Validity and reliability of the breast cancer comfort assessment scale in palliative care
Year 2025,
Volume: 12 Issue: 1, 33 - 44
Rahime Yöntem Ölmez
İlgün Özen Çınar
Abstract
Breast cancer is a disease that requires palliative care and comfort. The current study aimed to adapt the scale used to assess the comfort level of breast cancer patients receiving palliative care, for the Turkish population, and to contribute to the literature. A total of 340 breast cancer patients who were registered at a university hospital's oncology outpatient clinic, received therapy, and returned for follow-up were included in the study. Data were collected using the Introductory Information Form, Comfort Assessment Breast Cancer Instrument, and General Comfort Scale short form. The International Testing Commission Guide's (2018) suggestions were applied during the scale's modification procedure. The scale's Kaiser Meyer Olkin value was 0.78, and 4454.53 was the Barlett's test result. Fit indices for the confirmatory factor analysis were CFI=0.885, GFI=0.927, and χ²/df=2.612. The scale's Spearman-Brown correlation value is 0.78, and its Cronbach's alpha coefficient is 0.85. The Comfort Assessment Breast Cancer Instrument's Turkish version provides a reliable and valid tool for assessing the comfort of breast cancer patients. The use of it can help determine the comfort level of breast cancer patients receiving palliative care and inform the development of interventions and care practices throughout each stage of the disease.
Ethical Statement
The scale authors gave permission for use. The Non-Interventional Clinical Ethics Committee of a university obtained ethical approval (dated 06.08.2019 number 54328). The principles of the Declaration of Helsinki guided the conduct of this study. The data collection institution and study participants gave their consent.
Thanks
The authors thank all breast cancer patients and healthcare professionals for their support.
References
- Arnold, M., Morgan, E., Rumgay, H., Mafra, A., Singh, D., Laversanne, M., … Soerjomataram, I. (2022). Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast, 66, 15 23. https://doi.org/10.1016/j.breast.2022.08.010
- Brown, T.A. (2015). Confirmatory factor analysis for applied research. Guilford Press.
- Çapık, C. (2014). Geçerlik ve Güvenirlik Çalışmalarında Doğrulayıcı Faktör Analizinin Kullanımı [Use of Confirmatory Factor Analysis in Validity and Reliability Studies]. Journal of Anatolia Nursing and Health Sciences, 17(3),196-205.
- Caycho-Rodríguez, T., Rojas-Jara, C., Ventura-León J, Noe-Grijalva M, Cabrera-Orosco I., & Reyes-Bossio M. (2021). Single item to assess for worry for cancer: Initial evidence of validity and reliability. Enfermería Clínica, (Engl Ed.). 31, 203 210. https://doi.org/10.1016/j.enfcle.2019.11.002
- Çıtlık S.C., Çevik, S., & Özden, G. (2018). Genel konfor ölçeği kısa formu türkçe geçerliliği ve güvenilirliği [Validity and reliability study of the Turkish version of the short general comfort questionnaire]. Diyabet, Obezite ve Hipertansiyonda Hemşirelik Forumu Dergisi 10(2), 16-22. http://www.tdhd.org/pdf/Diyabet_Hems_Forumu_2018_2.pdf
- Çokluk, Ö., Şekercioğlu, G., & Büyüköztürk, Ş. (Eds). (2014). Sosyal bilimler için çok değişkenli istatistik SPSS ve LISREL uygulamaları, yapısal eşitlik modeli [Multivariate statistics for the social sciences, SPSS and LISREL applications, structural equation modeling]. Pegem Yayıncılık.
