DOI: https://doi.org/10.21203/rs.3.rs-1253643/v1
The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QL) Group has developed the EORTC INFO module to evaluate information received by cancer patients. The aim of this study is to examine the validity and reliability of the Turkish version of the EORTC QLQ-INFO25 scale.
Turkish version of the EORTC QLQ-INFO25, EORTC QLQ-C30 and EORTC IN-PATSAT32 questionnaires were applied to 197 patients at different stages of the disease and in the chemotherapy, radiotherapy, and surgery stages of the treatment. For the reliability and validity of the questionnaire, Cronbach's alpha, inter- scale correlation and factor analysis were used.
As a result of validity analysis; according to factor analysis findings, the explained variance of the scale was found to be sufficient with 66.68%. As a result of reliability analysis, Cronbach’s alpha coefficient was 0.92 for the entire questionnaire, which showed that the reliability of the scale was high. The correlation of each item with its own scale (Rho ≥ 0.6) represents a high convergent validity. The selected questions of EORTC IN-PATSAT32 and Pearson correlation coefficients between the 4 determined areas and 2 items of EORTC QLQ-INFO25 showed high convergent validity. Low correlation (Spearman Rho < 0.2) was found between the EORTC-QLQ-C30 questionnaire and the different areas of the EORTC QLQ-INFO25 questionnaire, indicating that the two questionnaires measured different concepts.
It was determined that the Turkish version of the EORTC QLQ-INFO25 scale is a valid, reliable tool for measuring the knowledge level of cancer patients and can be used in Turkish society.
Cancer is one of the major health problems in the world and in our country, which ranks second as a cause of death in Turkey [1, 2]. With the increase in the incidence of cancer, an increase is observed in the search for information about cancer of the patients and their relatives. In the study conducted by Akgül et al., it was reported that patients mostly obtained information about the disease and treatment from the doctor and the internet and found the communication of the assistant health personnel inadequate [3]. In the research of Schmid Büchi et al., it was found that cancer patients do not have enough information and they need information and professional support about the management and treatment of the disease [4]. Compliance of treatment, communication ability, satisfaction level and quality of life of patients who reach reliable and quality information are also increasing [5].
The level of knowledge is influenced by many factors including age, race, education, economic status, cancer region and stage [6, 7]. According to the studies carried out, patients with advanced cancer often receive limited information, while individuals with higher education levels receive more detailed information. Studies on the quantity and quality of the information provided to patients and their families need to be increased [7].
The studies in the field of oncology are increasing day by day and the level of knowledge provided in this field is improving. Tools developed to evaluate the level of knowledge about cancer are very important in clinical research [8]. In our country, a limited number of measurement tools are available to measure the amount of information given to cancer patients. Cancer Information Burden Scale is one of the measurement tools adapted to Turkish and whose validity and reliability has been proven to be used for this purpose. Most of the other scales evaluate the needs and satisfaction levels of patients [3]. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life (QL) has developed the EORTC Quality of Life Questionnaire-Information Module (EORC QLQ-INFO25) scale, which assesses the level of knowledge from cancer patients at different stages of care. The structure, validity, and reliability of the EORTC QLQ-INFO25 scale were tested in a large international and multi-cultural cancer population at different stages of the disease and treatment. This scale is used during routine clinical practice in the oncology department in both national and international studies. The EORTC QL working group suggests that the validity studies of their scales should be done for each country [9]. The aim of this study is to translate the EORTC QLQ-INFO25 scale into Turkish, to examine its validity and reliability and to investigate the effect of cultural difference on the patient's level of knowledge.
Our study was conducted with the approval of the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (dated 15.08.2018, decision 446). All individuals included in the study were given detailed information about the purpose, method, and duration of the study. In addition, patients were signed with an "Informed Consent Form". The identities of the participants were kept strictly confidential and only aggregate data were reported.
