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Preliminary Validation of the Injustice Experience Questionnaire in Patients With Advanced Cancer

      Abstract

      Context

      When diagnosed with advanced cancer, patients may perceive their situation as an injustice. The Injustice Experience Questionnaire (IEQ) is a 12-item measure of perceived unfairness originally developed for patients with chronic pain. The factor structure, reliability, and validity of the IEQ in patients with cancer have not been assessed.

      Objectives

      To examine the factor structure, internal consistency, and construct validity of the IEQ in patients with advanced cancer.

      Methods

      Patients with advanced lung or prostate cancer (N = 201) were recruited from academic and public clinics in Indianapolis, IN. Patients completed the 12-item IEQ and other measures of psychological processes and distress. IEQ instructions were modified to focus on cancer-related perceived injustice. Confirmatory factor analysis (CFA) was used to examine the dimensionality of the measure. Internal consistency reliability and construct validity were examined.

      Results

      CFA showed that the original IEQ's 2-factor structure had an adequate fit (RMSEA = 0.07, CFI = 0.96, SRMR = 0.05). The factors included Severity/irreparability and Blame/unfairness. Internal consistency was excellent (α = 0.92, ω = 0.94). The IEQ showed significant positive associations with physical and psychological symptoms (rs = 0.20 – 0.65, Ps < 0.05). The IEQ also showed significant negative associations with quality of life and acceptance of cancer (rs=-0.51 – -0.46, Ps < 0.05).

      Conclusion

      Findings provide preliminary support for using the IEQ in patients with advanced cancer. Future research should assess the sensitivity of the IEQ to change in an interventional context.

      Key Words

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      References

        • Drudge-Coates L
        • Oh WK
        • Tombal B
        • et al.
        Recognizing symptom burden in advanced prostate cancer: A global patient and caregiver survey.
        Clin Genitourin Cancer. 2018; 16: e411-e419
        • Morrison EJ
        • Novotny PJ
        • Sloan JA
        • et al.
        Emotional problems, quality of life, and symptom burden in patients with lung cancer.
        Clin Lung Cancer. 2017; 18: 497-503
        • Joshy G
        • Thandrayen J
        • Koczwara B
        • et al.
        Disability, psychological distress and quality of life in relation to cancer diagnosis and cancer type: Population-based Australian study of 22,505 cancer survivors and 244,000 people without cancer.
        BMC Med. 2020; 18
        • Cleeland CS
        • Zhao F
        • Chang VT
        • et al.
        The symptom burden of cancer: Evidence for a core set of cancer-related and treatment-related symptoms from the Eastern Cooperative Oncology Group's symptom outcomes and practice patterns study.
        Cancer. 2013; 119: 4333-4340
        • Sullivan MJL
        • Scott W
        • Trost Z.
        Perceived injustice: A risk factor for problematic pain outcomes.
        Clin J Pain. 2012; 28: 484-488
        • Sullivan MJL
        • Adams H
        • Horan S
        • et al.
        The role of perceived injustice in the experience of chronic pain and disability: Scale development and validation.
        J Occup Rehabil. 2008; 18: 249-261
        • Lerner MJ.
        The belief in a just world: A fundamental delusion.
        Plenum Press, New York1980
        • Carriere JS
        • Donayre Pimentel S
        • Yakobov E
        • Edwards RR
        A systematic review of the association between perceived injustice and pain-related outcomes in individuals with musculoskeletal pain.
        Pain Med. 2020; 21: 1449-1463
        • Lynch J
        • Fox S
        • D'Alton P
        • Gaynor K
        A systematic review and meta-analysis of the association between perceived injustice and depression.
        J Pain. 2021; 22: 643-654
      1. Sullivan MJ, Adams H, Horan S, et al. Injustice experience questionnaire. 2022. Available from: https://eprovide.mapi-trust.org/instruments/injustice-experience-questionnaire. Accessed 15 January 2019.

