Background
Methods
The study sample and setting
Study instruments
SCNS-SF34
Memorial symptom assessment scale-short form (MSAS-SF)
Short-Form-12 health survey version 2 (SF-12 v2)
Hospital anxiety and depression scale (HADS)
Statistical analysis
Factor structure and measurement invariance
Internal construct validity and convergent validity
Known-group validity
Reliability
Results
Participants’ characteristics
Mean age (SD), n=1103 | 55.41 (11.91) | Type of cancer, n (%) | Mean score of study outcomes (SD) | ||
---|---|---|---|---|---|
Gender | Breast cancer | 383 (34.63) | SCNS-SF34 | ||
Male | 451 (40.78) | Colorectal cancer | 133 (12.03) | Physical and daily living needs (PDL), n=1100 | 14.75 (14.49) |
Female | 655 (59.22) | Gynaecological cancer | 129(11.66) | Psychological needs (PSY), n=1084 | 12.42 (13.96) |
Marital status, n (%) | Prostate cancer | 75 (6.78) | Sexual need (SEX), n=1102 | 5.29 (11.46) | |
Single | 120 (10.85) | Lung cancer | 72 (6.51) | Patient care and support needs (PCS), n=1098 | 22.97 (20.46) |
Married/cohabited | 828 (74.86) | Head and neck cancer | 218 (19.71) | Health systems and information needs (HIS), n= 1086 | 34.56 (21.46) |
Divorced/separated | 87 (7.87) | Leukaemia/lymphoma | 25 (2.26) | SF-12 v2 | |
Widowed | 68 (6.15) | Sarcoma | 6 (0.54) | Physical Component Summary (PCS), n=1068 | 46.68 (8.45) |
Missing | 3 (0.27) | Hepatobiliary cancer | 8 (0.72) | Mental Component Summary (MCS), n=1068 | 44.82 (10.74) |
Education level, n (%) | Gastric cancer | 21 (1.30) | MSAS-SF | ||
No formal education | 60 (5.42) | Oesophageal cancer | 15 (1.36) | Physical Symptom subscale, n=1096 | 0.47 (0.52) |
Primary education | 318 (28.75) | Others | 21 (1.90) | Psychological Symptom subscale, n=1092 | 0.52 (0.69) |
Secondary education | 577 (52.17) | Stage of disease, n (%) | HADS | ||
Tertiary education | 149 (13.47) | Stage I | 224 (20.25) | Anxiety level, n=1100 | 2.32 (2.97) |
Missing | 2 (0.18) | Stage II | 366 (33.09) | Depression level, n=1098 | 3.06 (3.27) |
Occupation, n (%) | Stage III | 332 (30.02) | |||
Full-time | 340 (30.74) | Stage IV | 81 (7.32) | ||
Part-time | 48 (4.34) | Missing | 103 (9.31) | ||
Retired | 291 (26.31) | ||||
Housewife | 128 (11.57) | ||||
Unemployed (before diagnosis of cancer) | 28 (2.53) | ||||
Unemployed (since diagnosis of cancer) | 268 (24.23) | ||||
Missing | 3 (0.27) | ||||
Monthly household income, n (%) | |||||
≤ HKD$20,000 | 658 (59.49) | ||||
> HKD$20,001 | 380 (34.36) | ||||
Missing | 68 (6.15) |
Corrected item-total correlation | Mean (SD) | Floor scorea n (%) | Ceiling scorea n (%) | No need n (%) | Low unmet need n (%) | Moderate to high unmet need n (%) | Missing value n (%) | Rank, unmet need b | ||
---|---|---|---|---|---|---|---|---|---|---|