Power analysis was applied to calculate the required sample size. As a result of the calculation made using G-power analysis, the minimum sample number required for 95% reliability and 80% power was determined as 220. Our study is multidisciplinary care center in Turkey Istanbul Medipol University Hospital Complex of Hematology-Oncology section referencing between the years 2018-2020, the results of clinical and radiographic examinations are diagnosed with cancer and was conducted on patients who volunteered to participate in the study. Adult individuals over the age of 18 who received radiotherapy and/or chemotherapy treatment due to the primary tumor at different stages of the disease were included in the study. Individuals who do not have sufficient mental and speaking capacity in terms of understanding and answering the questionnaires and who have psychological morbidity were excluded from the study.
Patients who applied to the Hematology-Oncology Department between August 2018-January 2020 were included prospectively in the study. During the interviews, all questions in the Turkish version of the EORTC QLQ-INFO25 questionnaire were read carefully to the participants by experts in oncology and made sure that the participant understood correctly. Additional information about each patient's disease and medical history was collected from the patient's medical records. The first 10 patients registered were evaluated in a pilot study to confirm the questionnaire and were not included in the statistical analysis of the study.
A demographic form prepared by the researchers was filled in as the first step. In this form, it included questions giving information about the age, gender, marital status, education level, systemic disease, and diagnosis of the cancerous individual. In addition, a total of three questionnaires were conducted: EORTC QLQ-INFO25, EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30) and inpatient satisfaction module EORTC Cancer In-Patient Satisfaction with Care Questionnaire (IN-PATSAT32) survey. In the EORTC QLQ-C30 and EORTC IN-PATSAT32 surveys both in Turkey and standardization it has been translated before they were surveyed [10, 11].
EORTC QLQ-INFO25 is a 25-item questionnaire with information about the disease (4 items), medical tests (3 items), treatment (6 items), other services (4 items) and 8 additional topics. In addition to the survey, there are questions about self-help, different areas of care, receiving written and/or digital information, satisfaction with the information received, the desire to receive more or less information, and the usefulness of the information received. Response format is made according to 4-point Likert scale (1-nothing, 2-some, 3-quite, 4-very much). Items 52, 53, 54 and 55, which question whether they are satisfied with the level of information they receive and whether they want more information, have a two-way answer as Yes/No. Patients who respond positively to questions about requests for more or less information are asked to provide more detailed information on the subject. The scores of these items are converted linearly to 0-100 scale according to the EORTC guide [12]. The EORTC QLQ-INFO25 questionnaire was translated from English to Turkish using the translation / reversal method and was then translated back to English by a different translator who did not see the original version of the questionnaire. In 10 consecutive interviews with oncology patients, the questionnaire was tested for understanding and clarity, and no changes were made afterwards. The Turkish version of the questionnaire was approved by the EORTC translation unit after careful evaluation of the data from the pilot test.
The EORTC QLQ-C30 scale has three subtitles and 30 questions: general well-being, functional difficulties, and symptom control. Functional scales; physical, role, cognitive, emotional, and social functions; Symptom scales are assessed by weakness, pain, and nausea-vomiting. There are also questions related to dyspnea, insomnia, loss of appetite, constipation, diarrhea, and financial difficulties. The first 28 of the 30 questions in the scale are four-point Likert type (None: 1, A little: 2, Quite: 3, A lot: 4 points). General health in question 29 and general quality of life in question 30 are scored from 1 to 7 (1: very bad and 7: excellent). High scores of functional scale and general health status scale of patients; low symptom scale score indicates that the quality of life is high. Scores are calculated by converting the scores of the answers given to the questions to 100 [13].
The EORTC IN-PATSAT32 questionnaire is an internationally valid 32-item questionnaire that evaluates the quality of hospital care during oncology patients' stay in the hospital. The 32 items in the survey are also five-point Likert type (Bad: 1, Not bad: 2, Good: 3, Very good: 4, Excellent: 5 points). The first 11 questions are doctors, 12-22. questions nurses, 23-31. The questions generally question the hospital services and the care system, while the 32nd question questions the hospital stay in general. High score indicates that the quality of hospital care has increased, and low score indicates that the quality of hospital care has decreased [14].