        • Alizadeh-Fard S.
        Predicting pain catastrophizing of women with breast cancer based on perceived injustice and past time perspective.
        Int J Cancer Manag. 2020; 13e98949https://doi.org/10.5812/ijcm.98949
        • Leysen L
        • Cools W
        • Nijs J
        • et al.
        The mediating effect of pain catastrophizing and perceived injustice in the relationship of pain on health-related quality of life in breast cancer survivors.
        Support Care Cancer. 2021; 29: 5653-5661
        • Lynch J
        • D'Alton P
        • Gaynor K
        Evaluating the role of perceived injustice in mental health outcomes in cervical cancer care.
        Support Care Cancer. 2022; 30: 6215-6223
        • Criswell KR
        • Owen JE
        • Thornton AA
        • Stanton AL.
        Personal responsibility, regret, and medical stigma among individuals living with lung cancer.
        J Behav Med. 2016; 39: 241-253
        • Larkin D
        • Birtle AJ
        • Bradley L
        • et al.
        A systematic review of disease related stigmatization in patients living with prostate cancer.
        PLoS One. 2022; 17e0261557
        • Penn TM
        • Overstreet DS
        • Aroke EN
        • et al.
        Perceived injustice helps explain the association between chronic pain stigma and movement-evoked pain in adults with nonspecific chronic low back pain.
        Pain Med. 2020; 21: 3161-3171
        • Kirkova J
        • Walsh D
        • Rybicki L
        • et al.
        Symptom severity and distress in advanced cancer.
        Palliat Med. 2010; 24: 330-339
        • Callahan CM
        • Unverzagt FW
        • Hui SL
        • Perkins AJ
        • Hendrie HC.
        Six-item screener to identify cognitive impairment among potential subjects for clinical research.
        Med Care. 2002; 40: 771-781
        • Centers for Disease Control and Prevention
        Behavioral risk factor surveillance system survey questionnaire.
        U.S. Department of health and human services, Centers for disease control and prevention, Atlanta, GA2007
        • Cella D
        • Riley W
        • Stone A
        • et al.
        The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008.
        J Clin Epidemiol. 2010; 63: 1179-1194
        • Jensen RE
        • Potosky AL
        • Moinpour CM
        • et al.
        United States population-based estimates of patient-reported outcomes measurement information system symptom and functional status reference values for individuals with cancer.
        J Clin Oncol. 2017; 35: 1913-1920
        • Yu L
        • Buysse DJ
        • Germain A
        • et al.
        Development of short forms from the PROMIS™ sleep disturbance and Sleep-Related Impairment item banks.
        Behav Sleep Med. 2011; 10: 6-24
        • Pilkonis PA
        • Choi SW
        • Reise SP
        • et al.
        Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS(R)): Depression, anxiety, and anger.
        Assessment. 2011; 18: 263-283
        • Portenoy RK
        • Thaler HT
        • Kornblith AB
        • et al.
        The memorial symptom assessment scale: an instrument for the evaluation of symptom prevalence, characteristics and distress.
        Eur J Cancer. 1994; 30A: 1326-1336
        • Cohen SR
        • Sawatzky R
        • Russell LB
        • et al.
        Measuring the quality of life of people at the end of life: The McGill quality of life questionnaire-revised.
        Palliat Med. 2017; 31: 120-129
        • Mack JW
        • Nilsson M
        • Balboni T
        • et al.
        Peace, Equanimity, and Acceptance in the Cancer Experience (PEACE): Validation of a scale to assess acceptance and struggle with terminal illness.
        Cancer. 2008; 112: 2509-2517
        • R Core Team
        R: A language and environment for statistical computing.
        R Foundation for Statistical Computing, Vienna, Austria2013
        • Hu Lt
        • Bentler PM
        Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.
        Struct Equ Modeling. 1999; 6: 1-55
        • Sullivan MJ
        • Thorn B
        • Haythornthwaite JA
        • et al.
        Theoretical perspectives on the relation between catastrophizing and pain.
        Clin J Pain. 2001; 17: 52-64