# Futility in healthcare among Mexican female patients with breast cancer in advanced stage: The patient perspective

## TL;DR

This study explores the perception of futility in healthcare among Mexican women with advanced breast cancer and develops a questionnaire to assess it.

## Contribution

The study introduces and validates a new questionnaire (FHC-Q) to measure perceived futility in healthcare for advanced breast cancer patients.

## Key findings

- FHC was perceived by 3.9% of Mexican women with advanced breast cancer.
- The FHC-Q showed good validity and reliability with a Cronbach’s alpha of 0.766 and an ICC of 0.845.
- The FHC-Q consists of 16 items across five dimensions and explained 57.8% of the variance.

## Abstract

Breast cancer is the leading cause of cancer-related deaths among women in Mexico, and the outcomes for patients are often poor. Futility in healthcare (FHC) occurs when treatment fails to achieve its intended goals, resulting in negative consequences. This study aimed to estimate the proportion of female patients in Mexico with advanced-stage breast cancer (ABC) who perceive FHC. Additionally, we inform the development and validation of a questionnaire (FHC-Q) to assess this phenomenon.

This cross-sectional study was conducted from May 17, 2024, to December 30, 2024, in three phases. It involved three convenience samples (S) of adult women with ABC: S-1 (n = 30), S-2 (n = 201), and S-3 (n = 257). Phase 1 focused on constructing the FHC-Q, evaluating its content validity (expert agreement), and conducting a pilot test to assess its feasibility, all within S-1. Phase 2 involved assessing the questionnaire’s reliability (internal consistency and temporal stability), construct validity (correlations between FHC-Q and DASS21 scores, along with exploratory factor analysis), and criterion validity (correlations between FHC-Q and SF-36 scores), all in S-2. Phase 3 estimated the FHC phenomenon in S-3. The definition of FHC was established using the Delphi method.

Participants represented typical female Mexican patients with ABC. The FHC-Q comprised 16 items distributed into five dimensions. The FHC-Q demonstrated feasibility and validity, with expert agreement of ≥80% and a five-factor structure explaining 57.8% of the variance. Correlations between the FHC-Q, DASS21 and SF-36 scores were significant and low to moderate. The FHC-Q reliability was confirmed with a Cronbach’s alpha of 0.766 and an ICC of 0.845 (95% CI: 0.735–0.909).

FHC was perceived by 3.9% of the participants

FHC was perceived by a minority of Mexican women with ABC stages. The FHC-Q was valid, reliable and feasible to assess the phenomenon in the target population.