Physical and daily living needs (PDL) | 14.75 (14.49) | 168 (15.19%) | 1 (0.09%) | 6 (0.54%) | ||||||
1 | Pain | 0.44 | 1.70 (0.87) | 1023 (92.50%) | 20 (1.81%) | 63 (5.70%) | 21 | |||
2 | Lack of energy / tiredness | 0.54 | 1.69 (0.76) | 1047 (94.67%) | 15 (1.36%) | 44 (3.98%) | 26 | |||
3 | Feeling unwell a lot of time | 0.57 | 1.45 (0.81) | 1038 (93.85%) | 19 (1.72%) | 47 (4.25%) | 2 (0.18%) | 25 | ||
4 | Work around the home | 0.51 | 1.43 (0.75) | 1054 (95.30%) | 15 (1.36%) | 36 (3.25%) | 1 (0.09%) | 30 | ||
5 | Not being able to do the things you used to do | 0.51 | 1.69 (0.93) | 990 (89.51%) | 34 (3.07%) | 79 (7.14%) | 3 (0.27%) | 18 | ||
Cronbach’s alpha coefficient | 0.74 | |||||||||
Psychological needs (PSY) | 12.42 (13.96) | 149 (13.47%) | 22 (1.99%) | |||||||
6 | Anxiety | 0.71 | 1.59 (0.86) | 1024 (92.59%) | 20 (1.81%) | 62 (5.61%) | 22 | |||
7 | Feeling down or depressed | 0.67 | 1.42 (0.78) | 1047 (94.67%) | 15 (1.36%) | 44 (3.98%) | 27 | |||
8 | Feelings of sadness | 0.67 | 1.34 (0.71) | 1053 (95.21%) | 18 (1.63%) | 34 (3.07%) | 1 (0.09%) | 31 | ||
9 | Fears about the cancer spreading | 0.67 | 1.71 (0.97) | 981 (88.70%) | 34 (3.07%) | 88 (7.96%) | 3 (0.27%) | 17 | ||
10 | Worry that the results of treatment are beyond your control | 0.59 | 1.52 (0.88) | 1010 (91.32%) | 27 (2.44%) | 67 (6.06%) | 2 (0.18%) | 20 | ||
11 | Uncertainty about the future | 0.67 | 1.68 (0.93) | 992 (89.69%) | 31 (2.80%) | 79 (7.14%) | 4 (0.36%) | 18 | ||
12 | Learning to feel in control of your situation | 0.50 | 1.44 (0.88) | 1003 (90.69%) | 26 (2.35%) | 62 (5.61%) | 15 (1.36%) | 23 | ||
13 | Keeping a positive outlook | 0.43 | 1.17 (0.57) | 1073 (97.02%) | 11 (0.99%) | 21 (1.90%) | 1 (0.09%) | 32 | ||
14 | Feelings about death and dying | 0.56 | 1.44 (0.75) | 1050 (94.94%) | 16 (1.45%) | 37 (3.35%) | 3 (0.27%) | 29 | ||
17 | Concerns about the worries of those close to you | 0.49 | 1.67 (0.75) | 1039 (93.94%) | 21 (1.90%) | 44 (3.98%) | 2 (0.18%) | 28 | ||
Cronbach’s alpha coefficient | 0.87 | |||||||||
Sexual need (SEX) | 5.29 (11.46) | 806 (72.88%) | 2 (0.18%) | 4 (0.36%) | ||||||
15 | Changes in sexual feelings | 0.57 | 1.25 (0.55) | 1080 (97.65%) | 10 (0.90%) | 15 (1.36%) | 1 (0.09%) | 33 | ||
16 | Changes in your sexual relationships | 0.58 | 1.18 (0.48) | 1089 (98.46%) | 5 (0.45%) | 10 (0.90%) | 2 (0.18%) | 34 | ||
31 | Being given information about sexual relationships | 0.30 | 1.21 (0.74) | 1036 (93.67%) | 18 (1.63%) | 48 (4.34%) | 4 (0.36%) | 24 | ||
Cronbach’s alpha coefficient | 0.64 | |||||||||
Patient care and support needs (PCS) | 22.97 (20.46) | 129 (11.66%) | 5 (0.45%) | 8 (0.72%) | ||||||
18 | More choice about which cancer specialists you see | 0.50 | 2.02 (1.49) | 792 (71.61%) | 50 (4.52%) | 261 (23.60%) | 3 (0.27%) | 7 | ||
