Assessment tools for cancer patients

Zhang , Ph. Author information Copyright and License information Disclaimer. Corresponding author. Copyright notice. The publisher's final edited version of this article is available at Psychooncology.

This article has been corrected. See Psychooncology. See other articles in PMC that cite the published article. Abstract Purpose Caregivers and cancer patients frequently have conflicting and unmet communication needs. Methods The scale was developed using a sample of lung cancer patient - caregiver pairs. Introduction Diagnosis of cancer frequently leads to increased involvement of family members as caregivers and, ultimately, decision-makers.

Methods Data Collection The scale was developed and validated with a case series of patients with advanced stage III and IV non-small cell lung cancer and the caregivers identified by patients. Open in a separate window. Association of Communication Concordance and Other Psychosocial Characteristics We examined how family conflict was associated with patient and caregiver demographic characteristics.

Discussion and Conclusions The CCAT-PF is a valid and reliable tool to assess cancer patient-family communication congruence about treatment and care decisions. Acknowledgments Acknowledgement of research support: This study was funded through a grant awarded to Laura A.

Interpreting the score The maximum range of scores of the CCAT-PF is from 0 to 90 with higher scores indicating greater discrepancy or conflict. Compute the CCAT-P or CCAT-F as stand alone instruments as follows: The items that require reverse coding prior to creation of summary scores are items 5, 9, 10, 11, 12, 20, 21, 22, 23, 25, 27, 28 and Interpreting the score The maximum range of scores for either the patient-specific or the caregiver-specific scale is from 18 to with higher scores indicating greater conflict.

List of Items Patient Family My family plays a big role in the decisions I make about my cancer treatment. Our family plays a big role in making decisions about cancer treatment. I hesitate to mention treatment side effects to my doctors or nurses. My family member hesitates to mention treatment side effects to doctors or nurses. In general, side effects are not really important when I consider my larger goals of treatment. Medical science may find a cure for cancer so I am willing to take any treatment now to stay alive.

Medical science may find a cure for cancer so I want my family member to take any treatment now to stay alive. If treatment caused financial hardship for my family, I would not take it. My family and I have different views about the goal of treatment. My family member and I have different views about the goal of treatment. If treatment made me sick everyday I would not take it.

I could see that there could come a point when taking treatment would not be worth the discomfort it causes. I am willing to take treatment that causes me a significant amount of pain if I can live a few months longer. My family member values my judgment about treatment decisions. My acceptance of treatment decisions depends on how much I like the doctor s. It is important to base decisions about my cancer treatment on sources of information other than my doctor.

It is important to base decisions about cancer treatment on sources of information other than the doctor. My family does not really listen when I talk about my cancer.

I am frustrated when my family is overprotective of me because of my cancer. My family blames my cancer on my not having taken better care of myself. I would feel uncomfortable if the doctor began to talk to me about hospice care. I would feel uncomfortable if the doctor began to talk to my family member about hospice care. Contributor Information Laura A. References 1. Perceptions of family functioning and cancer.

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Factors related to patient's mental adjustment to breast cancer: patient characteristics and family functioning. Only items with mean scores significantly greater than zero were retained. The second step computed the multiple correlation of each item with all other items.

A high multiple correlation indicates item redundancy. A Kappa statistic was computed to indicate the exact degree of concordance of responses between patient and caregiver corrected for chance assignment. Scores below 0. Finally, we conducted a series of backward elimination regression analyses using the total score derived from the sum of the 30 absolute item difference scores as the dependent variable to further identify redundancy. The analyses continued until no further items could be eliminated and all remaining items made significant independent contributions to the prediction of the item total score.

Once all of the analyses were completed, a panel comprised of the 4 authors and a data analyst met to complete the item reduction. Each panelist independently rated whether to keep an item by considering the psychometric properties of each item using the analyses described above and theoretical considerations.

The panelists then met and were initially in complete agreement about retaining 11 of the 30 scale items. Another round of discussion settled on the next five items where disagreement centered on choosing between equivalent items that measured the same domains.

Lastly, it was agreed to retain 2 items for content purposes. The final scale consisted of 18 items with 8 domains; a high sum total of the item absolute difference scores CCAT-PF indicating disagreement between patient and caregiver. In addition, a simple raw sum of the 18 items for patients and caregivers separately was also computed. The psychometric properties of the scale were examined by testing the reliability and validity of the item CCAT-PF scale as well as the patient and caregiver specific scales.

Concurrent validity was assessed by correlational analysis, using the Pearson correlation statistic, to assess the degree of association between CCAT-PF, patient specific, and caregiver specific scores and scores on the standard outcome measures selected for this study.

Overall, patients were older mean 65 years vs. Reduction of item redundancy ensures that the CCAT-PF covers a wide range of content areas where families disagree resulting in a scale of relatively independent items. Item parsimony and independence, however, affect estimates of internal consistency reliability. This value of internal consistency is to be expected, as the CCAT-PF does not represent a typical summed scale of moderately correlated items, but the sum of mostly independent items.

