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BMC Cancer
Published in: BMC Cancer 1/2016

Open Access 01-12-2016 | Research article

Validation of the flemish CARES, a quality of life and needs assessment tool for cancer care

Authors: Bojoura Schouten, Johan Hellings, Elke Van Hoof, Patrick Vankrunkelsven, Paul Bulens, Frank Buntinx, Jeroen Mebis, Dominique Vandijck, Ward Schrooten

Published in: BMC Cancer | Issue 1/2016

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Abstract

Background

The Cancer Rehabilitation Evaluation System (CARES) is a quality of life (QOL) and needs assessment instrument of US origin that was developed in the 90’s. Since November 2012 the copyright and user fee were abolished and the instrument became publicly available the present study aims to reinvestigate the psychometric properties of the CARES for the Flemish population in Belgium.

Methods

The CARES was translated into Flemish following a translation-back translation process. A sample of 192 cancer patients completed the CARES, concurrent measures, and questions on socio-demographic and medical data. Participants were asked to complete the CARES a second time 1 week later, followed by some questions on their experiences with the instrument. Internal consistency, test-retest reliability, content validity, construct validity, concurrent validity and feasibility of the CARES were subsequently assessed.

Results

The Flemish CARES version demonstrated excellent reliability with high internal consistency (range .87–.96) and test-retest ratings (range .70–.91) for all summary scales. Factor analysis replicated the original factor solution of five higher order factors with factor loadings of .325–.851. Correlations with other instruments ranging from |.43|–|.75| confirmed concurrent validity. Feasibility was indicated by the low number of missing items (mean 2.3; SD 5.0) and positive feedback of participants on the instrument.

Conclusions

The Flemish CARES has strong psychometric properties and can as such be a valid tool to assess cancer patients’ QOL and needs in research, for example in international comparisons. The positive feedback of participants on the CARES support the usefulness of this tool for systematic assessment of cancer patients’ well-being and care needs in clinical practice.

