Development and Validation of a Dual Language Needs Assessment Tool for People Living With Colorectal Cancer (NeAT-CC)

Abstract

Background: Needs assessment tools may guide optimisation of clinical services to be more patient-centred. As needs of patients living with and beyond colorectal cancer (CRC) may also be influenced by socio-cultural backgrounds and healthcare ecosystems, we developed and validated a needs assessment questionnaire for CRC in a multiethnic, low and middle-income setting. Method: Study methodology was guided by the COSMIN checklist. Items generation was based on findings from independent qualitative inquiries with patients, input from cancer stakeholders, and literature review. Following translation into Malay language, content and face validation were undertaken. The tool was administered to 300 individuals living with and beyond CRC. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed. Criterion validity was assessed using EORTC QLQ-C30 and QLQ-CR29 questionnaires. Result: The 48-item bilingual needs assessment tool for colorectal cancer (NeAT-CC) encompassed six domains of needs, namely diagnosis, psychosocial and information, healthcare, practical and living with cancer, financial, and employment. Cronbach’s alpha was above 0.70 for all domains, indicating good internal consistency. CFA also demonstrated acceptable convergent and divergent validity with composite reliability >0.70 and Heterotrait–Monotrait index <0.90 for all constructs. Criterion validity was established given the significant negative correlation with quality of life. The NeAT-CC was easily understandable, took 15-20 minutes for completion and may be self-administered. Conclusion: Utilisation of NeAT-CC may enable optimisation of supportive and survivorship care services following CRC in local settings. The tool has wider potential for adaptation in other multiethnic and/or low and middle-income settings.