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【摘要】 目的:探讨癌痛自我效能感问卷应用于癌痛患者中的信度和效度。方法:采用癌痛自我效能感问卷调查129例癌痛患者,并进行信度(内部一致性信度、Guttmann折半信度和重测信度)和效度(内容效度、结构效度和效标效度)分析。结果:癌痛管理自我效能感问卷(PSE)、躯体功能自我效能感问卷(FSE)和症状应对自我效能感问卷(CES)的内部一致性信度为0.784~0.886,折半信度为0.767~0.894,重测信度为0.813~0.903,癌痛自我效能感问卷的内部一致性信度为0.897,折半信度为0.885,重测信度为0.864;分问卷与总问卷的相关系数为0.845~0.951,分问卷之间的相关系数为0.672~0.779,P<0.01;提取特征值大于1的因子共3个,累计贡献率为62.56%;三个分问卷与总问卷得分与NRS评分呈显著负相关性,相关系数分别为-0.514、-0.593、-0.447和-0.482(均P<0.01)。结论:癌痛自我效能感问卷应用于癌痛患者具有较好的信度和效度,可用其评价我国癌症患者的癌痛自我效能感。
【关键词】 癌痛自我效能感问卷; 癌痛; 信度; 效度
Reliability and Validity of Cancer Pain Self-efficacy Questionnaire in Cancer Pain Patients/HAN Ling,CHAO Donghua,WU Minhong,et al.//Medical Innovation of China,2018,15(08):132-135
【Abstract】 Objective:To investigate the reliability and validity of cancer pain self-efficacy questionnaire in patients with cancer pain.Method:A total of 129 patients with cancer pain were investigated by using the cancer pain self-efficacy questionnaire,and the reliability(internal consistency reliability,Guttmann fold reliability and retest reliability) and validity(content validity,structural validity and efficiency validity) analysis.Result:The internal consistency reliability of the self-efficacy questionnaire(PSE),physical function self-efficacy questionnaire(FSE) and symptom response self-efficacy questionnaire(CES) were 0.784-0.886,the fold reliability was 0.767-0.894,the reliability of the questionnaire was 0.897-0.903,the internal consistency reliability of the cancer pain self-efficacy questionnaire was 0.897,the folding reliability was 0.885,the retest reliability was 0.864,the correlation coefficient between the questionnaire and the total questionnaire was 0.845-0.951,the correlation coefficient between the three sub-questionnaires was 0.672-0.779,P<0.01,and the total contribution rate was 62.56%.The scores of the three sub-questionnaires and the total questionnaire were negatively correlated with NRS score,the correlation coefficients were -0.514,-0.593,-0.447 and -0.482(P<0.01).Conclusion:The self-efficacy questionnaire of cancer pain is suitable for cancer pain patients with good reliability and validity,and can be used to evaluate the cancer pain self-efficacy of cancer patients in China.
【Key words】 Cancer pain self-efficacy questionnaire; Cancer pain; Reliability; Validity
First-author’s address:Cancer Hospital of Guangzhou Medical University,Guangzhou 510000,China
doi:10.3969/j.issn.1674-4985.2018.08.033
