Performance of the Family Satisfaction with the End-of-Life Care (FAMCARE) measure in an ethnically diverse cohort: psychometric analyses using item response theory

Practices for Reporting Scale Structure and Summarizing Scores in Studies Using FAMCARE Scale to Assess Caregiver Satisfaction with Cancer Care: A Scoping Review

Background

Satisfaction with care is a concept quantified through diverse measurement tools. However, studies have indicated that measuring satisfaction is challenging due to the construct's multidimensional expression. Thus, obtaining valid results requires careful consideration of the construct's nature and measurement methods.

Purpose

The primary aim of this study was to examine how studies involving cancer caregivers have addressed the dimensionality of the construct when using satisfaction with care as an outcome, and whether this is reflected in the score reporting practices. We chose to investigate this by conducting a scoping review of the measurement tool Family Satisfaction with End-of-Life Care Scale (FAMCARE Scale), where scores can be reported as the mean of overall score, subscale scores and single-item scores.

Methods

This scoping review consisted of systematic searches using Medline, CINAHL, Embase, PsycInfo, Cochrane Library, and Epistemonikos. Two researchers used the Rayyan Qatar Computing Research Institute system to perform a blinded screening process. We extracted information on study design, purpose, evaluating of structural validity, variations in the type of scores reported, and justification for choosing the type(s) of scores that were analyzed.

Results

Twenty-three studies were included in the review, and their designs and reporting practices of score type varied substantially. Five studies reported analyses to test the scale's structural validity. Ten studies provided a justification for their choice of reporting method. The most common reporting practice found was using mean of overall scores, present in 20 of the included studies. Twelve studies reported mean of subscale scores, and ten reported single-item mean scores.

Conclusion

We found substantial variability in score reporting practices, highlighting the need for a more in-depth understanding and reflection on the multidimensional nature of caregiver satisfaction.

Optimizing geriatric palliative care in Egypt: Comprehensive patient and family perspectives

OBJECTIVES

In Egypt, palliative care for geriatric patients is understudied, necessitating exploration for service optimization. Amidst rising chronic illnesses and aging, understanding perspectives of geriatric patients and families is crucial for targeted improvements. This study aims to explore geriatric patients' and their families' perspectives on palliative care in Egypt, seeking opportunities to optimize service delivery for the elderly.

METHODS

Employing a cross-sectional design with 110 geriatric patients and an equal number of family caregivers from the Damietta Oncology Institute and the pain treatment clinics for cancer patients at Zagazig University Hospital, the study focuses on a specialized pain clinic. Validated tools (Palliative Care Outcome Scale, Family Satisfaction with End-of-Life Care [FAMCARE] Scale, Edmonton Symptom Assessment System [ESAS], Caregiver Strain Index [CSI]) assess quality of life, family satisfaction, symptom severity, and caregiver strain.

RESULTS

Geriatric patients (mean age: 65.0 ± 8.1 years; 45.5% male, 55.5% female) have diverse diagnoses (e.g., breast cancer 22%). Palliative care outcomes reveal challenges: low emotional well-being (2.6 ± 0.0) and alarming overall quality of life (1.8 ± 0.0). Family dissatisfaction (FAMCARE) is pervasive (total mean score 2.6 ± 0.5). Symptom severity (ESAS) is high, and caregiver strain (CSI) is notable (8.5 ± 2.2).

SIGNIFICANCE OF THE RESULTS

The findings underscore the significance of the challenges faced by geriatric patients and caregivers in palliative care. Patients confront considerable symptom burdens and emotional distress, while caregivers experience notable strain. Urgently needed are targeted interventions designed to enhance patient well-being, alleviate caregiver burden, and elevate satisfaction. The critical importance of implementing these interventions promptly is highlighted, as they are instrumental in improving the overall care experience for geriatric patients and their caregivers. Moreover, the results underscore the imperative of developing comprehensive support mechanisms to address the intricate dimensions of palliative care, ultimately contributing to a more compassionate and effective care continuum.