Trial registration

ClinicalTrials.gov: NCT02282696 (July 16, 2014).
Appendix
Available only for authorised users
Literature
1.
Kodner DL, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications--a discussion paper. Int J Integr Care. 2002;2:1568–4156.CrossRef
2.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington: National Academy Press; 2001.
3.
Warrington L, Absolom K, Velikova G. Integrated care pathways for cancer survivors-a role for patient-reported outcome measures and health informatics. Acta Oncol. 2015;54:1–9.CrossRef
4.
Accreditation Canada. Omentum program 2009 standards: cancer care and oncology services (ver 2). Ottawa: Accreditation Canada; 2008.
5.
Breitbart W, Rosenfeld B, Pessin H, Applebaum A, Kulikowski J, Lichtenthal WG. Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. J Clin Oncol. 2015;33(7):749–54.CrossRefPubMedPubMedCentral
6.
Holland J, Watson M, Dunn J. The IPOS new International Standard of Quality Cancer Care: integrating the psychosocial domain into routine care. Psychooncology. 2011;20(7):677–80.CrossRefPubMed
7.
Meyer LA, Nick AM, Shi Q, Wang XS, Williams L, Brock T, Iniesta MD, Rangel K, Lu KH, Ramirez PT. Perioperative trajectory of patient reported symptoms: a pilot study in gynecologic oncology patients. Gynecol Oncol. 2015;136(3):440–5.CrossRefPubMedPubMedCentral
8.
9.
Institute of Medicine. Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs. Washington, DC: The National Academies Press; 2008. doi:10.​17226/​11993.
10.
Merckaert I, Libert Y, Messin S, Milani M, Slachmuylder JL, Razavi D. Cancer patients’ desire for psychological support: prevalence and implications for screening patients’ psychological needs. Psychooncology. 2010;19(2):141–9.CrossRefPubMed
11.
Carlson LE, Groff SL, Maciejewski O, Bultz BD. Screening for distress in lung and breast cancer outpatients: a randomized controlled trial. J Clin Oncol. 2010;28(33):4884–91.CrossRefPubMed
12.
Bauwens S, Baillon C, Distelmans W, Theuns P. Systematic screening for distress in oncology practice using the Distress Barometer: the impact on referrals to psychosocial care. Psychooncology. 2014;23(7):8004–844.CrossRef
13.
Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P. The unmet supportive care needs of patients with cancer. Supportive Care Review Group. Cancer. 2000;88(1):226–37.CrossRefPubMed
14.
Ganz PA, Schag CC, Heinrich RL. The psychosocial impact of cancer on the elderly: a comparison with younger patients. J Am Geriatr Soc. 1985;33(6):429–35.CrossRefPubMed
15.
Ganz PA, Schag CA, Cheng HL. Assessing the quality of life--a study in newly-diagnosed breast cancer patients. J Clin Epidemiol. 1990;43(1):75–86.CrossRefPubMed
16.
Heinrich RL, Schag CC, Ganz PA. Living with cancer: the cancer inventory of problem situations. J Clin Psychol. 1984;40(4):972–80.CrossRefPubMed
17.
Schag CA, Heinrich RL, Aadland RL, Ganz PA. Assessing problems of cancer patients: psychometric properties of the cancer inventory of problem situations. Health Psychol. 1990;9(1):83–102.CrossRefPubMed
18.
Schag CA, Heinrich RL. Cancer Rehabilitation Evaluation System (CARES) Manual. Los Angeles: CARES Consultants; 1989.
19.
Schag CA, Heinrich RL. Development of a comprehensive quality of life measurement tool: CARES. Oncology. 1990;4(5):135–8. discussion 147.PubMed
20.
Meyerowitz BE, Heinrich RL, Schag CC. A competency-based approach to coping with cancer. In: Bradley L, Burish TG, editors. Coping with Chronic Disease: Research and Applications. New York: Academic; 1983.
21.
Schag CC, Heinrich RL, Ganz PA. The Cancer inventory of problem situations: an instrument for assessing cancer patients’ rehabilitation needs. J Psychosoc Oncol. 1983;1:11–24.CrossRef
22.
Deragotis LR. SCL-90-R. Manual-I. Baltimore: John Hopkins University School of Medicine; 1977.
23.
Spanier GB. Measuring dyadic adjustment. New scales for assessing the quality of marriage and similar dyads. J Marriage Fam. 1976;38(1):15–28.CrossRef
24.
Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol. 1984;2(3):187–93.PubMed
25.
Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In: Macleod CM, editor. Evaluation of Chemotherapeutic Agents. New York: Columbia University Press; 1949.
26.
Gough IR, Furnival CM, Schilder L, Grove W. Assessment of the quality of life of patients with advanced cancer. Eur J Cancer Clin Oncol. 1983;19(8):1161–5.CrossRefPubMed
27.
Ganz PA. Cancer Rehabilitation Evaluation System (CARES) and CARES-SF now publicly available. J Clin Oncol. 2012;30(32):4046–7.CrossRefPubMed
28.
Gjersing L, Caplehorn JR, Clausen T. Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol. 2010;10(1):1–10.CrossRef
29.
Harkness JA S-GA. Questionnaires in translation. In: JA H, editor. ZUMA Nachrichten Spezial No 3 Cross-Cultural Survey Equivalence. Mannheim: ZUMA; 1998.
30.
