Classification of Numerical Score of Shame and Stigma Scale for Head and Neck Cancer into the Discrete Categories

The shame and stigma scale was developed to specifically analyze the shame and stigma in head and neck cancer patients. However, being a numerical rating scale, it gives a continuous number for each patient, which is difficult for clinicians to interpret. The present study aimed to classify the numerical rating score of the shame and stigma scale into the discrete categories of normal, mild, moderate, and severe. Data from 197 patients with head and neck cancer was obtained using the shame and stigma scale. The shame and stigma scale has a global score and four domains, with a high score representing a high rate of shame and stigma. The numerical score was used to create classification schemes to derive the optimum cutoff points for discrete categories. The variability of the optimal classification scheme was quantified using a bootstrap resampling procedure by repeating the patient sample a thousand times. The classification scheme with the highest F value in ANOVA was used to assign a cutoff to classify the numerical score into normal, mild, moderate, and severe categories. Seven classification schemes were created for global score, appearance domain and stigma domain. Five classification schemes were created for the regret domain, and three classification schemes were created for the speech domain. The optimum cutoff values for global score were 0-10 (normal), 11-30 (mild), 31-50 (moderate) and 51-80 (severe) (F = 1044.105); cutoff values for appearance domain were 0-6 (normal), 7-14 (mild), 15-22 (moderate) and 23-32 (severe) (F = 1344.50); cutoff values for stigma domain were 0-2 (normal), 3-7 (mild), 8-12 (moderate) and 13-20 (severe) (F = 1590.94); cutoff values for regret domain were 0-2 (normal), 3-6 (mild), 7-10 (moderate) and 11-16 (severe) (F = 924.03); and cutoff values for speech domain were 0-2 (normal), 3-5 (mild), 6-8 (moderate) and 9-12 (severe) (F = 1008.38). The present study classifies the numerical rating score of the shame and stigma scale into discrete categories i.e. normal, mild, moderate, and severe by obtaining the optimum cutoff points as per maximum F value. Clinicians can use these cutoff values to classify shame and stigma numerical scores as normal, mild, moderate, and severe for easy interpretation.