Development and Validation of a Palliative Care Needs Assessment Tool (P-NAT) for Cancer Patients in Low-Resource Settings

Abstract

Background

With the rise in cancers, palliative care (PC) is increasingly important for improving the quality of life for patients and families. Systematically assessing PC needs is crucial for providing appropriate services.

Objective

To develop and validate an instrument (Palliative-care-Need Assessment-Tool [P-NAT]) to identify PC needs of cancer patients.

Methods

Mixed-method sequential exploratory design was used. The P-NAT development and validation was done in 3 phases: item generation & reduction, scale development, and scale evaluation. Items were generated in English based on literature and key informant interviews followed by item reduction with expert opinion. Forward and backward translation done (Sinhala/English). Translated Sinhala version was assessed for face and content validity. Exploratory Factor Analysis (EFA) was done with 302 subjects. Construct validity was assessed through Confirmatory Factor Analysis (CFA) on another 309 participants, followed by convergent validity in a subsample of 201. Test-retest reliability and internal consistency were assessed using Spearman r and Cronbach α, respectively.

Results

After reduction, 53 items were selected for the scale. The EFA identified 12 factors with 45 items. The CFA confirmed an 8-factor model as the best fit (root mean square of approximation = 0.068, CFI = 0.96, PNFI = 0.85). The overall scale had Cronbach α 0.919, Spearman r 0.986 (P < .01). Spearman r coefficient between P-NAT and European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire was 0.668.

Conclusions and recommendations

The P-NAT is a valid, reliable tool to assess PC needs among cancer patients. The P-NAT is recommended for rapid comprehensive assessment at hospital and community settings.