Development and Validation of a Questionnaire Assessing Patient Distress from Preoperative Fasting in Cataract Surgery

Purpose: To develop and psychometrically validate a questionnaire to measure patient distress with preoperative fasting related to cataract surgery. Methods: In this single-centered cross-sectional study, consecutive sampling of cataract patients was undertaken immediately preoperatively from February to December 2019. A questionnaire evaluating patient distress with fasting was designed and administered. Questionnaire development occurred in an iterative process and was conducted with consultation from expert investigators and patients. Validation and psychometric evaluation of the questionnaire were performed with Rasch analysis. Results: A preliminary version of the questionnaire was developed by 10 study investigators. Across five iterations of development, the questionnaire was administered to 186 cataract patients. Psychometric evaluation of the 13-item questionnaire demonstrated ordered thresholds, acceptable item calibration and fit, adequate internal consistency, ability to discriminate between three levels of distress from preoperative fasting and no notable differential item functioning. However, issues with mistargeting, clustering of items on the person-item map and multidimensionality remained. Given these concerns, 13 separate re-analyses were conducted via removal of certain items. A 6-item subset was determined to be well targeted, unidimensional, did not display item clustering and was able to discriminate between patients with high and low distress from preoperative fasting. Conclusion: A 6-item questionnaire is a valid, psychometrically robust and reliable measure for the assessment of patient distress with preoperative fasting in cataract surgery. Items include hunger, thirst, hoarseness, weakness, anxiety and nausea. Future studies should seek to validate this questionnaire across a variety of sociodemographic contexts, languages and specialties.

研究目的：开发一款用于评估白内障手术术前禁食相关患者痛苦体验的问卷，并对其开展心理测量学效度检验。研究方法：本研究为单中心横断面研究，于2019年2月至12月期间，在术前即刻采用连续抽样法招募白内障患者。本研究设计并施测了一款评估患者禁食相关痛苦的问卷，问卷开发采用迭代流程，并邀请领域专家研究者与患者参与咨询指导。问卷的效度检验与心理测量学评估采用Rasch分析（Rasch analysis）完成。研究结果：本研究由10名课题研究者初步开发了问卷初稿。历经5轮迭代开发后，共向186名白内障患者施测了该问卷。对13条目版问卷的心理测量学评估结果显示，其阈值呈有序排列，条目校准与拟合度均处于可接受水平，内部一致性良好，能够区分术前禁食相关痛苦的三个程度层级，且未出现显著的条目功能差异（differential item functioning）。不过该问卷仍存在定位偏倚、条目-人物映射聚类以及多维性等问题。针对上述不足，本研究通过移除特定条目开展了13次独立重分析，最终确定6条目子集版问卷具备良好的定位性、单维性，未出现条目聚类现象，且可有效区分术前禁食相关痛苦程度高低的患者群体。研究结论：6条目版问卷是一款有效、心理测量学性能稳健且可靠的评估工具，可用于测评白内障手术患者术前禁食相关的痛苦体验。该问卷条目涵盖饥饿感、口渴感、声音嘶哑、乏力、焦虑及恶心。未来研究可进一步在不同社会人口学背景、语言环境与专科场景下对该问卷开展效度验证。