The data were analyzed with SPSS 25.0 version. Categorical and continuous variables were studied using frequencies and mean ± standard deviations. In the study, multivariate statistics were used statistically. Kolmogorov-Smirnov and Shapiro-Wilk tests were used for normality evaluation. Factor analysis for validity, Cronbach’s Alfa, which is the internal consistency coefficient for reliability, was calculated. While making the correlation analysis between the scales, nonparametric test (Mann-Whitney test), parametric test (Student t test), and Anova tests were applied for the differences between the groups.
Ten women with a mean age of 54 ± 13 were included in the study. 5 patients were breast, 1 patient bone, 1 patient pancreas, 1 patient lung, 1 patient ovary, 1 patient brain cancer. The internal validity of INFO 25 was analyzed using the Cronbach alpha coefficient (a). Internal consistency showed a reliability of 0.917.
A total of 220 patients were evaluated. 23 patients were excluded from the study because they gave inconsistent answers. Finally, 197 patients were included in the study. 31 of the participants were male (15.7%) and 166 were female (84.3%). The average age of the participants was 53 ± 13 years. The majority of patients were married (83.8%). Considering the education level, 68.5% of the patients were below the compulsory education level (defined as school education for more than 12 years), 20.3% were at the compulsory education level and 11.1% were above the compulsory education level. The most common tumor was breast cancer (49.7%) followed by gynecological (12.7%) and gastrointestinal malignancies (11.6%). 28.8% of the patients had metastasis. The demographic and clinical features of the patients are shown in Table 1.
|
Patient characteristics |
N=197 |
|
|---|---|---|
|
Mean age—years (SD) |
53±13 |
|
|
BMI—mean (SD) |
27,9±5,32 |
|
|
N |
% |
|
|
Gender |
||
|
Female |
166 |
84,3 |
|
Male |
31 |
15,7 |
|
Marital Status |
||
|
Single |
32 |
16,2 |
|
Married |
165 |
83,8 |
|
Highest level of education |
||
|
İlliterate |
6 |
3,0 |
|
Primary school |
94 |
47,7 |
|
Middle School |
35 |
17,8 |
|
High school |
40 |
20,3 |
|
Undergraduate |
17 |
8,6 |
|
Postgraduate |
2 |
1,0 |
|
Associated degree |
3 |
1,5 |
|
Economic condition |
||
|
Low level |
13 |
6,6 |
|
İntermediate level |
139 |
70,6 |
|
High level |
45 |
22,8 |
|
Metastasis |
||
|
No |
136 |
69,0 |
|
Yes |
61 |
31,0 |
|
Hypertension |
||
|
No |
140 |
71,1 |
|
Yes |
57 |
28,9 |
|
Diabetes |
||
|
No |
165 |
83,8 |
|
Yes |
32 |
16,2 |
|
Genetic predisposition |
||
|
No |
145 |
73,6 |
|
Yes |
52 |
26,4 |
|
Smoking |
||
|
No |
139 |
70,6 |
|
Yes |
58 |
29,4 |
|
Disease stage |
||
|
Chemotherapy |
121 |
61,4 |
|
Radiotherapy |
24 |
12,2 |
|
Surgical |
11 |
5,6 |
|
Control |
41 |
20,8 |
| N: Number of Samples; SD: Standard Deviation; BMI: Body Mass Index | ||
The questions were clearly and well understood by most patients. However, despite the explanation made by the researcher, the question regarding the 'procedures of medical tests' was found confusing by 38 patients (item 36). The question regarding the 'dimensions of managing the disease at home' was not answered by 12 patients because there was no explanatory statement (item 46). It was observed that the items related to sexual activity caused embarrassment and annoying emotion in the participants. This situation could not be determined in the pilot study. The researcher did not have to clarify any confusion and any explanation given was easily understood.
