Development of the Home Hospice Nursing Care Scale to Support End-of-Life Patients With Cancer and Evaluation of its Reliability and Validity

Abstract

This study aimed to develop the “Home Hospice Nursing Care Scale” to assess the care provided by visiting nurses to patients with end-stage cancer and evaluate its reliability and validity. A draft of the scale was created based on a descriptive survey conducted among oncology nurse specialists and certified oncology nurses working as home-visit nurses. A questionnaire survey was administered to 1,770 home-visit nurses working at 296 functionally strengthening home-visit nursing establishments. A total of 436 valid responses were obtained (valid response rate: 24.6%). Exploratory factor analysis identified 5 factors comprising 40 items: care that supports the values of the patient and their family members, partnership involving the patient and their family members to maintain home care, care that allows for living with loved ones until end of life, care that supports the daily lives of family caregivers, and care that reconciles the feelings of those involved. Confirmatory factor analysis demonstrated that the goodness-of-fit indices of the model were as follows: GFI = 0.846, AGFI = 0.828, CFI = 0.915, and RMSEA = 0.050. Cronbach’s α coefficients ranged from 0.77 to 0.93. Criterion-related validity was verified by the Healthcare Professionals’ Attitudes towards Terminal Home Care Scale and Difficulties with Home Palliative Cancer Care Scale. The reliability and validity of the scale was verified, which demonstrates its utility. Future challenges include analyzing factors related to home hospice nursing care and developing an educational program based on the future study. Key words: home hospice, end-of-life, cancer, nursing, scale development, reliability, validity.

Keywords

home hospice end-of-life cancer nursing scale development reliability validity

Get full access to this article

View all access options for this article.

References

Cancer information service. Cancer Statistics in Japan

2024. https://ganjoho.jp/en/professional/statistics/table_download.html. Accessed September 17, 2024.

e-Stat Statistics of Japan . Vital statistics. https://www.e-stat.go.jp/en/stat-search/files?page=1&toukei=00450011&tstat=000001028. 897 Accessed October 21, 2024.

Ministry of Health, Labor and Welfare . Houmonkanngoryouyouhi ni Kakaru Houmonkango-station no Kijyuntou. [in Japanese]. https://www.mhlw.go.jp/web/t_doc?dataId=84aa7834&dataType=0&pageNo=1. Accessed 27 December 2024.

Japan Home Hospice Association . The standard of home hospice care. https://n-hha.com/about.html. Accessed 17 September 2024.

Metzger

Gray

. End-of-life communication and adjustment: pre-loss communication as a predictor of bereavement-related outcomes. Death Stud. 2008;32(4):301-325.

Gomes

Calanzani

Koffman

Higginson

. Is dying in hospital better than home in incurable cancer and what factors influence this? A population-based study. BMC Med. 2015;13(1):1-14.

Ito

Tadaka

. Quality of life among the family caregivers of patients with terminal cancer at home in Japan. Jpn J Nurs Sci. 2017;14(4):341-352.

Morita

Hirai

Sakaguchi

Maeyama

Tsuneto

Shima

. Measuring the quality of structure and process in end-of-life care from the bereaved family perspective. J Pain Symptom Manage. 2004;27(6):492-501.

Miyashita

Morita

Sato

Hirai

Shima

Uchitomi

. Good Death Inventory: a measure for evaluating good death from the bereaved family member's perspective. J Pain Symptom Manage. 2008;35(5):486-498.

10.

Miyashita

Morita

Tsuneto

Sato

Shima

. The Japan Hospice and Palliative Care Evaluation study (J-HOPE study): study design and characteristics of participating institutions. Am J Hosp Palliat Care. 2008;25(3):223-232.

11.

Aoyama

Morita

Kizawa

Tsuneto

Shima

Miyashita

. The Japan hospice and palliative care evaluation study 3: study design, characteristics of participants and participating institutions, and response rates. Am J Hosp Palliat Med. 2017;34(7):654-664.

12.

Masukawa

Aoyama

Morita

, et al. The Japan hospice and palliative evaluation study 4: a cross-sectional questionnaire survey. BMC Palliat Care. 2018;17(1):66.

