Cross-validation of the Care Dependency Scale in patients with Cancer

Cross-validation of the Care Dependency Scale in patients with Cancer



Socio-demographic shifts and advances in medicine and technology arechanging the landscape of cancer care in Europe. An ageing population, the growingincidence of cancer, and the reduction of overall mortality for cancer, imply that morepatients with cancer will face some level of dependence. The Care Dependency Scale(CDS) is a uni-dimensional instrument specifically aimed at measuring patient’dependence form nursing care. Its psychometric properties have been extensively ested in different countries, settings and populations, but not in with patients withcancer. This study aimed at testing the psychometric properties of the CDS in patientswith cancer.

Material and method

A cross-validation study was conducted using ExploratoryFactor Analysis (EFA) and Confirmatory Factor Analysis (CFA) with Mplus MLRestimator in two sub-samples of 176 and 154 adult inpatients with cancer, respectively.The study was conducted from June 2015 to February 2016 in the oncology units oftwo hospitals in Rome, Italy.

Results and discussion

The EFA revealed a two-factor model having good fit indexes(n = 176). Since item 5 yielded poor factor loading, the alpha increased if the item wasdeleted, and the corrected item-total correlation was low, we decided to eliminate it.This 14-item solution was cross-validated through CFA (n = 154). According tomodification indexes, we posited two cross-loadings (item 7 and 9) and twocovariances among the residuals (3 with 4 and 10 with 11). In addition, we specified asecond order factor. The model fitted the data well:χ2(72) = 168,p< .001; CFI = .918;TLI = .897; SRMR = .069; RMSEA = .093. The factor score determinacies were 0.971 forFactor 1 and 0.947 for Factor 2. The factors were labeledPhysical care dependency(item1-4, 6-9, 13, 14) andPsychosocial care dependency(item 7, 9-12, 15)


This study provides oncology nurses with a valid, reliable, andmultidimensional measure of care dependency. The CDS includes both physical andpsychosocial aspects; therefore nurses can assess patients’care dependency in a holisticand comprehensive way.


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