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Development and psychometric validation of the short-form mandarin Chinese demoralization scale for cancer patients
Yapeng Wang1,2, Cangmei Fu2,3, Xiaoxin Liu2,3
1Department of Oncology, Guilin Hospital of the Second Xiangya Hospital, Central South University, Guilin, Guangxi, China.
Background:
Demoralization is a common psychological distress in Chinese cancer patients, affecting treatment adherence and quality of life. NCCN Guidelines recommend routine monitoring of distress. The original 24-item Mandarin Demoralization Scale (DS-MV) is comprehensive but less suited for rapid, repeated screening in busy oncology clinics. We therefore refined and validated a short-form Mandarin Demoralization Scale (s-DS-MV) for efficient demoralization assessment.
Methods:
This psychometric validation study initially enrolled 1,050 Chinese cancer patients between June 14, 2022 and June 13, 2023. Of these participants, 971 completed the original 24-item DS-MV through face-to-face questionnaire administration. Exploratory factor analysis and Rasch modeling were used to evaluate, refine, and revalidate the scale, including examinations of dimensionality, response scale appropriateness, item fit, item bias, and item difficulty. Test-retest reliability was assessed in a subgroup of 50 patients with relatively stable clinical symptoms.
Results:
The revised 14-item s-DS-MV (3-point Likert format) showed a 2-subscale structure supported by exploratory factor analysis. Rasch modeling confirmed acceptable model fit, unidimensionality and compliance with core criteria for each subscale. The scale exhibited satisfactory internal consistency and test-retest reliability (Existential Emptiness and Affective Distress subscale: 9 items, α = 0.855, intraclass correlation coefficient (ICC) = 0.934; Self-Worth and Life Valuation subscale: 5 items, α = 0.708, ICC = 0.881; full scale: α = 0.864, ICC = 0.933).
Conclusion:
The s-DS-MV is a 3-point two-factor self-report scale with robust psychometric properties and favorable screening utility, making it well-suited for rapid clinical screening, dynamic monitoring, and related research on demoralization among cancer patients with similar demographic and clinical characteristics in Hunan and adjacent regions of China.