For the analysis of the responses of the patients to the questions about the level of knowledge, the answers were compared under two headings as "none"-"a little" and "quite"-"a lot" pairs. "None"-"a little" pair was considered as "insufficient level of knowledge", "fairly"-"very" pair "was considered sufficient level of knowledge. Analysis of the data collected; showed that patients have the highest level of knowledge about diagnosis, medical test results and whether their disease is under control. Patients had the least level of information about rehabilitation services (97.97%), extra hospital assistance (95.43%), different care places (96.95%) and the effects of treatment on sexual activity (85.79%). Percentage evaluation of the patients' level of knowledge about the disease, treatment and other fields is given in Table 2.
|
Items |
Number of patients who are unknowledgeablea (%) |
Number of patients who are knowledgeableb (%) |
|---|---|---|
|
The diagnosis of your disease? (item 1) |
85 (43,14%) |
112 (56,85%) |
|
The extent (spread) of your disease? (item 2) |
102 (51,77%) |
95 (48,22%) |
|
The possible causes of your disease? (item 3) |
135 (68,53%) |
62 (31,47%) |
|
Whether the disease is under control? (item 4) |
86 (43,65%) |
111 (56,35%) |
|
The purpose of any medical tests you have had or may undergo? (item 5) |
105 (53,30%) |
92 (46,70%) |
|
The procedures of the medical tests? (item 6) |
133 (67,51%) |
64 (32,49%) |
|
The results of the medical tests you have already received? (item 7) |
73 (37,06%) |
124 (62,94%) |
|
The medical treatment (chemotherapy, radiotherapy, surgery or other treatment modality)? (item 8) |
97 (49,24%) |
100 (50,76%) |
|
The expected benefit of the treatment? (item 9) |
98 (49,75%) |
99 (50,25%) |
|
The possible side-effects of your treatment? (item 10) |
80 (40,61%) |
117 (59,40%) |
|
The expected effects of the treatment on disease symptoms? (item 11) |
109 (55,33%) |
88 (44,67%) |
|
The effects of the treatment on social and family life? (item 12) |
159 (80,71%) |
38 (19,29%) |
|
The effects of the treatment on sexual activity? (item 13) |
169 (85,79%) |
28 (14,22%) |
|
Additional help outside the hospital (e.g., help with daily activities, self-help groups, district nurses)? (item 14) |
188 (95,43%) |
9 (4,57%) |
|
Rehabilitation services (e.g., physiotherapy, occupational therapy)? (item 15) |
193 (97,97%) |
4 (2,03%) |
|
Aspects of managing your illness at home? (item 16) |
160 (81,22%) |
37 (18,78%) |
|
Possible professional psychological support? (item 17) |
153 (77,67%) |
44 (22,33%) |
|
Different places of care (hospitals/outpatient services/home)? (item 18) |
191 (96,95%) |
6 (3,04%) |
a: Number and percentage of individuals with insufficient knowledge
b: Number and percentage of individuals with sufficient knowledge level
According to the results of the multi-trait scale, the correlation measurements of each item with its own scale and other fields are shown in Table 3.