癌痛自我效能感是癌癥患者判断自己能否自我管理癌痛疼痛和能否进行日常生活的能力感知[1]。国内以往的研究表明,慢性疼痛自我效能感量表是一种可用于评价慢性疼痛患者自我效能感的有效评估工具[2-3],然而关于癌症患者专用的癌痛自我效能感量表报道却较少。目前,大部分研究人员采用常规的慢性疼痛自我效能感量表进行相关调查研究[4-5]。本研究将常规的慢性疼痛自我效能感量表进行了适当修订形成了针对癌症患者的癌痛自我效能感问卷,而且分析了问卷的信效度,以期为国内癌症患者的癌痛评估和治疗干预提供科学的参考依据,现报告如下。 1 资料与方法
1.1 一般资料 选择2016年3月-2017年3月本院肿瘤科收治的癌性疼痛患者作为研究对象。纳入标准:(1)因肿瘤进展导致癌痛;(2)出现癌痛时间>1个月;(3)无精神疾病;(4)具备正常的语言表达能力;(5)意识清楚,能独立完成调查问卷;(6)同意签署知情同意书。排除标准:(1)意识不清;(2)有精神障碍。本研究已经伦理学委员会批准。
1.2 方法 采用面对面问卷调查法,填写问卷前,研究者应向患者详细讲解本研究的临床意义、问卷填写方法和相关注意事项,然后由患者自行填写问卷,若填写过程中出现疑问可随时询问研究者,若患者书写不便可由研究者代替填写,但应遵循患者意见逐条填写答案。问卷填写完毕后当场收回。此外,填写调查问卷前应采用疼痛数字评分法(NRS)评估患者的疼痛强度,以检验慢性疼痛自我效能感量表的效标效度。7 d后对所有患者再次进行问卷调查。癌痛自我效能感问卷包括癌痛管理自我效能感问卷(PSE)、軀体功能自我效能感问卷(FSE)和症状应对自我效能感问卷(CES),共包含25个分项,其中PSE问卷含5项,FSE问卷含9项,CES问卷含11项。三个分问卷均用项目计分表示自我效能感的高低,得分相加即为本问卷总得分,得分越高表示自我效能感越高。
1.3 统计学处理 采用SPSS 19.0软件进行统计学分析,信度分析分别使用内部一致性信度、折半信度和重测信度评估,效度分析分别使用内容效度、结构效度和效标效度评估。
2 结果
2.1 基线资料 最终共纳入129例患者,其中男
69例,女60例;年龄19~72岁,平均(61.4±10.1)岁;入组患者被诊断为单一种类的癌症,其中鼻咽癌25例,胆管癌2例,非霍奇金淋巴瘤4例,肺癌12例,肝癌14例,宫颈癌18例,骨肉瘤2例,喉癌2例,霍奇金淋巴瘤1例,甲状腺癌1例,结肠癌6例,卵巢癌2例,膀胱癌2例,前列腺癌2例,乳腺癌11例,肾癌1例,食管癌3例,胃癌6例,纤维肉瘤1例,阴茎癌1例,直肠癌2例,子宫内膜癌10例,纵隔精原细胞瘤1例;病程包括癌症各个分期,其中Ⅰ期2例,Ⅱ期6例,Ⅲ期49例,Ⅳ期72例。
2.2 三个分问卷各项目得分情况 PSE、FSE和CES三个问卷的得分分别为(196.8±12.7)、(361.3±16.2)和(415.4±13.4)分,总问卷得分为(973.5±19.1)分,各单项得分见表1。25个项目得分与总分的Pearson相关系数在0.378~0.653,P<0.01,见表2。
2.3 癌痛自我效能感问卷的信度分析 PSE、FSE和CES三个问卷的内部一致性信度为0.784~0.886,折半信度为0.767~0.894,重测信度为0.813~0.903,癌痛自我效能感问卷的内部一致性信度为0.897,折半信度为0.885,重测信度为0.864,见表3。
2.4 癌痛自我效能感问卷的效度分析
2.4.1 问卷的内容效度分析 内容效度采用分问卷与总问卷得分的相关性来评估。分问卷与总问卷的相关系数为0.845~0.951,分问卷之间的相关系数为0.672~0.779,P<0.01,见表4。
2.4.2 问卷的结构效度分析结果 经KMO和Bartlett检验分析显示,KMO=0.934,且P<0.01,表明适合进行因子分析,提取特征值大于1的因子共3个(癌痛管理自我效能感、躯体功能自我效能感和症状应对自我效能感),累计贡献率为62.56%,见表5。
2.4.3 问卷的效标效度分析结果 三个分问卷与总问卷得分与NRS评分呈显著负相关性,相关系数分别为-0.514、-0.593、-0.447和-0.482(均P<0.01)。
3 讨论
美国心理学家班杜拉最早提出自我效能感这一概念[6],并且很快得到了包括心理学、组织行为学和社会学等众多领域研究人员的广泛关注和应用[7-9]。尤其是近年来,许多学者将自我效能感应用于慢性疼痛领域,且取得了一定的成果[10]。以往的文献报道显示,慢性疼痛患者的生理功能、心理状况及对疼痛的自我调节等均影响患者的疼痛自我效能感[11]。近年来,越来越多的学者认为,科学的疼痛自我效能感管理方案对疼痛患者的治疗、康复和提高生活质量均具有积极的作用[12-13],而且许多医院已经单独设立疼痛科或者设立专为肿瘤患者开设的疼痛病房,以专门缓解患者的疼痛问题,而评估疼痛自我效能感则是疼痛患者,特别是癌痛患者,临床治疗的重要依据,同时也是疼痛理论应用和发展重要研究内容[14],然而对于癌症患者这一特定人群,目前国内尚缺乏测量癌痛自我效能感的专用问卷[15],因此,需要一种科学测量工具,准确反映癌痛患者的自我效能感,以便采取及时有效的治疗措施,减轻癌痛患者的痛苦。
信度是反映问卷可靠性和准确性的重要指标。内容一致性信度用于反映问卷的内在信度,而折半信度用于反映两次问卷得分是否一致[16]。一般来说,分问卷和总问卷的内容一致性信度系数应分别大于0.60和0.80[17]。本研究结果显示,分量表Cronbach’s α系数为0.784~0.886,折半系数为0.767~0.894,总量表Cronbach’s α系数为0.897,折半系数为0.885,该结果表明癌痛自我效能感问卷应用于癌痛患者具有较高的信度。此外,首次发放问卷7 d后对患者再次进行问卷调查,总问卷的重测信度为0.864,表明该问卷具有良好的稳定性,这与Ritter等[18]的研究结果相类似。