Harkness JA, Pennell B-E, Schoua-Glusberg A. Survey Questionnaire Translation and Assessment. In: Presser S, Rothgeb JM, Couper MP, Lessler JT, Martin E, Martin J, Singer E, editors. Methods for Testing and Evaluating Survey Questionnaires. New York: Wiley; 2004.
31.
Schouten B, Van Hoof E, Vankrunkelsven P, Schrooten W, Bulens P, Buntinx F, Mebis J, Vandijck D, Cleemput I, Hellings J. Assessing cancer patients’ quality of life and supportive care needs: Translation-revalidation of the CARES in Flemish and exhaustive evaluation of concurrent validity. BMC Health Serv Res. 2016;16(1):86.CrossRefPubMedPubMedCentral
32.
Terwee CB, Bot SD, De Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, De Vet HC. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34–42.CrossRefPubMed
33.
Sobin LH, Wittekind CH. TNM Classification of Malignant Tumours. 6th ed. Hoboken: Wiley; 2002.
34.
Mor V, Laliberte L, Morris JN, Wiemann M. The Karnofsky Performance Status Scale. An examination of its reliability and validity in a research setting. Cancer. 1984;53(9):2002–7.CrossRefPubMed
35.
Spinhoven P, Ormel J, Sloekers PP, Kempen GI, Speckens AE, Van Hemert AM. A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychol Med. 1997;27(2):363–70.CrossRefPubMed
36.
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.CrossRefPubMed
37.
Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010;126(3):335–48.CrossRefPubMed
38.
Van Sonderen E. The measurement of social support with the Social Support List-Interactions (SSL-I) and the Social Support List-Discrepancies (SSL-D). Dutch manual. Groningen: Noordelijk Centrum voor Gezondheidsvraagstukken; 1993.
39.
Bridges KR, Sanderman R, Van Sonderen E. An English language version of the social support list: preliminary reliability. Psychol Rep. 2002;90(3 Pt 1):1055–8.CrossRefPubMed
40.
Van Sonderen E. Het meten van sociale steun met de Sociale Steun Lijst-Interacties (SSL-I) en Sociale Steun Lijst-Discrepanties (SSL-D): een handleiding. Tweede herziene druk. Groningen: UMCG /Rijksuniversiteit Groningen, Research Institute SHARE; 2012.
41.
Arrindell WA, Boelens W, Lambert H. On the psychometric properties of the Maudsley Marital Questionnaire (MMQ): Evaluation of self-ratings in distressed and ‘normal’ volunteer couples based on the Dutch version. Pers Individ Dif. 1983;4(3):293–306.CrossRef
42.
Arrindell WA, Schaap C. The Maudsley Marital Questionnaire (MMQ): an extension of its construct validity. Br J Psychiatry. 1985;147:295–9.CrossRefPubMed
43.
Orathinkal J, Vansteenwegen A, Enright RD, Stroobants R. Further validation of the Dutch version of the Enright Forgiveness Inventory. Community Ment Health J. 2007;43(2):109–28.CrossRefPubMed
44.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, De Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.CrossRefPubMed
45.
Tuinman MA, Gazendam-Donofrio SM, Hoekstra-Weebers JE. Screening and referral for psychosocial distress in oncologic practice: use of the Distress Thermometer. Cancer. 2008;113(4):870–8.CrossRefPubMed
46.
Holland JC, Andersen B, Breitbart WS, Dabrowski M, Dudley MM, Fleishman S, Foley GV, Fulcher C, Greenberg DB, Greiner CB, et al. Distress management. J Natl Compr Canc Netw. 2007;5(1):66–98.PubMed
47.
Bauwens S, Baillon C, Distelmans W, Theuns P. The ‘Distress Barometer’: validation of method of combining the Distress Thermometer with a rated complaint scale. Psychooncology. 2009;18(5):534–42.CrossRefPubMed
48.
Pauwels EE, Charlier C, De Bourdeaudhuij I, Lechner L, Van Hoof E. Care needs after primary breast cancer treatment. Survivors’ associated sociodemographic and medical characteristics. Psychooncology. 2013;22(1):125–32.CrossRefPubMed
49.
Schouten B, Hellings J, Vankrunkelsven P, Vanhaecht K. Screening Cancer Patients’ Distress and Care Needs: Translation and Validation of the Cancer Rehabilitation Evaluation System (CARES) for the Flemish Population in Belgium [abstract]. Psychooncology. 2013;22:305–6.
50.
Nunnally JC, Bernstein IH. Psychometric theory. 3rd ed. New York: McGraw-Hill; 1994.
51.
Terwee CB, Dekker FW, Wiersinga WM, Prummel MF, Bossuyt PM. On assessing responsiveness of health-related quality of life instruments: guidelines for instrument evaluation. Qual Life Res. 2003;12(4):349–62.CrossRefPubMed
52.
Bartko JJ. The intraclass correlation coefficient as a measure of reliability. Psychol Rep. 1966;19(1):3–11.CrossRefPubMed
53.
Burns N, Grove SK. The practice of nursing research. 4th ed. Philadelphia: US: WB. Saunders; 2001.
54.
BelgianCancerRegistry. Cancer Prevalence in Belgium 2010. Brussels: Belgian Cancer Registry; 2014.
Metadata
Title
Validation of the flemish CARES, a quality of life and needs assessment tool for cancer care
Authors
Bojoura Schouten
Johan Hellings
Elke Van Hoof
Patrick Vankrunkelsven
Paul Bulens
Frank Buntinx
Jeroen Mebis
Dominique Vandijck
Ward Schrooten
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2016
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-016-2728-9

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