*220. Evaluating Patient Distress from Cancer Related Fatigue: An Instrument Development Study
Sandra Holley, PhD, ARNP, James A. Haley VAMC
Objectives: The purposes of this study were two-fold. The first purpose (Phase I) was to understand the common meanings of CRF and describe its’ impact on the lives of the participants. The second purpose (Phase II) was to develop a clinically useful and psychometrically sound tool for the measurement of fatigue in persons with cancer.
Methods: In Phase I, the sample consisted of seventeen patients with cancer who agreed to participate, yielding 23 in-depth audio-taped interviews. Participants included inpatients and outpatients from a dedicated cancer center and a VA Hospital.
In Phase II the Cancer Related Fatigue Distress Scale (CRFDS) was developed. Content analysis was used to analyze the Phase I transcribed interviews. The interviews were coded and categorized by domains of distress for analysis. Content validity was assessed by five cancer survivors. The resulting CRFDS was administered.
The Phase II sample consisted of 221 adults with cancer in a dedicated cancer center and a VA hospital.
Results: In Phase I, CRF was found to be more rapid in onset, more energy draining, more intense, longer lasting, more severe and unrelenting when compared to "typical" fatigue. CRF caused distress in the physical, social, spiritual, psychological, and cognitive domains of the participants’ lives.
In Phase II, factor analysis resulted in all items loading on one factor indicating a single scale. Coefficient alpha score was .98 after the elimination of three items.
Conclusions: The CRFDS has strong content validity, high reliability, and very good construct validity.The CRFDS is a clinically useful and psychometrically sound tool for the measurement of CRF. This tool is useful because it is brief (20 items) but thorough, with clear instructions requiring no training to use, and has a readability score at the third-grade level.
Impact: Oncology nurses need a clinically useful and sound tool for the measurement of CRF. The Cancer Related Fatigue Distress Scale is a tool that oncology nurses can use in practice to assess CRF and plan strategies with patients for its management. This tool may be used in inpatient or outpatient settings with patients who may be too tired to complete lengthy and complex tools. Nurses can quickly review patient responses and identify potential beneficial interventions and then later reassess with the CRFDS to evaluate the effectiveness of those interventions.