Graduation Year

2008

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Nursing

Major Professor

Susan C. McMillan, Ph.D., A.R.N.P.

Committee Member

Jason Beckstead, Ph.D.

Committee Member

Lois Gonzalez, Ph.D., A.R.N.P.

Committee Member

Janine Overcash, Ph.D., A.R.N.P.

Keywords

Oncology, Cancer, Performance, Symptom, Nursing

Abstract

Chemotherapy induced peripheral neuropathy (CIPN) is a common side effect of several chemotherapy drugs used for the treatment of many common malignancies. CIPN is both under-assessed and underreported and few self-report tools exist that measure CIPN. Existing instruments do not evaluate all of the multi-dimensional characteristics of neuropathic symptoms; intensity, distress, timing, and characteristics. The purpose of this descriptive, cross-sectional study was to develop and psychometrically evaluate a new self - report tool for CIPN, the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT). Interviews with 15 patients with known CIPN guided development of the CIPNAT.

The CIPNAT is a 69 item self-report tool which measures CIPN, including characteristics, intensity, distress, frequency, and interference with usual activities. Content validity was evaluated by a panel of experts and revisions were made to the CIPNAT based on those results. The CIPNAT was administered to 167 patients on chemotherapy at H. Lee Moffitt Cancer Center and a two physician medical oncology practice in Tampa, Florida. The Functional Assessment of Cancer Therapy-Neurotoxicity scale (FACT/GOG-Ntx), another self-report tool for CIPN was also administered. Correlations between the CIPNAT and the FACT/GOG-Ntx were evaluated. Differences between a group of 40 patients getting non-neurotoxic chemotherapy and a group of 127 patients getting neurotoxic chemotherapy were also examined. Test-retest reliability was evaluated by administering the CIPNAT a second time to a subgroup of 30 patients and correlating the results. Correlation with a measure of the same concept indicated that scores between the CIPNAT and the FACT-Ntx were strong (r =.73, p=.000, n=127).Differences between the two contrasting groups were significant (p = .000), supporting validity. High test-retest correlations (r =.921, p=.000) demonstrated reliability. Cronbach's alpha for the total CIPNAT (alpha=.945), the symptom experience scale (alpha =.927) and the interference scale (alpha=.897) demonstrated high internal consistency reliability. Confirmatory factor analysis of neuropathic symptoms indicated the presence of two underlying factors, sensory symptoms and motor symptoms. Confirmatory factor analysis of the interference scale also indicated two underlying factors, activities requiring manual dexterity and general activities. These results provide strong evidence of the validity and reliability of the CIPNAT.

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