經濟毒性量表中文版的信效度檢驗

Validation of the Chinese Version of the Comprehensive Score for Financial Toxicity

10.6550/ACP.202312_17(1_2).0002

劉乃誌(Nai-Chih Liu)；張正雄(Cheng-Shyong Chang)；洪志強(Chih-Chiang Hung)

經濟毒性 ； 癌症病人 ； 自費藥物 ； financial toxicity ； cancer patient ； self-paid drug

臨床心理學刊

17卷1/2期（2023 / 12 / 01）

13 - 28

繁體中文;英文

目的：癌症病人可能面對自費藥物的選擇，高價藥物造成經濟壓力影響生活品質與醫療效果，稱為「經濟毒性」（financial toxicity），醫療團隊及時介入可以協助病人因應，然而國內目前尚未有適合的評估工具，研究目的在於檢驗經濟毒性量表中文版（Comprehensive Score for Financial Toxicity-Chinses version, COST-C）的信效度。方法：在中部三家醫院招募118位第四期癌症病人，知情同意後填寫COST-C、醫院焦慮與憂鬱量表、個人化生活品質量表及基本資料。結果：COST-C進行探索性因素分析，顯示存在兩個潛在因子，命名為失控因子和經濟因子。COST-C的Cronbach's α值為.893。COST-C與焦慮、憂鬱達顯著正相關，與生活品質達顯著負相關。以主治醫師判定和自費藥物支出大於可負擔額度者做為效標組，其餘為一般組，效標組COST-C顯著高於一般組。以COST-C平均數分成高低兩組，高分組提名經濟為重要生活領域的人數比例最高。結論：COST-C是具有信效度的經濟毒性評量工具。在應用上，或可做為醫療團隊與末期病人討論何時轉介安寧病房的輔助工具之一。

Objectives: Cancer patients are likely to face the choice of self-paid drugs. High-priced self-paid drugs intensify financial burden and cause these patients to suffer from distress and lower their quality of life. This is called "financial toxicity". It might be helpful for medical teams to intervene. However, there is currently no proper assessment available in Taiwan. This study aims to test the reliability and validity of the Chinese version of Comprehensive Score for Financial Toxicity (COST-C). Methods: One hundred and eighteen stage four cancer patients were recruited from three hospitals in central Taiwan. After informed consent was provided, COST-C, Hospital Anxiety and Depression Scale, Schedule for the Evaluation of Individual Quality of Life- Direct Weighting (SEIQoL-DW) and related background information were completed. Results: Exploratory factor analysis was performed and showed that there was a two-factor model named an out-of-control factor and a financial factor. The Cronbach's α of COST-C was .893. COST-C was positively related to the anxiety and depression, and negatively related to the quality of life. The criterion group was determined by physicians, and those with self-paid drug expenses were greater than their affordable amount, and the others were the general group. The COST-C scores of the criterion group were significantly higher than the scores of the general group. Patients were divided into high and low groups at the means of the total scores on COST-C, and the high group had the highest percentage of people nominating a financial issue as an important life domain. Conclusions: The COST-C showed sufficient reliability and validity as an effective instrument. In terms of application, it may be used as one of the auxiliary tools for the medical teams to discuss with terminally ill patients when to refer them to hospice wards.

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