Caregivers' satisfaction with cervical cancer care in Ethiopia

BACKGROUND AND PURPOSE

Cervical cancer is the second most common cancer among African women, following breast cancer. Palliative care is among the standards of care in cancer management. While caregivers play key roles in palliative care, their satisfaction with the care influences treatment outcomes and patients' quality of life. This study evaluated caregivers' satisfaction with the care provided to patients with advanced cervical cancer.

METHOD

A cross-sectional evaluation of caregivers' satisfaction with patient care was conducted at a tertiary hospital in Ethiopia. The study tool included the 20-item family satisfaction with advanced cancer care (FAMCARE) and caregiver stress index (CSI). Using binary logistic regression, we identified factors associated with caregivers' satisfaction.

RESULT

A total of 360 caregivers were interviewed. Most of the caregivers were male (58.1%), below the age of 35 years (60.8%), and educated to the high school level or less (64.4%). The average FAMCARE score was 77.7 out of the maximum 100. High satisfaction was observed among subscales "availability of treatment and care" and "psychosocial care," while low satisfaction was observed with "physical patient care" and "provision of information." Caregivers' stress and time dedicated to the caregiving were associated with caregivers' satisfaction.

CONCLUSION

Overall, high satisfaction with advanced care at the tertiary hospital was documented. However, the caregivers also bore high burden of strain. Management of caregivers' strain, prompt treatment of patients' symptoms, and provision of adequate information to the caregivers could further improve caregivers' satisfaction.

Development and Validation of the QUALI-PALLI-FAM Questionnaire for Assessing Relatives' Perception of Quality of Inpatient Palliative Care: A Prospective Cross-Sectional Survey

CONTEXT

Relatives of patients receiving palliative care are at risk for psychological and physical distress, and their perception of quality of care can influence patients' quality of life.

OBJECTIVES

The purpose of this study was to develop and validate the QUALI-PALLI-FAM questionnaire (QUAlity of PALLIative car from FAMilies' perspective) to measure families' perception of and satisfaction with palliative care.

METHODS

An exploratory factor analysis was conducted, and we evaluated the questionnaire's internal consistency using Cronbach's alpha, its stability across various strata, and the correlation between the QUALI-PALLI-FAM (factors, total score, and global satisfaction) and the total score of the FAMCARE (FAMily satisfaction with CARE) questionnaire.

RESULTS

This multicentric prospective cross-sectional survey was conducted in seven French hospitals, namely, three palliative care units and four standard medical units with a mobile palliative care team. The questionnaire was completed by 170 relatives of patients (more than 90% of patients had advanced cancer). The final questionnaire included 14 items across three domains: organization of care and availability of caregivers, medical information provision, and confidence and involvement of relatives. Internal consistency was good for all subscales (Cronbach's α = 0.74-0.86). Our questionnaire was stable across various strata: age and gender (patients and relatives), Palliative Performance Scale scores, and care settings. The QUALI-PALLI-FAM total score was correlated with the total FAMCARE score.

CONCLUSION

The QUALI-PALLI-FAM appears to be a valid, reliable, and well-accepted tool to explore relatives' perception of quality of inpatient palliative care and complements the QUALI-PALLI-PAT questionnaire. Further testing is required in various settings and countries.

Evaluation of measurement equivalence of the Family Satisfaction with the End-of-Life Care (FAMCARE): Tests of differential item functioning between Hispanic and non-Hispanic White caregivers

OBJECTIVE

Although the psychometric properties of the Family Satisfaction with End-of-Life Care measure have been examined in diverse settings internationally; little evidence exists regarding measurement equivalence in Hispanic caregivers. The aim was to examine the psychometric properties of a short-form of the FAMCARE in Hispanics using latent variable models and place information on differential item functioning (DIF) in an existing family satisfaction item bank.

METHOD

The graded form of the item response theory model was used for the analyses of DIF; sensitivity analyses were performed using a latent variable logistic regression approach. Exploratory and confirmatory factor analyses to examine dimensionality were performed within each subgroup studied. The sample included 1,834 respondents: 317 Hispanic and 1,517 non-Hispanic White caregivers of patients with Alzheimer's disease and cancer, respectively.