- Davis, L.L. (1992). Instrument review: Getting the most from a panel of experts. Applied Nursing Research, 5(4), 194–197. https://doi.org/10.1016/S0897-1897(05)80008-4
- Erdoğan, S., Nahcivan, N., & Esin, M. (Eds) (2017). Hemşirelikte araştırma, süreç uygulama ve kritik, veri toplama yöntem ve araçları & Veri toplama araçlarının güvenirlik ve geçerliliği [Research in nursing, process, practice and critique, data collection methods and tools & Reliability and validity of data collection tools]. Nobel Tıp Kitapevleri
- Ferlay, J., Ervik, M., Lam, F. Colombet, M., Mery, L., Piñeros, M., … Bray, F. (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from (accessed 14 March 2023): https://gco.iarc.fr/today
- Ferrell, B. (2019). National consensus project clinical practice guidelines for quality palliative care: ımplications for oncology nursing asia-pacific. Journal of Oncology Nursing, 6(2), 151-153. https://doi.org/10.4103/apjon.apjon_75_18
- Gana, K., & Broc, G. (2019). Structual Equation Modeling with lavaan. Great Britain and United States by ISTE and John Wiley&Sons, Inc ISBN 978-1-78630-369-1.
- Grove, S.K., Burns, N., & Gray, J. (2013). The practice of nursing research: appraisal, synthesis, and generation of evidence, (7th ed.), St. Louis, Missouri: Elsevier Saunders 72.
- Grove, S.K., & Cipher, D.J. (2019). Statistics for nursing research e-book: a workbook for evidence-based practice. Elsevier Health Science.
- Gunzler, D.D., & Morris, N.A. (2015). Tutorial on structural equation modeling for analysis of overlapping symptoms in co-occurring conditions using Mplus. Statistics in Medicine, 34(24), 3246–3280. https://doi.org/10.1002/sim.6541
- Hailu, H.E., Mondul, A.M., Rozek, A.S., & Geleta, T. (2020). Descriptive epidemiology of breast and gynecological cancers among patients attending Saint Paul’s Hospital Millennium Medical College. Plos One 15(3), e0230625. https://doi.org/10.1371/journal.pone.0230625
- Harrington, D. (2009). Confimatory Factor Analysis. Oxfort Universty Press 21-35.
- Hernández, A., Hidalgo, M.D., Hambleton, R.K., & Gómez-Benito, J. (2020). International Test Commission guidelines for test adaptation: A criterion checklist. Psicothema, 32(3), 390–398. https://doi.org/10.7334/psicothema2019.306
- International Test Commission. (2018). ITC guidelines for translating and adapting tests (Second edition). International Journal of Testing, 18(2), 101 134. https://doi.org/10.1080/15305058.2017.1398166
- Kim, H.Y. (2013). Statistical notes for clinical researchers: Assessing normal distribution using skewness and kurtosis. Restorative Dentistry and Endodontics, 13(38), 52 54. https://doi.org/10.5395/rde.2013.38.1.5
- Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. Journal of Nursing Administration, 36(11), 538–544. https://doi.org/10.1097/00005110-200611000-00010
- Kolcaba, K. (1991). Taxonomik structure for the concept comfort. Journal of Nursing Scholarship, 23(4), 237-240. https://doi.org/10.1111/j.1547-5069.1991.tb00678.x
- Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. Springer Publishing Company. Canada.
- Malloy, P., Takenouchi, S., Kim, H.S., Lu, Y., & Ferrell, B. (2018). Providing Palliative Care Education: Showcasing Efforts of Asian Nurses. Asia Pacific Journal of Oncology Nursing, 5(1), 15-20. https://doi.org/10.4103/apjon.apjon_55_17
- Nia, H.S., Somasundram, S., Fomani, F.K., Kaveh, O., & Hosseini, L. (2023). Validity and Reliability of Persian Version of the 12-Item Expectations Regarding Aging Survey. The International Journal of Aging and Human Development, 96(2), 248 262. https://doi.org/10.1177/00914150221084650.