19 | More choice about which hospital you attend | 0.46 | 1.47 (1.06) | 976 (88.25%) | 19 (1.72%) | 109 (9.86%) | 2 (0.18%) | 16 | ||
20 | Reassurance by medical staff that the way you feel is normal | 0.56 | 1.97 (1.04) | 953 (86.17%) | 30 (2.71%) | 121 (10.94%) | 2 (0.18%) | 15 | ||
21 | Hospital staff attending promptly to your physical needs | 0.55 | 2.13 (1.05) | 916 (82.82%) | 35 (3.16%) | 151 (13.65%) | 4 (0.36%) | 9 | ||
22 | Hospital staff acknowledging, and showing sensitivity to, to your feelings and emotional needs | 0.55 | 2.01 (1.11) | 907 (82.01%) | 50 (4.52%) | 146 (13.20%) | 3 (0.27%) | 11 | ||
Cronbach’s alpha coefficient | 0.76 | |||||||||
Health systems and information needs (HSI) | 34.56 (21.46) | 32 (2.89%) | 20 (1.80%) | |||||||
23 | Being given written information about the important aspects of your care | 0.52 | 2.34 (1.58) | 723 (65.37%) | 55 (4.97%) | 323 (29.20%) | 5 (0.45%) | 4 | ||
24 | Being given information (written, diagrams, drawings) about aspects of managing your illness and side-effects at home | 0.45 | 1.71 (1.17) | 929 (84.00%) | 38 (3.44%) | 138 (12.48%) | 1 (0.09%) | 14 | ||
25 | Being given explanations of those tests for which you would like explanations | 0.65 | 2.46 (1.39) | 745 (67.36%) | 55 (4.97%) | 303 (27.40%) | 3 (0.27%) | 6 | ||
26 | Being adequately informed about the benefits and side-effects of treatments before you choose to have them | 0.61 | 2.35 (1.23) | 834 (75.41%) | 44 (3.98%) | 222 (20.07%) | 6 (0.54%) | 8 | ||
27 | Being informed about your test results as soon as feasible | 0.60 | 2.64 (1.36) | 742 (67.09%) | 43 (3.89%) | 316 (28.57%) | 5 (0.45%) | 5 | ||
28 | Being informed about cancer which is under control or diminishing (that is, remission) | 0.59 | 2.94 (1.48) | 619 (55.97%) | 42 (3.80%) | 437 (39.51%) | 8 (0.72%) | 2 | ||
29 | Being informed about things you can do to help yourself to get well | 0.58 | 2.78 (1.49) | 634 (57.32%) | 72 (6.51%) | 396 (35.80%) | 4 (0.36%) | 3 | ||
30 | Having access to professional counseling (e.g. psychologist, social worker, counselor, nurse specialist) if you, family or friends need it | 0.46 | 1.68 (1.21) | 913 (82.55%) | 40 (3.62%) | 150 (13.56%) | 3 (0.27%) | 10 | ||
32 | Being treated like a person not just another case | 0.49 | 2.05 (1.08) | 915 (82.73%) | 42 (3.80%) | 145 (13.11%) | 4 (0.36%) | 13 | ||
33 | Being treated in a hospital or clinic that is physically pleasant as possible | 0.46 | 2.14 (1.02) | 920 (83.18%) | 37 (3.35%) | 146 (13.20%) | 3 (0.27%) | 12 | ||
34 | Having one member of hospital staff with whom you can talk to about all aspects of your condition, treatment and follow-up | 0.56 | 3.15 (1.70) | 476 (43.04%) | 53 (4.79%) | 573 (51.81%) | 4 (0.36%) | 1 | ||
Cronbach’s alpha coefficient | 0.85 |
Factor structure and measurement invariance across gender and age groups
