Richter L, Pauge S, Mehlis K, Zueger A, Surmann B, Mathies V, Greiner W, Ernst T, Winkler E C, Menold N
Methods in Empirical Social Research, Institute of Sociology, Faculty of Arts, Humanities and Social Science, Dresden University of Technology, Dresden, Germany.
Department for Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany.
ESMO Open. 2024 Dec;9(12):103992. doi: 10.1016/j.esmoop.2024.103992. Epub 2024 Nov 29.
Cancer diagnosis and therapy can lead to significant financial distress for those affected, even in universal health care systems. We present the development and validation of a patient-reported outcome measure for financial distress in German cancer patients.
Validation of the newly developed instrument followed a two-step approach, including two quantitative paper-pencil surveys (N1 = 111, N2 = 267) with patients of all types of cancer and treatment status at two German university hospitals. Factorial validity, reliability, construct, and criterion validity were assessed using exploratory and confirmatory factor analysis, correlative and linear regression analysis.
The Financial Distress of Cancer Assessment Tool (FIAT) comprises 19 items across three domains of subjective financial distress: (i) financial worries; (ii) dissatisfaction across various life domains, and (iii) challenging experiences with authorities and benefit providers (e.g. employment agency, health insurance). Confirmatory factor analysis confirmed the instrument's factorial structure. Composite reliability (Raykov's rho) ranges from 0.88 to 0.96, and retest reliability ranges from 0.64 to 0.75. Correlational analyses showed significant associations between FIAT scores and related constructs [e.g. correlations with the EORTC-QLQ-C30 financial distress subscale (Q28) ranging from 0.47 to 0.60], supporting its construct validity. Additionally, higher FIAT scores were significantly associated with lower health-related quality of life measured by Q29 and Q30 of the EORTC-QLQ-C30, with correlations ranging from -0.21 to -0.28. They were also positively correlated with depression (PHQ-4), with correlations ranging from 0.33 to 0.45, and anxiety (PHQ-4) with correlations ranging from 0.25 to 0.36, confirming its criterion validity.
The newly developed patient-reported outcome measure is the first reported measurement tool to assess financial distress in German cancer patients. The instrument can be used for research purposes and to enable the provision of coordinated support services.
癌症诊断和治疗会给患者带来巨大的经济压力，即便在全民医保体系下亦是如此。我们展示了一种针对德国癌症患者经济压力的患者报告结局指标的开发与验证过程。
新开发工具的验证采用两步法，包括在两家德国大学医院对各类癌症及治疗状态的患者进行两次纸笔形式的定量调查（N1 = 111，N2 = 267）。使用探索性和验证性因子分析、相关性和线性回归分析来评估因子效度、信度、结构效度和效标效度。
癌症经济压力评估工具（FIAT）由19个项目组成，涵盖主观经济压力的三个领域：（i）经济担忧；（ii）对各个生活领域的不满，以及（iii）与当局和福利提供者（如职业介绍所、健康保险公司）打交道时遇到的困难经历。验证性因子分析证实了该工具的因子结构。组合信度（雷科夫ρ系数）在0.88至0.96之间，重测信度在0.64至0.75之间。相关性分析表明FIAT得分与相关结构之间存在显著关联[例如，与欧洲癌症研究与治疗组织生活质量问卷核心30项（EORTC-QLQ-C30）经济压力子量表（Q28）的相关性在0.47至0.60之间]，支持其结构效度。此外，FIAT得分越高，与EORTC-QLQ-C30的Q29和Q30所衡量的较低健康相关生活质量显著相关，相关性在 -0.21至 -0.28之间。它们还与抑郁（PHQ-4）呈正相关，相关性在0.33至0.45之间，与焦虑（PHQ-4）呈正相关，相关性在0.25至0.36之间，证实了其效标效度。
新开发的患者报告结局指标是首个用于评估德国癌症患者经济压力的测量工具。该工具可用于研究目的，并有助于提供协调的支持服务。
