# Psychometric assessment of the Chinese version of the perceptions of palliative care instrument in advanced cancer patients: a cross-sectional study

## TL;DR

This study validated a Chinese version of a questionnaire to assess advanced cancer patients' perceptions and needs regarding palliative care.

## Contribution

The study provides a culturally adapted and psychometrically sound tool for evaluating palliative care perceptions in Chinese advanced cancer patients.

## Key findings

- The C-PPCI showed strong internal consistency with a Cronbach’s alpha of 0.852.
- A four-domain, nine-factor structure was confirmed with good fit indices in CFA.
- The instrument demonstrated good concurrent validity when correlated with existing symptom and distress scales.

## Abstract

This study aimed to validate the Chinese version of the perceptions of palliative care instrument (C-PPCI) for assessing the perceptions and needs of advanced cancer (AC) patients regarding palliative care in China.

The C-PPCI was translated following Brislin’s guidelines and tested for psychometric properties through a cross-sectional survey of 537 AC patients. Internal consistency was evaluated using Cronbach’s alpha, and test-retest reliability was assessed with the intra-class correlation coefficient (ICC). Content validity was examined with the content validity index (CVI), and construct validity was explored using exploratory factor analysis (EFA) and confirmed with confirmatory factor analysis (CFA). Concurrent validity was assessed by correlating the C-PPCI with the Edmonton symptom assessment scale (ESAS) and distress thermometer (DT).

Of 537 recruited participants, 444 completed the questionnaire (response rate: 82.6%). The scale-level content validity index (S-CVI) was 0.99. The C-PPCI demonstrated strong internal consistency, with a Cronbach’s alpha of 0.852 for the total scale (subscale range: 0.820–0.872). Test-retest reliability was good, with an ICC of 0.855 for the total scale (subscale range: 0.751–0.815). EFA yielded a four-domain, nine-factor structure explaining 64% to 75% of the total variance. CFA supported this model with good fit indices (comparative fit index (CFI) = 0.917, Tucker-Lewis index (TLI) = 0.904, root mean square error of approximation (RMSEA) = 0.051, standardized root mean square residual (SRMR) = 0.072). Concurrent validity was supported by significant correlations with the ESAS and DT for most subscales.

The 35-item C-PPCI is a valid and reliable instrument for measuring Chinese AC patients’ perceptions and needs regarding palliative care, providing a valuable tool for clinicians to enhance palliative care (PC) utilization in this context.