外来化学療法を受けているがん患者の気がかり評定尺度の開発と信頼性・妥当性の検討

Development of Cancer-chemotherapy Concerns Rating Scale and Study of Its Reliability and Validity

要旨

　本研究の目的は，外来化学療法を受けているがん患者の気がかりを簡便に測定することのできる尺度を作成し，その信頼性と妥当性を検討することである．気がかり評定尺度の質問票の原案は，面接調査と文献検討に基づいて作成し，化学療法を受けているがん患者の気がかりに関する30項目で構成した．その後，同意の得られたがん患者275名を対象に自己記述式による調査を施行した．有効回答率74.9％（206名）のデータを用いて項目分析を行った．その結果，『自己存在』，『病気の進行』『日常生活の再構成』『社会・経済の見通し』の4下位尺度，合計15項目から構成される化学療法を受けているがん患者気がかり評定尺度（CCRS）を作成した．尺度の信頼性の検討は，Cronbach'sα係数とSpearman-Brownの公式により信頼係数を算出した．それぞれの信頼係数は0.88,0.89であり，高い内的整合性と安定性が確認された．

　また，CCRSと状態不安尺度，ストレス反応尺度との間に有意な相関関係（p＜0.0001）を認め，基準関連妥当性が支持された．さらに統計学的に因子妥当性も確認された．

　以上のことから，作成したCCRSは，高い信頼性，妥当性を有し，今後の臨床への応用が期待される測定用具であることが示唆された．

Abstract

　This study developed a scale that measures concern of cancer patients undergoing chemotherapy, then investigated the reliability and validity of this new scale. First, a questionnaire consisting of 30 items was developed. For each item, there were four possible answers that had been chosen based on the literature and our previous qualitative study. Subjects were 206(males 83, females 123, average age 57.3 ± 10.7 years) cancer patients who were undergoing chemotherapy at two hospitals. After excluding statistically inappropriate items from the study, factor analysis was performed by principal factor analysis and Varian rotation. The study protocol was approved by the institutional review boards at both hospitals.

　Four factors with 15 items were finally obtained : Self - existence, disease progress, reorganization of daily life and social and economic concerns. The 15 items were defined as the Cancer - chemotherapy Concerns Rating Scale(CCRS)．The cumulative contribution percentage after extracting these factors was 48.6 %. The reliability of CCRS was investigated by Cronbach's alpha and Spearman - Brown's coefficient. These were 0.88 and 0.89 respectively. The validity of CCRS was investigated through content validity, concurrent validity and discriminate validity. Concurrent validity was confirmed by STAI(r=0.42, p＜0.001)and Stress Responses Scale - 18(r=0.634, p＜0.001), and discriminate validity was found between high and low stressed subjects.

　The above findings indicate that the CCRS is sufficiently reliable and valid for practical use.