A Visual Fatigue Scale to Measure Cancer-Related Fatigue: The Process of Development

Cancer-related fatigue (CRF) is a common and often underreported issue in the outpatient setting. Advanced practitioners are crucial in assessing and managing CRF, as they are frequently in contact with patients and can observe changes in their condition. Implementing a multidimensional fatigue scale that incorporates images could enhance and expedite the screening process for CRF in cancer outpatient care.

The purpose of this study was to create a practical tool for clinical use, specifically a brief, self-rating pictorial scale designed to assess CRF.

Nine focus groups comprised of oncology clinical experts and volunteer patients/survivors were conducted at a large National Cancer Institute-designated cancer center. Clinical expert focus groups convened online for 1-hour meetings every 2 weeks, spanning four sessions. During these sessions, the focus groups examined existing cancer fatigue scales and reviewed relevant literature. One of the advanced practice providers created an initial version of a pictorial fatigue scale. Patients then contributed their insights via multiple focus groups based on their personal experiences with CRF. Subsequently, a professional graphic artist refined the images, incorporating the patients' feedback to enhance the scale's accuracy and effectiveness.

Content validity was established for a Visual Fatigue Scale measuring CRF using an iterative process with nine focus groups made up of oncology clinical experts and patients. The final scale included two image sets and a 10-point numeric scale to correspond with four levels of fatigue (none, mild, moderate, severe).

The Visual Fatigue Scale can help identify patients who need more comprehensive evaluation and management, ensuring timely and effective interventions. By utilizing such a scale, health-care providers can better address the multifaceted nature of CRF, improving patient outcomes and quality of life.