Reliability and Validity of the Suffering Scale of Family of Patients with Terminal Cancer

말기 암환자 가족의 고통 측정도구의 신뢰도와 타당도 검증

  • Received : 2010.12.04
  • Accepted : 2011.01.26
  • Published : 2011.02.28


Purpose: The purpose of this study was to test the reliability and validity of an instrument to measure suffering of family of patients with terminal cancer. Methods: This research was a methodological study processed as follows: 1) The preliminary 32 items were developed based a conceptual framework of suffering for patients with cancer. 2) The content was validated by an expert panel (n=24) and the family of patients with terminal cancers (n=33). 3) The instrument was validated by survey (n=92). Finally, 29 items were selected in developing final version of the scale. Results: Seven factors were extracted through factor analysis: 'economical distress', 'loss of meaning in life', 'feeling of social isolation', 'emotional distress', 'burnout', 'guilty feeling', and 'physical discomfort'. These factors explained 66.94% of the total variance. Cronbach's alpha and Guttman Split-half coefficient of the 29 items were .93 and .92. respectively. Conclusion: This scale identified as a valid and reliable tool with a high degree of reliability and validity. It can be effectively utilized to assess the degree of suffering of family in palliative care settings.


  1. Kang KA. Concept analysis and development of suffering: application of hybrid model method. J Nurs Acad Soc 1996;26:290-303.
  2. Korea National Statistical Office. Annual report on the cause of death statistics (Based on vital registration). Daejeon:Korea National Statistical Office;2008.
  3. Folkman S, Chesney MA, Christopher-Richards A. Stress and coping in caregiving partners of men with AIDS. Psychiatr Clin North Am 1994; 17:35-53.
  4. Nijboer C, Tempelaar R, Sanderman R, Triemstra M, Spruijt RJ, Ban den bos GA. Cancer and caregiving: the impact on the caregiver's health. Psychooncology 1998;7:3-13<3::AID-PON320>3.0.CO;2-5
  5. Goldstein NE, Concato J, Fried TR, Kasl SV, Johnson-Jurzeler RB. Factors associated with caregiver burden among caregivers of ill patients with cancer. J Palliat Care 2004;20:38-43.
  6. Choi ES. Experiences of family caregivers with terminal cancer patients [dissertation]. Seoul: Seoul National Univ.;2006.
  7. Oliviers D, Monroe B. Death, dying, and social differences. Oxford University Press;2004.
  8. Jung JG, Kim JS, Kim JS, Kim SS, Kang DS, Kim SM, et al. Quality of life among family caregivers of terminal cancer patient. Korean J Hosp Palliat Care 2006;9:1-10.
  9. Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL. Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Int Med 2000;132:451-9.
  10. Webb M. The good death. Seven: bearing the burden, Families in distress. New York: Bantam Book;1997.
  11. Kim HS, Yu SJ, Kwon SY, Park YH. Differences in patients and family caregivers' ratings of cancer pain. Korean J Hosp Palliat Care 2008;11: 42-50.
  12. Kim HC, Kim ES, Park KH. Needs of patients and their families in hospice care unit. Korean J Hosp Palliat Care 2007;10:137-44.
  13. Kang KA, Kim SJ, Kim YS. The need for hospice care in families of patients with cancer. J Korean Community Nurs 2004;20: 277-84.
  14. Kang KA. Development of a tool to measure suffering in patients with cancer. J Korean Acad Nurs 1999;29:1365-78.
  15. Kang KA, Kim SJ. Development of needs assessment instrument for hospice care in families of the patients with cancer. J Korean Biol Nurs Sci 2005;7:57-68.
  16. Lynn MR. Determinatin and quantification of content validity. Nurs Res 1986;35:382-5.
  17. Lee EO, Lim NY, Park HA. Statistical analysis and nursing∙medical research. Seoul:Soomoon Publishing Co;1998.
  18. Han SS, Lee SC, Ku JC. Health and medical statistical analysis. Seoul: Fornurse;2008.
  19. Kang BS, Serk KS, Oh YJ. SPSS/PC+ for statistical analysis. Seoul: Trade Management Press;1993.
  20. Kim SC, Jeoung DW, Son HR. Depression level among family caregivers of hospice patients. Korean J Fam Med 2009;30:175-81.
  21. Ha JS, Yea SJ, Park SH, Kim I, Shin SS, Bae CY, et al. A study of the relationship between health risk factors and family function. J Korean Acad Fam Med 1993;14:647-52.
  22. Andrews SC. Caregiver burden and symptom distress in people with cancer receiving hospice care. Oncol Nurs Forum 2001;28:1469-74.
  23. Murray SA, Kendall M, Boyd K, Grant L, Highet G, Sheikh A. Archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer: secondary analysis of serial qualitative interviews. BMJ 2010;340:c2581.
  24. Chan CW, Chang AM. Stress associated with tasks for family caregivers of patients with cancer in Hong Kong. Cancer Nurs 1999;22:260-5.
  25. Hull MM. Sources of stress for hospice caregiving families. Hosp J 1990; 6:29-54.
  26. Han KH, Jung JG, Oh SK, Kim JS, Kim SS, Kim SY. Depression level among family caregivers of terminal cancer patients. J Korean Acad Fam Med 2005; 26:752-8.
  27. Meyers JL, Gray LN. The relationships between family primary caregiver characteristics and satisfaction with hospice care, quality of life, and burden. Oncol Nurs Forum 2001;28:73-82.
  28. Cohen CA, Colantonio A, Vernich L. Positive aspects of caregiving: rounding out the caregiver experience. Int J Geriatr Psychiatry 2002;17: 184-8.
  29. Patterson LB, Dorfman LT. Family support for hospice caregivers. Am J Hosp Palliat Care 2002;19:315-23.