|
Scale 1 |
Scale 2 |
Scale 3 |
Scale 4 |
|
|---|---|---|---|---|
|
I31 |
0,874 |
0,643 |
0,523 |
0,359 |
|
I32 |
0,881 |
0,655 |
0,463 |
0,370 |
|
I33 |
0,788 |
0,558 |
0,463 |
0,434 |
|
I34 |
0,830 |
0,659 |
0,545 |
0,391 |
|
I35 |
0,690 |
0,897 |
0,600 |
0,392 |
|
I36 |
0,582 |
0,848 |
0,599 |
0,349 |
|
I37 |
0,639 |
0,815 |
0,582 |
0,377 |
|
I38 |
0,507 |
0,633 |
0,702 |
0,415 |
|
I39 |
0,481 |
0,546 |
0,843 |
0,336 |
|
I40 |
0,401 |
0,471 |
0,781 |
0,307 |
|
I41 |
0,475 |
0,561 |
0,847 |
0,387 |
|
I42 |
0,442 |
0,519 |
0,763 |
0,441 |
|
I43 |
0,452 |
0,513 |
0,726 |
0,530 |
|
I44 |
0,374 |
0,321 |
0,363 |
0,655 |
|
I45 |
0,297 |
0,325 |
0,329 |
0,601 |
|
I46 |
0,364 |
0,436 |
0,478 |
0,764 |
|
I47 |
0,238 |
0,172 |
0,283 |
0,674 |
|
I48 |
0,376 |
0,297 |
0,315 |
0,722 |
|
EORTC-INFO25 questionnaire |
Scale and item's name |
EORTC IN-PATSAT32 questionnaire |
Scale and item's name |
Spearman's RHO |
P value |
|---|---|---|---|---|---|
|
Scale 1 |
Information about disease |
Question 7 |
Information provided by doctors about disease |
0,427 |
0,001 |
|
Scale 1 |
Question 25 |
Information provided on patients’ admission to the hospital |
0,312 |
0,001 |
|
|
Scale 2 |
Information about medical tests |
Question 8 |
Information provided by doctors about medical tests |
0,38 |
0,001 |
|
Scale 2 |
Question 18 |
Information provided by nurses about medical tests |
0,259 |
0,001 |
|
|
Scale 2 |
Question 25 |
Information provided on patients’ admission to the hospital |
0,252 |
0,001 |
|
|
Scale 3 |
Information about treatment |
Question 9 |
Information provided by doctors about treatment |
0,328 |
0,001 |
|
Scale 3 |
Question 20 |
Information provided by nurses about treatment |
0,202 |
0,005 |
|
|
Scale 4 |
Information about other services |
Question 26 |
Information provided on patients’ discharge from the hospital |
0,085 |
0,237 |
|
Question 19 |
Information about things that the patient can do to help him/herself get well (rest, contact with others...) |
Question 26 |
Information provided on patients’ discharge from the hospital |
0,806 |
0,001 |
|
Question 22 |
Satisfaction with the amount of information the patient had received |
Scale3 |
Information provided by doctors |
0,625 |
0,001 |
|
Question 22 |
Scale7 |
Information provided by nurses |
0,958 |
0,001 |
EORTC QLQ-INFO25: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Information 25
EORTC IN-PATSAT32: European Organization for Research and Treatment of Cancer In-Patient Satisfaction with Care Questionnaire 32
To evaluate Divergent validity, the correlation between the EORTC-QLQ-C30 questionnaire and the different areas of the EORTC-INFO25 questionnaires was calculated (Table 5). The low correlation between the areas of the two questionnaires (Spearman Rho < 0.2) showed that these two questionnaires measured different concepts.
|
EORTC QLQ-INFO25 |
||||
|---|---|---|---|---|
|
İnformation about the disease (scale 1) |
İnformation about the medical tests (scale 2) |
İnformation about treatments (scale 3) |
İnformation about other services (scale 4) |
|
|
EORTC-QLQ-C30 Physical Functioning Scale |
-0,070 |
-,154* |
-0,115 |
0,076 |
|
EORTC-QLQ-C30 Emotional Functioning Scale |
-0,037 |
-0,085 |
-0,070 |
0,089 |
|
EORTC-QLQ-C30 Cognitive Functioning Scale |
0,023 |
-0,068 |
-0,111 |
0,097 |
|
EORTC-QLQ-C30 Social Functioning Scale |
0,044 |
0,003 |
-0,063 |
0,098 |
|
EORTC-QLQ-C30 Financial Scale |
0,016 |
-0,001 |
0,031 |
0,084 |
|
EORTC-QLQ-C30 Symptom Scale |
-0,031 |
-0,100 |
-0,070 |
0,121 |
|
EORTC-QLQ-C30 Global Health/QL Scale |
0,010 |
0,058 |
0,018 |
-,140* |
|
EORTC-QLQ-C30 Measuring Pain Scale |
0,005 |
0,066 |
0,042 |
-0,125 |
|
EORTC-QLQ-C30 Quality of Life Scale |
0,036 |
-0,078 |
-0,065 |
0,105 |
| EORTC QLQ-30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 | ||||
Factor analysis was used to investigate the structure of the survey. After Bartlett's sphericity test (p value < 0.000) and Kaiser-Meyer-Olkin sample adequacy criterion, 4 factors were selected after the significance was achieved in terms of sample adequacy. 1st factor, information about the disease (item 31, 32, 33, 34), 2nd factor information about medical tests (item 35, 36, 37), 3rd factor information about treatment (item 38, 39, 40, 41, 42, 43) and factor 4 included information about other services (items 44, 45, 46, 47). These 4 factors selected from the questionnaire questioning the level of knowledge of cancer patients are shown in Table 6. These four factors explained a total of 66.68% of the variance.
