Hoffman Aubri, Denham Chloe Josephine, Fu Shuangshuang, Mendoza Tito, Nitecki Roni, Jorgensen Kirsten A, Garcia Jose, Lamiman Kelly, Woodard Terri L, Rauh-Hain J Alejandro
Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
University of Texas McGovern Medical School, Houston, Texas, USA.
Int J Gynecol Cancer. 2023 May 1;33(5):778-785. doi: 10.1136/ijgc-2023-004302.
With a growing population of young cancer survivors, there is an increasing need to address the gaps in evidence regarding cancer survivors' obstetric outcomes, fertility care access, and experiences. As part of a large research program, this study engaged survivors and experts in co-developing and testing the validity, reliability, acceptability, and feasibility of a scale to assess survivor-reported barriers to motherhood after cancer.
Scale items were developed based on literature and expert review of 226 reproductive health items, and six experience and focus groups with 26 survivors of breast and gynecological cancers. We then invited 128 survivors to complete the scale twice, 48 hours apart, and assessed the scale's psychometric properties using exploratory factor analyses including reliability, known-group validity, and convergent validity.
Item development identified three primary themes: multifaceted barriers for cancer survivors; challenging decisions about whether and how to pursue motherhood; and a timely need for evidence about obstetric outcomes. Retained items were developed into a 24-item prototype scale with four subscales. Prototype testing showed acceptable internal consistency (Cronbach's alpha=0.71) and test-retest reliability (intraclass correlation coefficient=0.70). Known-group validity was supported; the scale discriminated between groups by age (x=70.0 for patients ≥35 years old vs 54.5 for patients <35 years old, p=0.02) and years since diagnosis (x=71.5 for ≥6 years vs 54.3 for<6 years, p=0.01). The financial subscale was correlated with the Economic StraiN and Resilience in Cancer measure of financial toxicity (ρ=0.39, p<0.001). The scale was acceptable and feasibly delivered online. The final 22-item scale is organized in four subscales: personal, medical, relational, and financial barriers to motherhood.
The Survivorship Oncofertility Barriers Scale demonstrated validity, reliability, and was acceptable and feasible when delivered online. Implementing the scale can gather the data needed to inform shared decision making and to address disparities in fertility care for survivors.
随着年轻癌症幸存者数量的不断增加，越来越有必要填补关于癌症幸存者产科结局、生育护理可及性和经历方面证据的空白。作为一个大型研究项目的一部分，本研究让幸存者和专家共同开发并测试一个量表的有效性、可靠性、可接受性和可行性，该量表用于评估幸存者报告的癌症后成为母亲的障碍。
量表项目基于对226项生殖健康项目的文献和专家审查，以及与26名乳腺癌和妇科癌症幸存者进行的6次经验和焦点小组讨论而制定。然后，我们邀请128名幸存者在48小时内分两次完成该量表，并使用探索性因素分析评估量表的心理测量特性，包括信度、已知群体效度和收敛效度。
项目开发确定了三个主要主题：癌症幸存者面临的多方面障碍；关于是否以及如何追求成为母亲的艰难决定；以及对产科结局证据的迫切需求。保留的项目被开发成一个有24个项目的原型量表，分为四个子量表。原型测试显示出可接受的内部一致性（克朗巴哈系数=0.71）和重测信度（组内相关系数=0.70）。已知群体效度得到支持；该量表按年龄区分不同群体（≥35岁患者的x=70.0，<35岁患者的x=54.5，p=0.02）以及自诊断以来的年限（≥6年患者的x=71.5，<6年患者的x=54.3，p=0.01）。财务子量表与癌症财务毒性的经济压力与恢复力测量相关（ρ=0.39，p<0.001）。该量表是可接受的，并且可以通过在线方式可行地交付。最终的22项量表分为四个子量表：成为母亲的个人、医疗、关系和财务障碍。
癌症幸存者生育障碍量表在通过在线方式交付时，证明了其有效性、可靠性，并且是可接受和可行的。实施该量表可以收集所需数据，为共同决策提供信息，并解决幸存者在生育护理方面的差异。
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