RESULTS

There was strong support for essential unidimensionality for both Hispanic and non-Hispanic White subgroups. Modest DIF of low magnitude and impact was observed; flagged items related to information sharing. Only 1 item was flagged with significant DIF by both a primary and sensitivity method after correction for multiple comparisons: "The way the family is included in treatment and care decisions." This item was more discriminating for the non-Hispanic, White responders than for the Hispanic subsample, and was also a more severe indicator at some levels of the trait; the Hispanic respondents located at higher satisfaction levels were more likely than White non-Hispanic respondents to report satisfaction.

SIGNIFICANCE OF RESULTS

The magnitude of DIF was below the salience threshold for all items. Evidence supported the measurement equivalence and use for cross-cultural comparisons of the short-form FAMCARE among Hispanic caregivers, including those interviewed in Spanish.

Patient-physician discordance in goals of care for patients with advanced cancer

Background

Shared decision-making at end of life (eol) requires discussions about goals of care and prioritization of length of life compared with quality of life. The purpose of the present study was to describe patient and oncologist discordance with respect to goals of care and to explore possible predictors of discordance.

Methods

Patients with metastatic cancer and their oncologists completed an interview at study enrolment and every 3 months thereafter until the death of the patient or the end of the study period (15 months). All interviewees used a 100-point visual analog scale to represent their current goals of care, with quality of life (scored as 0) and survival (scored as 100) serving as anchors. Discordance was defined as an absolute difference between patient and oncologist goals of care of 40 points or more.

Results

The study enrolled 378 patients and 11 oncologists. At baseline, 24% discordance was observed, and for patients who survived, discordance was 24% at their last interview. For patients who died, discordance was 28% at the last interview before death, with discordance having been 70% at enrolment. Dissatisfaction with eol care was reported by 23% of the caregivers for patients with discordance at baseline and by 8% of the caregivers for patients who had no discordance (p = 0.049; ϕ = 0.20).

Conclusions

The data indicate the presence of significant ongoing oncologist-patient discordance with respect to goals of care. Early use of a simple visual analog scale to assess goals of care can inform the oncologist about the patient's goals and lead to delivery of care that is aligned with patient goals.

Satisfaction with hospital care at the end of life

OBJECTIVES

To determine the satisfaction of relatives of deceased patients with the care received in a palliative care unit (PCU) and compare it with cases in which a team with specific psychological care were not involved.

MATERIAL AND METHODS

An anonymous survey (n=202) was administered to the relatives (response rate, 42.1%), which evaluated 9 issues related to the process of dying and the overall assessment of the care.

RESULTS

The overall satisfaction was high (mean score of 9.22); the score for the full team was 9.40, while that of the team without the psychologist was 8.40 (P=.005). The items that scored highest were "team availability", "information received" and "assistance for facing the disease", followed by "pain control", "peaceful death", "assistance for patient-family communication", "grief support" and "quality of life".

CONCLUSIONS

Based on the relatives' assessment, the hospital PCU teams help increase the quality of care at the end of life.

Translation and Validation of the 10-Item FAMCARE Scale to Assess Satisfaction of Family Caregivers With Care Given to Cancer Patients

CONTEXT

Family satisfaction with care is an important quality indicator in palliative care.

OBJECTIVES

This study aimed to translate and validate the 10-item Family Satisfaction with End-of-Life Care (FAMCARE) tool.

METHODS

Family caregivers of patients with advanced cancer were recruited. FAMCARE was translated from English to Chinese using a forward and backward translation process. Chinese-speaking caregivers were interviewed with the preliminary Chinese FAMCARE, and phrasing was edited to ensure clarity of the items. Subsequently, a baseline and follow-up survey in English and the finalized Chinese version were performed to assess psychometric properties. Cronbach's alpha (α) and intraclass correlation coefficient were used for internal consistency and test-retest reliability, respectively. Validity was assessed with Spearman's correlation coefficient (r). The Comprehensive Needs Assessment Tool-Caregiver (CNAT-C) and a one-item assessment by caregivers regarding "good-care" acted as a validity criterion. Pooled analysis of both languages and language-specific analyses were performed.