效度是衡量问卷质量的重要指标,用来评价问卷内容和其要测量的变量是否一致[19]。本研究采用内容效度、结构效度和效标效度对癌痛自我效能感问卷进行了评价。内容效度采用分问卷和总问卷得分相关性来评估。本研究结果显示,分问卷和总问卷的相关系数为0.845~0.951,三个分问卷之间的相关系数为0.672~0.779,表明分问卷与总问卷之间及分问卷之间的得分具有高度相关性,这一结果提示本问卷具有较高的内容效度。目前,结构效度最常用采用的评价方法是因子分析法[20]。本研究结果经KMO和Bartlett检验分析显示,KMO=0.934,且P<0.01,表明适合进行因子分析,提取特征值大于1的因子共3个,累计贡献率为62.56%,表明该问卷结构合理,具有较高的结构效度,该结果与N?rgaard等[21]的报道相一致。效标效度是反映调查问卷与其他衡量标准之间的相关性,由于以往的报道表明,癌痛自我效能感与疼痛强度密切相关[22],故采用NRS评分作为效标来检验癌痛自我效能感问卷的效标关联效度。本研究结果显示,NRS评分与三个分问卷和总问卷得分呈明显负相关性,这表明癌症患者的癌痛越严重,癌痛自我效能感就越低,这与Weinberg等[23]对于疼痛自我效能感的研究结果相一致。 综上所述,癌痛自我效能感问卷应用于癌痛患者具有较好的信度和效度,可用其评价我国癌症患者的癌痛自我效能感,同时也有利于癌症患者的疼痛治疗和生活质量的提高。
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(收稿日期:2017-12-18) (本文編辑:程旭然)
【关键词】 癌痛自我效能感问卷; 癌痛; 信度; 效度
Reliability and Validity of Cancer Pain Self-efficacy Questionnaire in Cancer Pain Patients/HAN Ling,CHAO Donghua,WU Minhong,et al.//Medical Innovation of China,2018,15(08):132-135
【Abstract】 Objective:To investigate the reliability and validity of cancer pain self-efficacy questionnaire in patients with cancer pain.Method:A total of 129 patients with cancer pain were investigated by using the cancer pain self-efficacy questionnaire,and the reliability(internal consistency reliability,Guttmann fold reliability and retest reliability) and validity(content validity,structural validity and efficiency validity) analysis.Result:The internal consistency reliability of the self-efficacy questionnaire(PSE),physical function self-efficacy questionnaire(FSE) and symptom response self-efficacy questionnaire(CES) were 0.784-0.886,the fold reliability was 0.767-0.894,the reliability of the questionnaire was 0.897-0.903,the internal consistency reliability of the cancer pain self-efficacy questionnaire was 0.897,the folding reliability was 0.885,the retest reliability was 0.864,the correlation coefficient between the questionnaire and the total questionnaire was 0.845-0.951,the correlation coefficient between the three sub-questionnaires was 0.672-0.779,P<0.01,and the total contribution rate was 62.56%.The scores of the three sub-questionnaires and the total questionnaire were negatively correlated with NRS score,the correlation coefficients were -0.514,-0.593,-0.447 and -0.482(P<0.01).Conclusion:The self-efficacy questionnaire of cancer pain is suitable for cancer pain patients with good reliability and validity,and can be used to evaluate the cancer pain self-efficacy of cancer patients in China.