- Nuraini, T., Antirijono, Gayatri, D., Irawaty, D., Umar, J., & Gayatri, D. (2019). Construct and criterion validity of The Comfort Assessment Breast Cancer Instrument. Enfermería Clínica, 29(2), 826-830. https://doi.org/10.1016/j.enfcli.2019.04.124
- Nuraini, T., Gayatri, D., & Irawaty, D. (2018). Validity And Reliability of the Comfort Assessent Breast Cancer Instrument in Breast Cancer Palliative Care. Enfermería Clínica, 28(1), 162-166. https://doi.org/10.1016/S1130-8621(18)30059-7
- R Core Team. (2020). A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/
- Rosseel, Y. (2012). Lavaan: An R ackage for Structural Equation Modeling. Journal of Statistical Software, 48(2), 1-36. https://doi.org/10.18637/jss.v048.i02
- Rugno, F.C., Paiva, B.S., & Paiva, C.E. (2014). Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic Cancers. Gynecologic Oncology, 135(2), 249 254. https://doi.org/10.1016/j.ygyno.2014.08.030.
- Sarmento, R., & Costa, V. (2017). Comparative approaches to using R and Python for statistical data analysis. (p:124-156) IGI Global. https://doi.org/10.4018/978-1-68318-016-6
- Seçer, İ. (2018). Psikolojik test geliştirme ve uyarlama süreci [Psychological test development and adaptation process]. Anı Yayıncılık.
- Streiner, D., Norman, G., & Cairney, J. (2015). Health measurement scales: A practical guide to their development and use 5th ed. Oxford, UK: Oxford University Press, (p;234-248). https://doi.org/10.1093/med/9780199685219.001.0001
- Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomatatam, I., Cemal, A., & Bray F. (2020). Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. A Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
- World Health Organization (WHO). (2023a). Global Breast Cancer Initiative Implementation Framework (GBCI) 2023: Assessing, strengthening and scaling-up of services for the early detection and management of breast cancer. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO
- World Health Organization (WHO). (2023b). Palliative-care. Available from (accessed; 15.06.2023): https://www.who.int/health-topics/palliative-care
- Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza A., … Lo, C. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet, 383(9930), 1721–1730. https://doi.org/10.1016/S0140-6736(13)62416-2
Validity and reliability of the breast cancer comfort assessment scale in palliative care
Year 2025,
Volume: 12 Issue: 1, 33 - 44
Rahime Yöntem Ölmez
İlgün Özen Çınar
Abstract
Breast cancer is a disease that requires palliative care and comfort. The current study aimed to adapt the scale used to assess the comfort level of breast cancer patients receiving palliative care, for the Turkish population, and to contribute to the literature. A total of 340 breast cancer patients who were registered at a university hospital's oncology outpatient clinic, received therapy, and returned for follow-up were included in the study. Data were collected using the Introductory Information Form, Comfort Assessment Breast Cancer Instrument, and General Comfort Scale short form. The International Testing Commission Guide's (2018) suggestions were applied during the scale's modification procedure. The scale's Kaiser Meyer Olkin value was 0.78, and 4454.53 was the Barlett's test result. Fit indices for the confirmatory factor analysis were CFI=0.885, GFI=0.927, and χ²/df=2.612. The scale's Spearman-Brown correlation value is 0.78, and its Cronbach's alpha coefficient is 0.85. The Comfort Assessment Breast Cancer Instrument's Turkish version provides a reliable and valid tool for assessing the comfort of breast cancer patients. The use of it can help determine the comfort level of breast cancer patients receiving palliative care and inform the development of interventions and care practices throughout each stage of the disease.
Ethical Statement
The scale authors gave permission for use. The Non-Interventional Clinical Ethics Committee of a university obtained ethical approval (dated 06.08.2019 number 54328). The principles of the Declaration of Helsinki guided the conduct of this study. The data collection institution and study participants gave their consent.
Thanks
The authors thank all breast cancer patients and healthcare professionals for their support.
References
- Arnold, M., Morgan, E., Rumgay, H., Mafra, A., Singh, D., Laversanne, M., … Soerjomataram, I. (2022). Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast, 66, 15 23. https://doi.org/10.1016/j.breast.2022.08.010
- Brown, T.A. (2015). Confirmatory factor analysis for applied research. Guilford Press.
- Çapık, C. (2014). Geçerlik ve Güvenirlik Çalışmalarında Doğrulayıcı Faktör Analizinin Kullanımı [Use of Confirmatory Factor Analysis in Validity and Reliability Studies]. Journal of Anatolia Nursing and Health Sciences, 17(3),196-205.
