Development and Validation of the Reconstruction After Skin Cancer Resection Questionnaire: The RASCR-Q

Abstract

Keratinocyte carcinoma is the most common cancer in the United States with over 5 million cases per year in the United States and has the potential to impact quality of life and mental health outcomes for a significant proportion of the population. Health-related quality of life (HRQoL) is an important research area at the nexus of medicine and psychology and is a key outcome of interest from a societal perspective. Therefore, the potential impact of skin cancer on quality of life is a critical consideration for clinicians and healthcare organizations alike. This thesis describes the development and validation of the Reconstruction After Skin Cancer Resection Questionnaire (RASCR-Q) as a new instrument to assess patient satisfaction after skin cancer therapy. Three phases were included in this project: Phase I, based on interviews with 14 skin cancer patients, was used for domain identification and initial item development. Phase II, based on interviews with 4 experts in the field, helped further establish domains and face validity, and Phase III, an interim exploratory factor analysis with item reduction on 221 skin cancer patients, helped develop the final RASCR-Q questionnaire. The final RASCR-Q instrument included 12 items covering 5 domains: appearance, functional, recurrence, experience/ fear of missing out, and worry. The final RASCR-Q was reliable, with a Cronbach’s alpha of 0.84, and demonstrated good convergent validity with the FACE-Q appearance subscale (r=0.54) and excellent discriminant validity (r=-0.02). Further testing, including a planned confirmatory factor analysis, will be useful before the scale is widely adopted.