13.

Miyashita

Morita

Sato

Tsuneto

Shima

. A nationwide survey of quality of end-of-life cancer care in designated cancer centers, inpatient palliative care units, and home hospices in Japan: the J-HOPE study. J Pain Symptom Manage. 2015;50(1):38-47.

14.

Tyamoto

Hanazato

. Home-visiting Nurses’Practice for terminal cancer patients until end-of-life care at home. J Jpn Acad Home Care. 2023;26(2):128-136. [in Japanese].

15.

Katahira

Uemura

. A narrative review of studies on nursing practice competencies of Japanese home health nurses [in Japanese]. Jap J Prim Care. 2021;44(2):89-96.

16.

Hirooka

Kawagoe

Watanabe

, et al. Zaitaku-kanwakea wo Ninau Houmonkangoshi ni motomerareru jissennouryoku. Japanese Journal of Cancer Care. 2016;21(7):742-748. [in Japanese].

17.

Ben-Arye

Samuels

Keshet

Golan

Baruch

Dagash

. Exploring unmet concerns in home hospice cancer care: perspectives of patients, informal caregivers, palliative care providers, and family physicians. Palliat Support Care. 2024;8:1-9.

18.

Dingley

Margaret

Lai

Doyon

Reblin

Ellington

. Caregiver activation and home hospice nurse communication in advanced cancer care. Cancer Nurs. 2017;40(5):E38-E50.

19.

Shimizu

Nishimura

Ishii

Kuramochi

Kakuta

Miyashita

. Development and validation of scales for attitudes, self-reported practices, difficulties and knowledge among home care nurses providing palliative care. Eur J Oncol Nurs. 2016;22:8-12.

20.

Japanese nursing association. https://www.nurse.or.jp/. Accessed January 1, 2025.

21.

Polit

Beck

Owen

. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459-467.

22.

Arbuckle

. IBM^®SPSS^®Amos ^TM 28 User’s Guide. IBM; 2021.

23.

Devellis

. Scale Development Theory and Applications. 2nd ed. Thousand Oaks: Sage Publications; 2003.

24.

Sudore

Lum

You

, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary delphi panel. J Pain Symptom Manage. 2017;53(5):821-832.

25.

Shield

Bayliss

Hodkinson

, et al. What factors are associated with informal carers' psychological morbidity during end-of-life home care? A systematic review and thematic synthesis of observational quantitative studies. Health soc Care Deliv Res. 2023;15:1-58.

26.

Phongtankuel

Scherban

Reid

, et al. Why do home hospice patients return to the hospital? A study of hospice provider perspectives. J Palliat Med. 2016;19(1):51-56.

27.

Cabinet Office Japan . Annual report on the ageing society 2019. https://www8.cao.go.jp/kourei/whitepaper/w-2019/html/zenbun/s1_3_1_4.html. Accessed October 22, 2024.

28.

Osono

Ishii

Miyashita

. Obstacles to continued home care for terminal cancer patients from perspective of visiting nurse. J Jpn Soc Cancer Nurs. 2015;29(1):44-53. [in Japanese].

29.

Osono

Fukui

Kawano

. Effects of events prompting or hampering the continuation of home care of terminal cancer patients to the places of their deaths: categorization of longitudinal patterns. Palliat Care Res. 2014;9(1):121-128. [in Japanese].

30.

Sato

Hashimoto

Utsumi

, et al. Factors influencing death or the cessation of palliative care in home―based setting among patients with cancer. Palliat Care Res. 2015;10(2):116-123. [in Japanese].

31.

Hamano

Hanari

Tamiya

. Attitudes and other factors influencing end-of-life discussion by physicians, nurses, and care staff: a nationwide survey in Japan. Am J Hosp Palliat Care. 2020;37(4):258-265.

32.

Hayashi

Sato

Ogawa

, et al. Association among end-of-life discussions, cancer patients' quality of life at end of life, and bereaved families' mental health. Am J Hosp Palliat Care. 2022;39(9):1071-1081.