- Caycho-Rodríguez, T., Rojas-Jara, C., Ventura-León J, Noe-Grijalva M, Cabrera-Orosco I., & Reyes-Bossio M. (2021). Single item to assess for worry for cancer: Initial evidence of validity and reliability. Enfermería Clínica, (Engl Ed.). 31, 203 210. https://doi.org/10.1016/j.enfcle.2019.11.002
- Çıtlık S.C., Çevik, S., & Özden, G. (2018). Genel konfor ölçeği kısa formu türkçe geçerliliği ve güvenilirliği [Validity and reliability study of the Turkish version of the short general comfort questionnaire]. Diyabet, Obezite ve Hipertansiyonda Hemşirelik Forumu Dergisi 10(2), 16-22. http://www.tdhd.org/pdf/Diyabet_Hems_Forumu_2018_2.pdf
- Çokluk, Ö., Şekercioğlu, G., & Büyüköztürk, Ş. (Eds). (2014). Sosyal bilimler için çok değişkenli istatistik SPSS ve LISREL uygulamaları, yapısal eşitlik modeli [Multivariate statistics for the social sciences, SPSS and LISREL applications, structural equation modeling]. Pegem Yayıncılık.
- Davis, L.L. (1992). Instrument review: Getting the most from a panel of experts. Applied Nursing Research, 5(4), 194–197. https://doi.org/10.1016/S0897-1897(05)80008-4
- Erdoğan, S., Nahcivan, N., & Esin, M. (Eds) (2017). Hemşirelikte araştırma, süreç uygulama ve kritik, veri toplama yöntem ve araçları & Veri toplama araçlarının güvenirlik ve geçerliliği [Research in nursing, process, practice and critique, data collection methods and tools & Reliability and validity of data collection tools]. Nobel Tıp Kitapevleri
- Ferlay, J., Ervik, M., Lam, F. Colombet, M., Mery, L., Piñeros, M., … Bray, F. (2020). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from (accessed 14 March 2023): https://gco.iarc.fr/today
- Ferrell, B. (2019). National consensus project clinical practice guidelines for quality palliative care: ımplications for oncology nursing asia-pacific. Journal of Oncology Nursing, 6(2), 151-153. https://doi.org/10.4103/apjon.apjon_75_18
- Gana, K., & Broc, G. (2019). Structual Equation Modeling with lavaan. Great Britain and United States by ISTE and John Wiley&Sons, Inc ISBN 978-1-78630-369-1.
- Grove, S.K., Burns, N., & Gray, J. (2013). The practice of nursing research: appraisal, synthesis, and generation of evidence, (7th ed.), St. Louis, Missouri: Elsevier Saunders 72.
- Grove, S.K., & Cipher, D.J. (2019). Statistics for nursing research e-book: a workbook for evidence-based practice. Elsevier Health Science.
- Gunzler, D.D., & Morris, N.A. (2015). Tutorial on structural equation modeling for analysis of overlapping symptoms in co-occurring conditions using Mplus. Statistics in Medicine, 34(24), 3246–3280. https://doi.org/10.1002/sim.6541
- Hailu, H.E., Mondul, A.M., Rozek, A.S., & Geleta, T. (2020). Descriptive epidemiology of breast and gynecological cancers among patients attending Saint Paul’s Hospital Millennium Medical College. Plos One 15(3), e0230625. https://doi.org/10.1371/journal.pone.0230625
- Harrington, D. (2009). Confimatory Factor Analysis. Oxfort Universty Press 21-35.