Cronbach's alpha coefficients for all domains and all surveys were between 85% and 95%. In-class correlation (ICC) ranged between 0.571 and 0.861. In-class correlation (ICC) of total scales and items of the questionnaire, Cronbach's alpha coefficient for the total scale is shown in Table 7.
|
Items |
||||
|---|---|---|---|---|
|
During your current disease or treatment, how much information have you recieved on: |
Factor 1 |
Factor 2 |
Factor 3 |
Factor 4 |
|
The diagnosis of your disease? (item 1) |
0,853 |
|||
|
The extent (spread) of your disease? (item 2) |
0,855 |
|||
|
The possible causes of your disease? (item 3) |
0,68 |
|||
|
Whether the disease is under control? (item 4) |
0,767 |
|||
|
The purpose of any medical tests you have had or may undergo? (item 5) |
0,836 |
|||
|
The procedures of the medical tests? (item 6) |
0,744 |
|||
|
The results of the medical tests you have already received? (item 7) |
0,745 |
|||
|
The medical treatment (chemotherapy, radiotherapy, surgery or other treatment modality)? (item 8) |
0,633 |
|||
|
The expected benefit of the treatment? (item 9) |
0,851 |
|||
|
The possible side-effects of your treatment? (item 10) |
0,781 |
|||
|
The expected effects of the treatment on disease symptoms? (item 11) |
0,844 |
|||
|
The effects of the treatment on social and family life? (item 12) |
0,643 |
|||
|
The effects of the treatment on sexual activity? (item 13) |
0,604 |
|||
|
Additional help outside the hospital (e.g., help with daily activities, self help groups, district nurses)? (item 14) |
0,669 |
|||
|
Rehabilitation services (e.g., physiotherapy, occupational therapy)? (item 15) |
0,715 |
|||
|
Aspects of managing your illness at home? (item 16) |
0,615 |
|||
|
Possible professional psychological support? (item 17) |
0,315 |
|||
|
Different places of care (hospitals/outpatient services/home)? (item 18) |
0,756 |
|||
|
% of variance |
42,967 |
10,001 |
8,10 |
5,608 |
|
Eigenvalues |
7,734 |
1,8 |
1,459 |
1,009 |
The items included in the questionnaire allowed the classification of information given to patients in terms of different aspects of cancer diagnosis and treatment. The level of education, economic status, and age were examined to determine the amount of information received and whether it affected satisfaction. While there was a significant difference in the level of knowledge about education level, disease, medical tests, and treatments (p < 0.05), there was no difference in knowledge level for other services (p > 0.05). The economic situation was found to have a significant relationship with all parameters (p < 0.05). There was no significant difference in the level of knowledge among those over 50 and those under 50 (p > 0.05).
