Namba-Bando María Del Mar Yukie, Contreras-Yáñez Irazú, Tenorio-Torres Juan Alberto, Pascual-Ramos Virginia
Fundación de Cáncer de Mama (Breast Cancer Foundation) FUCAM A.C., Mexico City, Mexico.
Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
PLoS One. 2025 Jun 23;20(6):e0326332. doi: 10.1371/journal.pone.0326332. eCollection 2025.
Breast cancer is the leading cause of cancer-related deaths among women in Mexico, and the outcomes for patients are often poor. Futility in healthcare (FHC) occurs when treatment fails to achieve its intended goals, resulting in negative consequences. This study aimed to estimate the proportion of female patients in Mexico with advanced-stage breast cancer (ABC) who perceive FHC. Additionally, we inform the development and validation of a questionnaire (FHC-Q) to assess this phenomenon.
This cross-sectional study was conducted from May 17, 2024, to December 30, 2024, in three phases. It involved three convenience samples (S) of adult women with ABC: S-1 (n = 30), S-2 (n = 201), and S-3 (n = 257). Phase 1 focused on constructing the FHC-Q, evaluating its content validity (expert agreement), and conducting a pilot test to assess its feasibility, all within S-1. Phase 2 involved assessing the questionnaire's reliability (internal consistency and temporal stability), construct validity (correlations between FHC-Q and DASS21 scores, along with exploratory factor analysis), and criterion validity (correlations between FHC-Q and SF-36 scores), all in S-2. Phase 3 estimated the FHC phenomenon in S-3. The definition of FHC was established using the Delphi method.
Participants represented typical female Mexican patients with ABC. The FHC-Q comprised 16 items distributed into five dimensions. The FHC-Q demonstrated feasibility and validity, with expert agreement of ≥80% and a five-factor structure explaining 57.8% of the variance. Correlations between the FHC-Q, DASS21 and SF-36 scores were significant and low to moderate. The FHC-Q reliability was confirmed with a Cronbach's alpha of 0.766 and an ICC of 0.845 (95% CI: 0.735-0.909). FHC was perceived by 3.9% of the participants.
FHC was perceived by a minority of Mexican women with ABC stages. The FHC-Q was valid, reliable and feasible to assess the phenomenon in the target population.
乳腺癌是墨西哥女性癌症相关死亡的主要原因，患者的治疗结果往往不佳。当治疗未能实现其预期目标并产生负面后果时，就会出现医疗保健中的无效性（FHC）。本研究旨在估计墨西哥晚期乳腺癌（ABC）女性患者中感知到FHC的比例。此外，我们为评估这一现象的问卷（FHC-Q）的开发和验证提供信息。
这项横断面研究于2024年5月17日至2024年12月30日分三个阶段进行。它涉及成年ABC女性的三个便利样本（S）：S-1（n = 30）、S-2（n = 201）和S-3（n = 257）。第一阶段专注于构建FHC-Q，评估其内容效度（专家共识），并在S-1内进行预测试以评估其可行性。第二阶段涉及评估问卷的信度（内部一致性和时间稳定性）、结构效度（FHC-Q与DASS21分数之间的相关性以及探索性因素分析）和效标效度（FHC-Q与SF-36分数之间的相关性），均在S-2中进行。第三阶段估计S-3中的FHC现象。使用德尔菲法确定FHC的定义。
参与者代表典型的墨西哥ABC女性患者。FHC-Q由16个项目组成，分为五个维度。FHC-Q展示了可行性和有效性，专家共识≥80%，五因素结构解释了57.8%的方差。FHC-Q、DASS21和SF-36分数之间的相关性显著且为低到中度。FHC-Q的信度通过Cronbach's α为0.766和ICC为0.845（95%CI：0.735 - 0.909）得到确认。3.9%的参与者感知到FHC。
少数处于ABC期的墨西哥女性感知到了FHC。FHC-Q对于评估目标人群中的这一现象是有效、可靠且可行的。
