癌症病患及照顧者資源使用：評估工具發展與測試

Abstract

背景與目的 癌症已成為需長期管理的慢性疾病，病患與照顧者須使用多元資源，以因應生理、心理及生活功能上的挑戰，惟現有工具多未能完整評估其資源使用情形。本研究以社會生態理論為基礎，發展資源使用量表（Resource Use Assessment, RUA），並檢驗其心理計量特性。 研究方法 本研究分三階段進行。第一階段為題項庫建構與專家內容效度審查；第二階段包含預試與表面效度建立；第三階段則為正式施測與信效度檢驗。其中，以驗證性因素分析（confirmatory factor analysis, CFA）檢驗量表之建構效度，並透過區辨效度評估其區辨不同人口學與臨床特徵之能力；信度則以Cronbach’s α係數與組內相關係數（intraclass correlation coefficient, ICC）進行評估。並於北部某醫學中心及其癌症分院招募287位癌症病患及232位主要照顧者。 研究結果 資源使用量表具良好內容效度（S-CVI/Ave＝0.95）與表面效度。病患版與照顧者版量表之內部一致性良好（Cronbach’s α分別為0.82與0.84），再測信度亦達良好水準（ICC分別為0.80與0.89）。CFA結果支持雙版本皆為六構面結構：資訊性資源、家人與朋友支持資源、長期照護資源、醫療團隊成員資源、心理與身體復健相關資源及社區資源，且整體模型適配度達可接受範圍（病患版：χ²(335) = 832.49、χ²/df = 2.49、CFI = 0.95、TLI = 0.94、RMSEA = 0.09；照顧者版：χ²(335) = 690.79、χ²/df = 2.06、CFI = 0.96、TLI = 0.96、RMSEA = 0.07）。此外，兩版本量表皆展現良好區辨效度能力。 結論 資源使用量表具備良好信效度，能有效評估癌症病患及照顧者資源使用情形，並可作為後續研究及臨床需求評估之工具。

Background and Purpose Cancer has increasingly become a chronic condition requiring long-term management. Patients and caregivers must use a wide variety of resources to address physiological, psychological, and functional challenges. However, existing instruments often fail to comprehensively assess resource use. Based on social–ecological model, this study developed the Resource Use Assessment (RUA) and evaluated its psychometric properties. Methods This study was conducted in three phases. Phase one involved the development of an item pool and evaluation of expert validity. Phase two included pilot testing and assessment of face validity. Phase three comprised formal administration, along with reliability and validity testing. Confirmatory factor analysis (CFA) was used to examine the construct validity of the scale, and discriminant validity was assessed to determine its ability to differentiate among various demographic and clinical characteristics. Reliability was evaluated using Cronbach's α coefficient and the intraclass correlation coefficient (ICC). The study recruited 287 cancer patients and 232 primary caregivers from a medical center in northern Taiwan and its affiliated cancer center. Results The RUA demonstrated strong content validity (S-CVI/Ave = 0.95) and face validity. Both the patient and caregiver versions exhibited good internal consistency (Cronbach's α = 0.82 and 0.84, respectively) and test-retest reliability (ICC = 0.80 and 0.89, respectively). CFA results supported a six-factor structure for both versions, encompassing informational resources, family and friend support resources, long-term care resources, healthcare team member resources, psychological and physical rehabilitation-related resources, and community resources. Overall model fit indices were within acceptable ranges (patient version: χ²(335) = 832.49, χ²/df = 2.49, CFI = 0.95, TLI = 0.94, RMSEA = 0.09; caregiver version: χ²(335) = 690.79, χ²/df = 2.06, CFI = 0.96, TLI = 0.96, RMSEA = 0.07). Additionally, both versions demonstrated good discriminant validity. Conclusions The RUA effectively assesses resource awareness and use among cancer patients and caregivers, facilitating the clinical identification of resource gaps and informing care referral decisions.