Symptom Research CAO, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
GI Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America.
PLoS One. 2022 Aug 25;17(8):e0272804. doi: 10.1371/journal.pone.0272804. eCollection 2022.
This study sought to evaluate advanced psychometric properties of the 15-item Economic Strain and Resilience in Cancer (ENRICh) measure of financial toxicity for cancer patients.
We surveyed 515 cancer patients in the greater Houston metropolitan area using ENRICh from March 2019 to March 2020. We conducted a series of factor analyses alongside parametric and non-parametric item response theory (IRT) assessments using Mokken analysis and the graded response model (GRM). We utilized parameters derived from the GRM to run a simulated computerized adaptive test (CAT) assessment.
Among participants, mean age was 58.49 years and 278 (54%) were female. The initial round factor analysis results suggested a one-factor scale structure. Negligible levels of differential item functioning (DIF) were evident between eight items. Three items were removed due to local interdependence (Q3>+0.4). The original 11-point numerical rating scale did not function well, and a new 3-point scoring system was implemented. The final 12-item ENRICh had acceptable fit to the GRM (p<0.001; TLI = 0.94; CFI = 0.95; RMSEA = 0.09; RMSR = 0.06) as well as good scalability and dimensionality. We observed high correlation between CAT version scores and the 12-item measure (r = 0.98). During CAT, items 2 (money you owe) and 4 (stress level about finances) were most frequently administered, followed by items 1 (money in savings) and 5 (ability to pay bills). Scores from these four items alone were strongly correlated with that of the 12-item ENRICh (r = 0.96).
These CAT and 4-item versions provide options for quick screening in clinical practice and low-burden assessment in research.
本研究旨在评估用于癌症患者的 15 项经济负担和癌症韧性（ENRICh）财务毒性量表的高级心理测量学特性。
我们于 2019 年 3 月至 2020 年 3 月期间使用 ENRICh 对休斯顿大都市区的 515 名癌症患者进行了调查。我们进行了一系列因素分析，同时使用莫肯分析和分级响应模型（GRM）进行参数和非参数项目反应理论（IRT）评估。我们使用 GRM 得出的参数来运行模拟计算机自适应测试（CAT）评估。
在参与者中，平均年龄为 58.49 岁，278 名（54%）为女性。初步的因子分析结果表明存在一个单因素量表结构。八项中的差异项目功能（DIF）水平可忽略不计。由于局部相关性（Q3>+0.4），删除了三个项目。原始的 11 点数字评分量表表现不佳，因此实施了新的 3 分评分系统。最终的 12 项 ENRICh 与 GRM 具有良好的拟合度（p<0.001；TLI = 0.94；CFI = 0.95；RMSEA = 0.09；RMSR = 0.06），并且具有良好的可扩展性和维度性。我们观察到 CAT 版本得分与 12 项测试之间的高度相关性（r = 0.98）。在 CAT 中，最常使用的是项目 2（欠款）和项目 4（对财务状况的压力水平），其次是项目 1（储蓄中的钱）和项目 5（支付账单的能力）。仅这四个项目的得分与 12 项 ENRICh 得分强烈相关（r = 0.96）。
这些 CAT 和 4 项版本为临床实践中的快速筛查和研究中的低负担评估提供了选择。