Chi-square value of model fit | DF | p-value | CFId | TLId | RMSEAd | 90% CI | |
---|---|---|---|---|---|---|---|
Baseline model | 1762.722 | 517 | < 0.001 | 0.952 | 0.947 | 0.047 | 0.044, 0.049 |
Measurement invariance across gender | |||||||
Model 1 a | 2240.351 | 1049 | < 0.001 | 0.950 | 0.946 | 0.045 | 0.043, 0.048 |
Model 2 b | 2246.337 | 1160 | < 0.001 | 0.954 | 0.956 | 0.041 | 0.039, 0.044 |
Chi-Square difference test for measurement invariance across gender | |||||||
Chi-square value | DF | p-valuec | |||||
120.256 | 111 | 0.2581 | |||||
Measurement invariance across age groups | |||||||
Chi-square value of model fit | DF | p-value | CFI | TLI | RMSEA | 90% CI | |
Model 1 a | 2172.758 | 1049 | < 0.001 | 0.948 | 0.944 | 0.045 | 0.042, 0.048 |
Model 2 b | 2226.458 | 1160 | < 0.001 | 0.953 | 0.954 | 0.041 | 0.038, 0.043 |
Chi-Square difference test for measurement invariance across age groups | |||||||
Chi-square value | DF | p-valuec | |||||
113.049 | 111 | 0.4280 |
Internal construct validity and convergent validity
HADS Anxiety | HADS Depression | MSAS-PHY | MSAS-PSYC | SF-12 v2 PCS | SF-12 v2 MCS | |
---|---|---|---|---|---|---|
Physical and daily living needs (PDL) | 0.39** | 0.45** | 0.53** | 0.44** | − 0.48** | − 0.39** |
Psychological needs (PSY) | 0.65** | 0.54** | 0.45** | 0.64** | − 0.33** | − 0.46** |
Sexual need (SEX) | 0.14** | 0.17** | 0.18** | 0.19** | −0.15** | −0.11** |
Patient care and support needs (PCS) | 0.37** | 0.28** | 0.23** | 0.37** | −0.20** | −0.24** |
Health systems and information needs (HSI) | 0.35** | 0.26** | 0.25** | 0.35** | −0.20** | −0.23** |
Known-group validity
60 years or below | > 60 years | Cohen’s D effect Size | P-value | |||
---|---|---|---|---|---|---|
n | Mean (SD) | n | Mean (SD) | |||
Physical and daily living needs (PDL) | 732 | 16.08 (15.03) | 365 | 12.12 (13.01) | 0.28 | < 0.001 |
Psychological needs (PSY) | 723 | 14.36 (14.96) | 359 | 8.49 (10.73) | 0.45 | < 0.001 |
Sexual need (SEX) | 735 | 6.56 (12.06) | 365 | 2.74 (9.71) | 0.35 | < 0.001 |
Patient care and support needs (PCS) | 734 | 25.66 (20.78) | 362 | 17.49 (18.71) | 0.41 | < 0.001 |
Health systems and information needs (HSI) | 727 | 37.35 (20.95) | 357 | 28.93 (21.46) | 0.40 | < 0.001 |
Males | Females | Cohen’s D effect Size | P-value | |||
n | Mean (SD) | n | Mean (SD) | |||
Physical and daily living needs (PDL) | 450 | 13.51 (13.80) | 650 | 15.61 (14.30) | 0.15 | 0.02 |
Psychological needs (PSY) | 444 | 9.76 (11.57) | 640 | 14.27 (15.14) | 0.33 | < 0.001 |
Sexual need (SEX) | 449 | 5.44 (11.33) | 653 | 5.18 (11.56) | 0.02 | 0.69 |
Patient care and support needs (PCS) | 447 | 18.50 (18.69) | 651 | 26.04 (21.07) | 0.38 | < 0.001 |
Health systems and information needs (HSI) | 443 | 30.53 (20.93) | 643 | 37.35 (21.40) | 0.32 | < 0.001 |