For of the patient-caregiver pairs, the family conflict measure was administered twice. Loss of patients to follow up was mostly due to patient mortality. Thus, over a short period of follow-up, the average conflict between patient and caregiver decreased. More work needs to be done to understand this phenomenon. These included computation of patient and caregiver summary scores based on individual responses to the 18 items. The correlation between the two individual summary scores was 0.

The item statistics also reflect what was also observed in the item correlation matrix, that the different content areas of disagreement did not correlate with each other, i. Therefore, it may be useful to examine the 8 individual domain scores separately in addition to the total score. A copy of the instrument is available from the corresponding author on request.

We examined how family conflict was associated with patient and caregiver demographic characteristics. The CCAT-PF scores were not associated with the following patient or caregiver demographics: gender, race, marital status, education, or religion.

High CCAT-P scores were associated with the same five outcomes plus lower patient reported cohesion, emotional well-being, and patient functional well-being. Further evidence for the validity of the item CCAT-PF score and evidence for the individual caregiver score are provided in Table 4. High conflict scores were associated with lower scores on caregiver expressiveness, social functioning, and caregiver perceived family cohesion, and lower caregiver-family assessment.

The CCAT-PF is a valid and reliable tool to assess cancer patient-family communication congruence about treatment and care decisions. The importance of developing this tool is underscored by the increased importance of the role of families in caring for cancer patients, including the shift of the therapeutic setting from in- to out-patient treatment.

Patients who fail to communicate or who are experiencing communication discord with caregivers are at risk for poorer outcomes. The rigorous development process, ranging from item development to testing its statistical properties, in addition to its acceptance in a patient population of late-stage lung cancer patients and their families, emphasizes the usefulness of this new tool.

The CCAT-PF had convergent and divergent validity across a spectrum of well-validated social and physical status instruments. Interestingly, caregivers who are younger or who are the adult children of older patients also reported higher discord scores. This may in part be the result of a generational mismatch concerning expectations for care and approach to serious illness.

The study revealed that family caregivers are more aware of and affected by communication problems than the patient. The implications of this are two-fold.

First, obtaining only the CCAT-F can provide an acceptable measure of discord on the part of the caregiver in the absence of the patient-completed portion of the scale.

The implications for clinical care are that caregivers may be experiencing greater stress than patient. Provision of mental health and other supportive services to the caregiver may also indirectly benefit patient outcomes.

Finally, the higher CCAT-PF scores were found to be significantly correlated with greater patient depression, lower patient-caregiver assessment and well-being, and less expressiveness and family cohesion. These findings highlight the importance of identifying and ameliorating communication problems early. First, the study was conducted at a single geographical location. Third, a single diagnostic category, lung cancer, was included.

However, a small pilot study was subsequently conducted with a sample of 52 hematological cancer patients. This patient sample was slightly younger than the original lung cancer patient sample and had a mean age of Mean scores were Mean difference scores between patient-caregiver pairs were also similar, The tool was accepted by both patients and families.

Although administering both family and patient versions is optimal, administering it to a patient or family caregiver only can produce reliable information. Acknowledgement of research support: This study was funded through a grant awarded to Laura A. The CCAT-PF is a valid and reliable instrument for obtaining information about communication concordance and conflict between cancer patients and their caregivers.

It is comprised of two parts. The CCAT-P is an 18 item instrument completed by the patient about their preferences, values and experiences in making treatment and care decisions, with an emphasis on how family caregivers fit into this process. The CCAT-PF is ideally used as a measure of discrepancy between the perceptions and expectations of patients as compared to those of a family caregiver. In general, it is recommended that the caregiver who is the primary caregiver i.

Scoring instructions for this are also provided. Subtract the patient response from the caregiver response separately for each of the 18 items. This will produce 18 item differences, some positive and some negative. Convert the signed differences into 18 absolute difference values. The maximum range of scores of the CCAT-PF is from 0 to 90 with higher scores indicating greater discrepancy or conflict. Patient-specific or caregiver-specific summary scores are based on the separate patient and caregiver responses to the 18 items.

To compute a patient-specific or a caregiver-specific summary score, 13 of the 18 items must be reversed coded i. The items that require reverse coding prior to creation of summary scores are items 5, 9, 10, 11, 12, 20, 21, 22, 23, 25, 27, 28 and The maximum range of scores for either the patient-specific or the caregiver-specific scale is from 18 to with higher scores indicating greater conflict. Laura A. Stephen J. Amy Y. National Center for Biotechnology Information , U. Search database Search term.

Author manuscript; available in PMC Mar 1. Siminoff , PhD, Stephen J. Zhang , Ph. Author information Copyright and License information Disclaimer. Corresponding author. By having a keen understanding of symptoms, assessment procedures, and necessary response skills, oncology nurses can work together with the mental health team to provide holistic care throughout the cancer journey.

Oncology professionals must check their own emotional responses when treating this patient population. By recognizing different mental illnesses and their associated behaviors, symptoms, and treatments, healthcare professionals can understand the specific profile of each patient and his or her condition.

Through collaboration, nurses can learn the unique language of mental illness and close the gap between patient and provider. When caring for patients who struggle with mental challenges, oncology nurses should consider implementing concepts from Psychological First Aid PFA.