍程度以及术后并发症的存在显著相关。观察者的毁容评分与患者的毁容评分显著相关。这些发现支持了毁容量表的聚合效度。该量表的评分者间信度很高（组内相关系数 = 0.91）。
本研究为一种新型的九点观察者评定毁容量表的效度和评分者间信度提供了初步证据，该量表可能有助于评估毁容对头颈癌患者生活质量的影响。
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