RESULTS

There were 259 participants; 134 and 125 participants filled in the English and Chinese versions, respectively. Pooled analysis showed that the intraclass correlation coefficient of FAMCARE was 0.95; α was 0.91. There was a moderate positive correlation between the total FAMCARE scores and "good-care" (r = 0.54) and a moderate negative correlation between the total FAMCARE score and the CNAT-C "Healthcare Staff" domain (r = 0.41). There was a weak negative correlation between the total FAMCARE score and the CNAT-C domain of "family and social support" (r = -0.13). Language-specific analyses revealed similar results regarding FAMCARE's psychometric properties.

CONCLUSION

FAMCARE showed good reliability and validity.

Psychometric Properties of a Spanish-Language Version of a Short-Form FAMCARE: Applications to Caregivers of Patients With Alzheimer's Disease and Related Dementias

Although family satisfaction is recognized as a critical indicator of quality care for persons with serious illness, Spanish-language measures are limited. The study aims were to develop a Spanish translation of the short-form Family Satisfaction With End-of-Life Care (FAMCARE), investigate its psychometric properties in Hispanic caregivers to patients with Alzheimer's disease and related dementias (ADRD; N = 317; 209 interviewed in Spanish), and add parameters to an existing item bank. Based on factor analyses, the measure was found to be essentially unidimensional. Reliabilities from a graded item response theory model were high; the average estimate was 0.93 for the total and Spanish-language subsample. Discrimination parameters were high, and the model fit adequate. This is the first study to examine the performance of the short-form FAMCARE measure among Hispanics and caregivers to patients with ADRD. The short-form measure can be recommended for Hispanics and caregivers to patients with ADRD.

Association between family satisfaction and caregiver burden in cancer patients receiving outreach palliative care at home

Objective:

Little is known about the associations between family satisfaction with end-of-life care and caregiver burden. We conducted a researcher-assisted questionnaire survey to clarify the impact of caregiver burden on family satisfaction and to determine the types of burden that decrease family satisfaction.

Method:

Bereaved family caregivers of patients with advanced cancer who received our outreach palliative care service were retrospectively identified. Family satisfaction with the end-of-life care provided by the palliative care service and caregiver burden were quantified using the Japanese versions of the FAMCARE Scale and the Zarit Burden Interview (ZBI), respectively.

Results:

Our study subjects included 23 family caregivers. The mean scores on the FAMCARE Scale and the ZBI for the total population were 72.8 ± 11.2 and 22.8 ± 17.3, respectively, indicating moderate-to-high satisfaction and low-to-moderate burden. Caregiver burden had a strong negative correlation to family satisfaction with end-of-life care (Spearman's rho [ρ] = −0.560, p = 0.005), which remained after adjustment for potential confounders (standardized beta [β] = −0.563, p = 0.01). Several burden items—including loss of control, personal time, social engagement with others, feeling angry with the patient, feeling that the patient wants more help than he/she needs, and a wish to leave the care to someone else—were associated with decreased satisfaction. The major cause of dissatisfaction for family members included the information provided regarding prognosis, family conferences with medical professionals, and the method of involvement of family members in care decisions.

Significance of results:

Caregiver burden can be a barrier to family satisfaction with end-of-life care at home. A home care model focused on caregiver burden could improve end-of-life experiences for patients and family caregivers.

Translation and Testing of the Italian Version of FAMCARE-2: Measuring Family Caregivers' Satisfaction With Palliative Care

Family satisfaction is an important outcome of palliative care and is a critical measure for health care professionals to address when assessing quality of care. The FAMCARE-2 is a widely used measure of family satisfaction with the health care received by both patient and family in palliative care. In this study, a team of Italian researchers culturally adapted the FAMCARE-2 to the Italian language and psychometrically tested the instrument by measuring satisfaction of 185 family caregivers of patients admitted into two palliative care services. FAMCARE-2 showed excellent levels of internal consistency (Cronbach's α coefficient = .96) and test-retest reliability ( r = .98, p < .01). The confirmatory factor analysis showed a single-factor structure with good fit. Satisfaction levels were significantly correlated with family caregivers being females with less education, patient length of care, and place of assistance and death. This scale can help health care professionals identify which aspects of care need improvement and enable family caregivers to manage their challenging role.