|
EORTC-INFO25 scales |
Mean |
SD |
Cronbach's alpha coefficient |
ICC |
%floor |
%ceiling |
|
|---|---|---|---|---|---|---|---|
|
Scale 1 |
Information about the disease |
2,4873 |
0,8178 |
0,864 |
0,833 |
2 |
8,1 |
|
Scale 2 |
Information about medical tests |
2,4467 |
0,8492 |
0,814 |
0,768 |
4,6 |
11,2 |
|
Scale 3 |
Information about treatments |
2,2318 |
0,7551 |
0,869 |
0,795 |
2 |
4,6 |
|
Scale 4 |
Information about other services |
1,3533 |
0,4698 |
0,659 |
0,571 |
39,6 |
0,5 |
|
Whole questionnaire |
2,0093 |
0,4959 |
0,92 |
0,861 |
2 |
0,5 |
|
| ICC: In-Class Correlation | |||||||
| SD: Standard Deviation | |||||||
| EORTC QLQ-INFO25: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Information 25 | |||||||
This study examined the level of knowledge that Turkish cancer patients received from healthcare personnel, in terms of both quantity and quality. It also questioned the general satisfaction of Turkish patients with the information they received. Statistical analyzes have shown that the Turkish version of the EORTC QLQ-INFO25 scale is a valid and reliable tool for measuring the knowledge levels of cancer patients. The high completion rate (> 90%) of the surveys explained that the scale was understood by the patients and was clear and acceptable. The extra topics suggested by the patients proved that new items are not needed and the content validity of the scale. Group validity analyzes are generally supported by data.
Cronbach's alpha value for each area of the survey provided the criteria (≥ 0.6) that the scale can be used to compare different groups. For the entire survey, Cronbach's alpha coefficient was 0.92, which confirmed that the scale's reliability was high. When the literature is examined, the results of other studies proved the high reliability of the questionnaire. In studies conducted in Lebanon [6] and Iran [9], Cronbach's alpha coefficient for the entire questionnaire was reported to be more than 0.7 and in Spain and Taiwan [7] 0.7-0.9. The result of our study was consistent with the results of these studies investigating the reliability of the EORTC QLQ-INFO25 scale. A standard divergent validity was observed in all areas of the scale (Rho < 0.5), confirming that the two questionnaires used evaluated different concepts. This result is similar to other EORTC studies. Convergent and divergent validity analyzes also supported our expectations.
Findings regarding the construct validity of the scale were obtained by factor analysis. Generally, the load value between 0.30-0.59 is considered to be medium and those above 0.60 are considered high [15]. In our study, it was found that this value had a medium and high factor load of 0.66. This is an indication of the construct validity of the questionnaire. In Asadi-lari et al. study was found that the value is 0.79 and this result is in line with our study [9].
The limitation of our study is that the information given to the participants cannot be measured objectively. In addition, test-retest analyzes, which show that the questionnaire does not change over time, were not conducted. It is not practical to apply a standardized information program to patients, but it is not possible to collect all these data in a multinational and diverse example. However, after a more detailed analysis of intercultural differences, a common scale can be developed for each culture.
According to the results obtained from our study planned and implemented in order to bring the EORTC QLQ-INFO25 scale to the Turkish culture; The validity and reliability of the scale has been determined and it can be used in Turkish society. The questionnaire is a valid scale that can be used by healthcare professionals to evaluate the knowledge level of the person specific to cancer disease in clinical trials.
The European Organization for Research and Treatment of Cancer (EORTC)
Quality of Life (QL)
EORTC Quality of Life Questionnaire-Information Module (EORC QLQ-INFO25)
EORTC Quality of Life Questionnaire-Core 30 (QLQ-C30)
Inpatient satisfaction module EORTC Cancer In-Patient Satisfaction with Care Questionnaire (IN-PATSAT32)
In-class correlation (ICC)
The study was approved by the Istanbul Medipol University Non-Interventional Clinical Research Ethics Committee (dated 15.08.2018, decision 446) All the participants gave written informed consent before participation in the study.
Not applicable
The datasetsused and/oranalysed during the current study are available from the corresponding author on reasonable request.
The authors declare that they have no competing interests
Theauthorsdeclarethattheyhavenofunding
PAÇ and BK collected the data. SEanalysed data. FM was coordinator of this study. All authors read and approved the final manuscript. All authors report no conflict of interest that may have influenced either the conduct or the presentation of the research.
Not applicable