【Key words】 Cancer pain self-efficacy questionnaire; Cancer pain; Reliability; Validity
First-author’s address:Cancer Hospital of Guangzhou Medical University,Guangzhou 510000,China
doi:10.3969/j.issn.1674-4985.2018.08.033
癌痛自我效能感是癌癥患者判断自己能否自我管理癌痛疼痛和能否进行日常生活的能力感知[1]。国内以往的研究表明,慢性疼痛自我效能感量表是一种可用于评价慢性疼痛患者自我效能感的有效评估工具[2-3],然而关于癌症患者专用的癌痛自我效能感量表报道却较少。目前,大部分研究人员采用常规的慢性疼痛自我效能感量表进行相关调查研究[4-5]。本研究将常规的慢性疼痛自我效能感量表进行了适当修订形成了针对癌症患者的癌痛自我效能感问卷,而且分析了问卷的信效度,以期为国内癌症患者的癌痛评估和治疗干预提供科学的参考依据,现报告如下。 1 资料与方法
1.1 一般资料 选择2016年3月-2017年3月本院肿瘤科收治的癌性疼痛患者作为研究对象。纳入标准:(1)因肿瘤进展导致癌痛;(2)出现癌痛时间>1个月;(3)无精神疾病;(4)具备正常的语言表达能力;(5)意识清楚,能独立完成调查问卷;(6)同意签署知情同意书。排除标准:(1)意识不清;(2)有精神障碍。本研究已经伦理学委员会批准。
1.2 方法 采用面对面问卷调查法,填写问卷前,研究者应向患者详细讲解本研究的临床意义、问卷填写方法和相关注意事项,然后由患者自行填写问卷,若填写过程中出现疑问可随时询问研究者,若患者书写不便可由研究者代替填写,但应遵循患者意见逐条填写答案。问卷填写完毕后当场收回。此外,填写调查问卷前应采用疼痛数字评分法(NRS)评估患者的疼痛强度,以检验慢性疼痛自我效能感量表的效标效度。7 d后对所有患者再次进行问卷调查。癌痛自我效能感问卷包括癌痛管理自我效能感问卷(PSE)、軀体功能自我效能感问卷(FSE)和症状应对自我效能感问卷(CES),共包含25个分项,其中PSE问卷含5项,FSE问卷含9项,CES问卷含11项。三个分问卷均用项目计分表示自我效能感的高低,得分相加即为本问卷总得分,得分越高表示自我效能感越高。
1.3 统计学处理 采用SPSS 19.0软件进行统计学分析,信度分析分别使用内部一致性信度、折半信度和重测信度评估,效度分析分别使用内容效度、结构效度和效标效度评估。
2 结果
2.1 基线资料 最终共纳入129例患者,其中男
69例,女60例;年龄19~72岁,平均(61.4±10.1)岁;入组患者被诊断为单一种类的癌症,其中鼻咽癌25例,胆管癌2例,非霍奇金淋巴瘤4例,肺癌12例,肝癌14例,宫颈癌18例,骨肉瘤2例,喉癌2例,霍奇金淋巴瘤1例,甲状腺癌1例,结肠癌6例,卵巢癌2例,膀胱癌2例,前列腺癌2例,乳腺癌11例,肾癌1例,食管癌3例,胃癌6例,纤维肉瘤1例,阴茎癌1例,直肠癌2例,子宫内膜癌10例,纵隔精原细胞瘤1例;病程包括癌症各个分期,其中Ⅰ期2例,Ⅱ期6例,Ⅲ期49例,Ⅳ期72例。
2.2 三个分问卷各项目得分情况 PSE、FSE和CES三个问卷的得分分别为(196.8±12.7)、(361.3±16.2)和(415.4±13.4)分,总问卷得分为(973.5±19.1)分,各单项得分见表1。25个项目得分与总分的Pearson相关系数在0.378~0.653,P<0.01,见表2。
2.3 癌痛自我效能感问卷的信度分析 PSE、FSE和CES三个问卷的内部一致性信度为0.784~0.886,折半信度为0.767~0.894,重测信度为0.813~0.903,癌痛自我效能感问卷的内部一致性信度为0.897,折半信度为0.885,重测信度为0.864,见表3。
2.4 癌痛自我效能感问卷的效度分析