The Use of a Brief 5-Item Measure of Family Satisfaction as a Critical Quality Indicator in Advanced Cancer Care: A Multisite Comparison

BACKGROUND

Although family satisfaction is recognized as a critical indicator of quality for patients with advanced cancer, it is rarely assessed as part of routine clinical care. Measurement burden may be one barrier to widespread use of family satisfaction measures.

OBJECTIVE

The goal of this study was to test the ability of a new, brief 5-item measure of family satisfaction with care to accurately capture differences across hospital settings.

DESIGN

Using data from the Palliative Care for Cancer Patients study, a prospective study of 1979 patients and caregivers, we used multivariate regression analysis to detect significant differences across five sites.

SETTINGS

Hospitalized patients with advanced cancer and their caregivers Methods: We used both the shortened 5-item version of the FAMCARE scale (previously developed using Item Response Theory) and the original 20-item FAMCARE to measure family satisfaction.

RESULTS

On the 5-item FAMCARE, sites ranged from mean scores of 5.5-6.9 out of a possible high score of 10. Family members at one care site (n = 783) were significantly (p < 0.05) less satisfied with their care than family members at four other care sites. The original 20-item measure failed to differentiate satisfaction levels between all hospital sites.

DISCUSSION

Variability in family satisfaction with advanced cancer care across hospital settings can be more sensitively detected using a brief 5-item questionnaire versus longer measures. The development of less lengthy and burdensome measures for monitoring family satisfaction, which are still valid, can facilitate routine assessments to maintain and promote high-quality care across care settings.

Use of an Item Bank to Develop Two Short-Form FAMCARE Scales to Measure Family Satisfaction With Care in the Setting of Serious Illness

CONTEXT

Family satisfaction is an important and commonly used research measure. Yet current measures of family satisfaction are lengthy and may be unnecessarily burdensome--particularly in the setting of serious illness.

OBJECTIVES

To use an item bank to develop short forms of the Family Satisfaction with End-of-Life Care (FAMCARE) scale, which measures family satisfaction with care.

METHODS

To shorten the existing 20-item FAMCARE measure, item response theory parameters from an item bank were used to select the most informative items. The psychometric properties of the new short-form scales were examined. The item bank was based on data from family members from an ethnically diverse sample of 1983 patients with advanced cancer.

RESULTS

Evidence for the new short-form scales supported essential unidimensionality. Reliability estimates from several methods were relatively high, ranging from 0.84 for the five-item scale to 0.94 for the 10-item scale across different age, gender, education, ethnic, and relationship groups.

CONCLUSION

The FAMCARE-10 and FAMCARE-5 short-form scales evidenced high reliability across sociodemographic subgroups and are potentially less burdensome and time-consuming scales for monitoring family satisfaction among seriously ill patients.

Evaluation of measurement equivalence of the Family Satisfaction with the End-of-Life Care in an ethnically diverse cohort: tests of differential item functioning

BACKGROUND

The Family Satisfaction with End-of-Life Care is an internationally used measure of satisfaction with cancer care. However, the Family Satisfaction with End-of-Life Care has not been studied for equivalence of item endorsement across different socio-demographic groups using differential item functioning.

AIMS

The aims of this secondary data analysis were (1) to examine potential differential item functioning in the family satisfaction item set with respect to type of caregiver, race, and patient age, gender, and education and (2) to provide parameters and documentation of differential item functioning for an item bank.

DESIGN

A mixed qualitative and quantitative analysis was conducted. A priori hypotheses regarding potential group differences in item response were established. Item response theory and Wald tests were used for the analyses of differential item functioning, accompanied by magnitude and impact measures.

RESULTS

Very little significant differential item functioning was observed for patient's age and gender. For race, 13 items showed differential item functioning after multiple comparison adjustment, 10 with non-uniform differential item functioning. No items evidenced differential item functioning of high magnitude, and the impact was negligible. For education, 5 items evidenced uniform differential item functioning after adjustment, none of high magnitude. Differential item functioning impact was trivial. One item evidenced differential item functioning for the caregiver relationship variable.

CONCLUSION

Differential item functioning was observed primarily for race and education. No differential item functioning of high magnitude was observed for any item, and the overall impact of differential item functioning was negligible. One item, satisfaction with "the patient's pain relief," might be singled out for further study, given that this item was both hypothesized and observed to show differential item functioning for race and education.