- Hernández, A., Hidalgo, M.D., Hambleton, R.K., & Gómez-Benito, J. (2020). International Test Commission guidelines for test adaptation: A criterion checklist. Psicothema, 32(3), 390–398. https://doi.org/10.7334/psicothema2019.306
- International Test Commission. (2018). ITC guidelines for translating and adapting tests (Second edition). International Journal of Testing, 18(2), 101 134. https://doi.org/10.1080/15305058.2017.1398166
- Kim, H.Y. (2013). Statistical notes for clinical researchers: Assessing normal distribution using skewness and kurtosis. Restorative Dentistry and Endodontics, 13(38), 52 54. https://doi.org/10.5395/rde.2013.38.1.5
- Kolcaba, K., Tilton, C., & Drouin, C. (2006). Comfort theory: A unifying framework to enhance the practice environment. Journal of Nursing Administration, 36(11), 538–544. https://doi.org/10.1097/00005110-200611000-00010
- Kolcaba, K. (1991). Taxonomik structure for the concept comfort. Journal of Nursing Scholarship, 23(4), 237-240. https://doi.org/10.1111/j.1547-5069.1991.tb00678.x
- Kolcaba, K. (2003). Comfort theory and practice: A vision for holistic health care and research. Springer Publishing Company. Canada.
- Malloy, P., Takenouchi, S., Kim, H.S., Lu, Y., & Ferrell, B. (2018). Providing Palliative Care Education: Showcasing Efforts of Asian Nurses. Asia Pacific Journal of Oncology Nursing, 5(1), 15-20. https://doi.org/10.4103/apjon.apjon_55_17
- Nia, H.S., Somasundram, S., Fomani, F.K., Kaveh, O., & Hosseini, L. (2023). Validity and Reliability of Persian Version of the 12-Item Expectations Regarding Aging Survey. The International Journal of Aging and Human Development, 96(2), 248 262. https://doi.org/10.1177/00914150221084650.
- Nuraini, T., Antirijono, Gayatri, D., Irawaty, D., Umar, J., & Gayatri, D. (2019). Construct and criterion validity of The Comfort Assessment Breast Cancer Instrument. Enfermería Clínica, 29(2), 826-830. https://doi.org/10.1016/j.enfcli.2019.04.124
- Nuraini, T., Gayatri, D., & Irawaty, D. (2018). Validity And Reliability of the Comfort Assessent Breast Cancer Instrument in Breast Cancer Palliative Care. Enfermería Clínica, 28(1), 162-166. https://doi.org/10.1016/S1130-8621(18)30059-7
- R Core Team. (2020). A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. https://www.R-project.org/
- Rosseel, Y. (2012). Lavaan: An R ackage for Structural Equation Modeling. Journal of Statistical Software, 48(2), 1-36. https://doi.org/10.18637/jss.v048.i02
- Rugno, F.C., Paiva, B.S., & Paiva, C.E. (2014). Early integration of palliative care facilitates the discontinuation of anticancer treatment in women with advanced breast or gynecologic Cancers. Gynecologic Oncology, 135(2), 249 254. https://doi.org/10.1016/j.ygyno.2014.08.030.
- Sarmento, R., & Costa, V. (2017). Comparative approaches to using R and Python for statistical data analysis. (p:124-156) IGI Global. https://doi.org/10.4018/978-1-68318-016-6
- Seçer, İ. (2018). Psikolojik test geliştirme ve uyarlama süreci [Psychological test development and adaptation process]. Anı Yayıncılık.
- Streiner, D., Norman, G., & Cairney, J. (2015). Health measurement scales: A practical guide to their development and use 5th ed. Oxford, UK: Oxford University Press, (p;234-248). https://doi.org/10.1093/med/9780199685219.001.0001
- Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomatatam, I., Cemal, A., & Bray F. (2020). Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. A Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
- World Health Organization (WHO). (2023a). Global Breast Cancer Initiative Implementation Framework (GBCI) 2023: Assessing, strengthening and scaling-up of services for the early detection and management of breast cancer. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO
- World Health Organization (WHO). (2023b). Palliative-care. Available from (accessed; 15.06.2023): https://www.who.int/health-topics/palliative-care
- Zimmermann, C., Swami, N., Krzyzanowska, M., Hannon, B., Leighl, N., Oza A., … Lo, C. (2014). Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet, 383(9930), 1721–1730. https://doi.org/10.1016/S0140-6736(13)62416-2