2.4.1 问卷的内容效度分析 内容效度采用分问卷与总问卷得分的相关性来评估。分问卷与总问卷的相关系数为0.845~0.951,分问卷之间的相关系数为0.672~0.779,P<0.01,见表4。
2.4.2 问卷的结构效度分析结果 经KMO和Bartlett检验分析显示,KMO=0.934,且P<0.01,表明适合进行因子分析,提取特征值大于1的因子共3个(癌痛管理自我效能感、躯体功能自我效能感和症状应对自我效能感),累计贡献率为62.56%,见表5。
2.4.3 问卷的效标效度分析结果 三个分问卷与总问卷得分与NRS评分呈显著负相关性,相关系数分别为-0.514、-0.593、-0.447和-0.482(均P<0.01)。
3 讨论
美国心理学家班杜拉最早提出自我效能感这一概念[6],并且很快得到了包括心理学、组织行为学和社会学等众多领域研究人员的广泛关注和应用[7-9]。尤其是近年来,许多学者将自我效能感应用于慢性疼痛领域,且取得了一定的成果[10]。以往的文献报道显示,慢性疼痛患者的生理功能、心理状况及对疼痛的自我调节等均影响患者的疼痛自我效能感[11]。近年来,越来越多的学者认为,科学的疼痛自我效能感管理方案对疼痛患者的治疗、康复和提高生活质量均具有积极的作用[12-13],而且许多医院已经单独设立疼痛科或者设立专为肿瘤患者开设的疼痛病房,以专门缓解患者的疼痛问题,而评估疼痛自我效能感则是疼痛患者,特别是癌痛患者,临床治疗的重要依据,同时也是疼痛理论应用和发展重要研究内容[14],然而对于癌症患者这一特定人群,目前国内尚缺乏测量癌痛自我效能感的专用问卷[15],因此,需要一种科学测量工具,准确反映癌痛患者的自我效能感,以便采取及时有效的治疗措施,减轻癌痛患者的痛苦。
信度是反映问卷可靠性和准确性的重要指标。内容一致性信度用于反映问卷的内在信度,而折半信度用于反映两次问卷得分是否一致[16]。一般来说,分问卷和总问卷的内容一致性信度系数应分别大于0.60和0.80[17]。本研究结果显示,分量表Cronbach’s α系数为0.784~0.886,折半系数为0.767~0.894,总量表Cronbach’s α系数为0.897,折半系数为0.885,该结果表明癌痛自我效能感问卷应用于癌痛患者具有较高的信度。此外,首次发放问卷7 d后对患者再次进行问卷调查,总问卷的重测信度为0.864,表明该问卷具有良好的稳定性,这与Ritter等[18]的研究结果相类似。
效度是衡量问卷质量的重要指标,用来评价问卷内容和其要测量的变量是否一致[19]。本研究采用内容效度、结构效度和效标效度对癌痛自我效能感问卷进行了评价。内容效度采用分问卷和总问卷得分相关性来评估。本研究结果显示,分问卷和总问卷的相关系数为0.845~0.951,三个分问卷之间的相关系数为0.672~0.779,表明分问卷与总问卷之间及分问卷之间的得分具有高度相关性,这一结果提示本问卷具有较高的内容效度。目前,结构效度最常用采用的评价方法是因子分析法[20]。本研究结果经KMO和Bartlett检验分析显示,KMO=0.934,且P<0.01,表明适合进行因子分析,提取特征值大于1的因子共3个,累计贡献率为62.56%,表明该问卷结构合理,具有较高的结构效度,该结果与N?rgaard等[21]的报道相一致。效标效度是反映调查问卷与其他衡量标准之间的相关性,由于以往的报道表明,癌痛自我效能感与疼痛强度密切相关[22],故采用NRS评分作为效标来检验癌痛自我效能感问卷的效标关联效度。本研究结果显示,NRS评分与三个分问卷和总问卷得分呈明显负相关性,这表明癌症患者的癌痛越严重,癌痛自我效能感就越低,这与Weinberg等[23]对于疼痛自我效能感的研究结果相一致。 综上所述,癌痛自我效能感问卷应用于癌痛患者具有较好的信度和效度,可用其评价我国癌症患者的癌痛自我效能感,同时也有利于癌症患者的疼痛治疗和生活质量的提高。
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(收稿日期:2017-12-18) (本文編辑:程旭然)