Swedish Validation of the Expectation Module of Breast-Q Reconstruction

Abstract

Background: Women’s satisfaction with their breast reconstruction after mastectomy due to breast cancer depends on several factors including expectations. Understanding their expectations allows medical staff to identify patients who carry unrealistic expectations preoperatively and help with achieving more realistic ones. The increasing need to measure expectations led to development of a questionnaire called the Expectation Module of Breast-Q Reconstruction (Breast-Q Expectations). However, the Swedish version of this questionnaire requires psychometric validation. Aim: To perform a psychometric validation of the Swedish version of the questionnaire at Sahlgrenska University Hospital of Gothenburg. The psychometric properties were assessed on the basis of reliability and validity. Method: This was a validation study based on a prospectively collected data set of 208 patients >18 years scheduled for breast reconstruction 2021 after mastectomy due to breast cancer. All participants received the questionnaire at home. For validity, known-group validation, and construct validity were examined. For reliability, test-retest, and internal consistency were examined. Results: In total, 121 participants responded (58%). Validity analyses when examining construct validity yielded moderate (0.4, p<0.01) inter-scale correlation for Support from Medical Staff scale and weak (0.2-0.3) correlation between Sensation after DIEP/TRAM scale’s items and corresponding VAS question. When examining known-group validation patients undergoing prophylactic mastectomy scored higher as expected, but not for all scales. Reliability analyses when examining internal consistency yielded acceptable Cronbach alpha values (0.7-0.95), high corrected item-total correlations (≥0.3), appropriate inter-item 2 correlations (0.2-0.8), and appropriate Intraclass Correlation Coefficient (ICC) values (0.5- 0.8). Conclusion: Reliability tests indicated good internal consistency, and test-retest reliability. Results from validity tests indicated weak-moderate construct validity, and moderate knowngroup validation. Additional studies investigating e.g., different psychometric tests are recommended before reconsidering the questionnaire in clinical practice in Sweden for the assessment of individual patient expectations in an effective way.