Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI.
Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI.
Diabetes Care. 2022 Nov 1;45(11):2535-2543. doi: 10.2337/dc22-0494.
The Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy (COST-FACIT) is a validated instrument measuring financial distress among people with cancer. The reliability and construct validity of the 11-item COST-FACIT were examined in adults with diabetes and high A1C.
We examined the factor structure (exploratory factor analysis), internal consistency reliability (Cronbach α), floor/ceiling effects, known-groups validity, and predictive validity among a sample of 600 adults with diabetes and high A1C.
COST-FACIT demonstrated a two-factor structure with high internal consistency: general financial situation (7-items, α = 0.86) and impact of illness on financial situation (4-items, α = 0.73). The measure demonstrated a ceiling effect for 2% of participants and floor effects for 7%. Worse financial toxicity scores were observed among adults who were women, were below the poverty line, had government-sponsored health insurance, were middle-aged, were not in the workforce, and had less educational attainment (P < 0.01). Worse financial toxicity was observed for those engaging in cost coping behaviors, such as taking less or skipping medicines, delaying care, borrowing money, "maxing out" the limit on credit cards, and not paying bills (P < 0.01). In regression models for the full measure and its two factors, worse financial toxicity was correlated with higher A1C (P < 0.01), higher levels of diabetes distress (P < 0.01), more chronic conditions (P < 0.01), and more depressive symptoms (P < 0.01).
Findings support both the reliability and validity of the COST-FACIT tool among adults with diabetes and high A1C levels. More research is needed to support the use of the COST-FACIT tool as a clinically relevant patient-centered instrument for diabetes care.
财务毒性综合评分-慢性疾病治疗功能评估（COST-FACIT）是一种经验证的用于衡量癌症患者财务困境的工具。本研究旨在检验高糖化血红蛋白（A1C）水平的糖尿病患者中 COST-FACIT 的 11 项条目信度和效度。
我们对 600 名高糖化血红蛋白水平的糖尿病患者进行了调查，调查内容包括：因子结构（探索性因子分析）、内部一致性信度（克朗巴赫 α）、地板/天花板效应、已知群组的有效性和预测有效性。
COST-FACIT 表现出两个具有高度内部一致性的因子结构：一般财务状况（7 个条目，α=0.86）和疾病对财务状况的影响（4 个条目，α=0.73）。该测量方法的参与者中存在 2%的天花板效应和 7%的地板效应。在女性、收入低于贫困线、拥有政府赞助的医疗保险、处于中年、不在工作岗位以及教育程度较低的成年人中，观察到更差的财务毒性评分（P＜0.01）。对于那些采取减少或跳过药物、延迟护理、借钱、“刷爆”信用卡额度和不付账单等成本应对行为的人，观察到更差的财务毒性（P＜0.01）。在用于全面评估及其两个因素的回归模型中，更差的财务毒性与更高的 A1C（P＜0.01）、更高水平的糖尿病困扰（P＜0.01）、更多的慢性疾病（P＜0.01）和更多的抑郁症状（P＜0.01）相关。
这些发现支持了 COST-FACIT 工具在高糖化血红蛋白水平的糖尿病患者中的可靠性和有效性。需要进一步研究来支持将 COST-FACIT 工具作为一种与临床相关的以患者为中心的糖尿病护理工具。
