Confirmatory factor analysis of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD–B) among Italian medical students

Abstract

Objective:A steady increase in the number of patients requiring end-of-life care has been observed during the last decades. The assessment of healthcare students' attitudes toward end-of-life care is an important step in their curriculum, as it provides information about their disposition to practice palliative medicine. The Frommelt Attitude Toward Care of the Dying Scale (FATCOD–B) was developed to detect such a disposition, but its psychometric properties are yet to be clearly defined.Method:A convenience sample of 608 second-year medical students participated in our study in the 2012/2013 and 2013/2014 academic years. All participants completed the FATCOD–B. The sample was randomly divided in two subsamples. In the item analysis, reliability (Cronbach's α), internal consistency (item–total correlations), and an exploratory factor analysis (EFA) were conducted using the first subsample (n= 300). Using the second subsample (n= 308), confirmatory factor analysis (CFA) was performed using the robust ML method in the Lisrel program.Results:Reliability for all items was 0.699. Item–total correlations, ranging from 0.03 to 0.39, were weak. EFA identified a two-dimensional orthogonal solution, explaining 20% of total variance. CFA upheld the two-dimensional model, but the loadings on the dimensions and their respective indicators were weak and equal to zero for certain items.Significance of Results:The findings of the present study suggest that the FATCOD–B measures a two-dimensional construct and that several items seem in need of revision. Future research oriented toward building a revised version of the scale should pay attention to item ambiguity and take particular care to distinguish among items that concern emotions and beliefs related to end-of-life care, as well as their subjects (e.g., the healthcare provider, the patient, his family).

Nursing students’ attitudes toward care of dying patients: A pre- and post-palliative course study

“…It also has been argued that the FATCOD scale [24] has issues in terms of validity (Box 1) and the low Cronbach's alpha in the present study points to this problem. We have not studied the long-term effects of the education on palliative care, which limits the possibilities for drawing conclusions on the effect for nurses' working life and thus the quality of care for patients at the end of life.…”

“…However, the Cronbach's alpha was low for the two domains in the Swedish version [8]. Critique of the questionnaireThe scale has been shown to measure a two-dimensional construct [8, 24]. It has been found to contain items that could be revised or omitted, and items 10 and 25 in particular are said to be problematic [24].…”

Refining the Frommelt Attitude Toward the Care of the Dying Scale (FATCOD–B) for medical students: A confirmatory factor analysis and Rasch validation study

“…Some items refer to the emotional burden involved in caring for the dying, some address beliefs about caring for the dying, and others concern care of families. The most frequently proposed factorial solution seems to involve a two-dimensional structure (Nakai et al, 2006; Henoch et al, 2014; Leombruni et al, 2015 a ). This conceptualization was originally proposed by Nakai and colleagues (Nakai et al, 2006), who defined the first dimension as a “positive attitude about caring for the dying patient” and the second as “perception of patient- and family-centered care.”…”

“…In a previous study, the present authors tested the efficiency of the two-dimensional model using confirmatory factor analysis (CFA), and we also tested the functionality of the items (Leombruni et al, 2015 a ). We found that the scale construct is two-dimensional, but also that its structure is quite weak due to items with poor validity (i.e., high levels of item measurement error).…”

“…2015). In our present study, CFA was employed to determine the dimensionality of the FATCOD–B by imposing three specifications that might reflect the structure of the underlying construct measured by the scale: a one-factor model (M1), as originally suggested by the author of the scale; a two-factor model (M2), based on the results of previous research (Nakai et al, 2006; Henoch et al, 2014; Leombruni et al, 2015 a ); and a three-factor model (M3), which might distinguish between emotions related to care of the dying, beliefs regarding treatment of the dying, and beliefs about treatment of families. The Rasch model was applied to the data to test the functionality of the items in terms of difficulties (i.e., their capability to discriminate between individuals with different levels of attitude).…”