Confirmatory validation of a brief patient-reported outcome measure assessing psychological distress in caregivers of malignant mesothelioma patients: the Mesothelioma Psychological Distress Tool-Caregivers

Our plain-English summary of Confirmatory validation of a brief patient-reported outcome measure assessing psychological distress in caregivers of malignant mesothelioma patients: the Mesothelioma Psychological Distress Tool-Caregivers, by A. Granieri, I.G. Franzoi, M.D. Sauta, et al (Frontiers in Psychology, 2024).

The study

• Authors: A. Granieri, I.G. Franzoi, M.D. Sauta, A. Marinaccio, C. Mensi, S. Rugarli, E. Migliore, I. Cozzi, D. Cavone, L. Vimercati, F. Grosso, M. Bertolotti, G. Raimondi, M. Innamorati, M. Bonafede
• Journal: Frontiers in Psychology
• Published: 2024;15:1444960
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: The diagnosis of malignant mesothelioma (MM) can be devastating for both patients and caregivers, who may experience intense suffering from a physical, psychological, and interpersonal perspective. Despite the extensive literature on caregiver distress, there is a lack of validated measures to provide evidence of psychological distress of caregivers of MM patients. Therefore, in a previous study we developed the Mesothelioma Psychological Distress Tool-Caregivers (MPDT-C) to evaluate the specific profile of psychological distress in this population. This paper describes the item selection, factor analysis, and psychometric evaluation of the revised MPDT-C.

Methods: The analyses of this work first aimed to confirm the previous factorial structure. In the case of nonfit, it aimed to find an alternative structure and causes of nonfit in the model. Examination of the fit of the factorial model was conducted using a Bayesian approach.

Results: The final version of the MPDT-C is a 7-item self-report questionnaire consisting of one factor (Burden for the caregiver).

Conclusion: Having a short self-report questionnaire to assess the psychological distress experienced by caregivers of MM patients has several advantages. First, it is suited to epidemiological studies where multiple variables and measures are involved. Second, it is easy to administer and does not take much time to complete. Therefore, the MPDT-C can also be administered in clinical contexts, perhaps when MM patients attend follow-up medical evaluation. Lastly, short measures are less affected by cognitive fatigue, which is very common in a long battery of tests and could affect response reliability.

Copyright © 2024 Granieri, Franzoi, Sauta, Marinaccio, Mensi, Rugarli, Migliore, Cozzi, Cavone, Vimercati, Grosso, Bertolotti, Raimondi, Innamorati and Bonafede.

In plain English

This study shortened and tested the Mesothelioma Psychological Distress Tool–Caregivers (MPDT-C), a questionnaire on distress in caregivers of malignant mesothelioma patients. In all, 178 caregivers in Italy took part (75.56% female, mean age 56.70). They were recruited through regional centers of the national mesothelioma registry and two Piedmont hospitals. Each completed the 47-item preliminary version and other questionnaires. The earlier three-factor structure did not fit. After selecting burden-related items, the authors arrived at a 7-item, one-factor version (burden for the caregiver) that fit the data. Two internal consistency measures were both 0.70 (95% credible intervals 0.62 to 0.76 and 0.63 to 0.76); the authors called this satisfactory, though the probability of values between 0.70 and 0.90 was below 70%. Scores were associated with secondary traumatic stress and with most caregiver burden subscales. Score bands: 12 or less low, above 12 and below 16 moderate, 16 or more high burden. The authors concluded a short questionnaire suits research and clinical use. They noted possible self-report bias, no discriminant validity testing, and the need for a larger, more gender-balanced sample.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Prospective observational multicentric study; psychometric validation (exploratory and Bayesian confirmatory factor analysis) of a questionnaire
• Who was studied: 178 caregivers (75.56% female; mean age 56.70, SD 12.31, range 42–83) of patients diagnosed with definite, probable or possible malignant mesothelioma, regardless of location and stage. They were recruited in Italy through the Lombardy (108), Apulia (39), Piedmont (6) and Lazio (3) regional centers of the national registry, the hospital in Alessandria (12) and the hospital in Casale Monferrato (10). Exact recruitment dates are not given.
• Exposure: Asbestos exposure was not studied. The study concerned caregiving for a person with malignant mesothelioma. Participants completed the 47-item preliminary MPDT-C plus the Secondary Traumatic Stress Scale, the Caregiver Burden Inventory and the Personal Need for Structure Scale.
• Main results:
  • The three-factor structure from the earlier study did not fit the data in this sample of caregivers (posterior predictive p-value less than 0.001).
  • From 21 items selected for their meaning, exploratory factor analysis kept seven items, all loading on a single dimension.
  • The 7-item single-factor model fit the data (posterior predictive checking interval −17.47 to 31.24; posterior predictive p-value 0.28).
  • All seven items loaded on the single dimension, with loadings between 0.408 and 0.703.
  • Internal consistency of the 7-item scale was McDonald's omega 0.70 (95% credible interval 0.62 to 0.76; posterior probability of lying between 0.70 and 0.90 = 0.51) and Cronbach's alpha 0.70 (95% credible interval 0.63 to 0.76; posterior probability 0.59).
  • The authors judged internal consistency satisfactory, but the probability that the reliability values fell in the 0.70 to 0.90 range was below 70%.
  • MPDT-C scores had a strong association with the arousal subscale and a moderate association with the intrusion subscale of the Secondary Traumatic Stress Scale.
  • MPDT-C scores were associated with all Caregiver Burden Inventory dimensions except the time-dependent subscale.
  • Of the Personal Need for Structure subscales, MPDT-C scores correlated only with Response to Lack of Structure, not with Desire for Structure (r = 0.03).
  • In this sample the mean MPDT-C score was 13.91 (SD 3.20; range 7–22).
  • Score bands were set from quartiles: 12 or less is low burden, above 12 and below 16 is moderate, and 16 or more is high.
• The authors' conclusion: The authors concluded that a short self-report questionnaire for distress in caregivers of malignant mesothelioma patients has advantages. It suits epidemiological studies, is quick to administer, could be used in clinical settings such as patients' follow-up visits, and is less affected by cognitive fatigue.
• Limitations the authors state:
  • Self-report measures may be affected by response biases such as social desirability.
  • Respondents may not be able to assess themselves accurately, and question wording may be understood differently.
  • The stability of the factor structure at the item level and the scale's discriminant validity were not examined.
  • A larger sample with more balanced numbers of women and men would be needed to generalize the results.

Topics

Medical terms in this study, explained in our Lexicon: Mesothelioma.

Related studies

• Preliminary validation of a questionnaire assessing psychological distress in caregivers of patients with malignant mesothelioma: Mesothelioma Psychological Distress Tool-Caregivers — M. Bonafede, C. Chiorri, et al. (2022)
• Preliminary validation of a brief PROM assessing psychological distress in patients with malignant mesothelioma: The mesothelioma psychological distress tool-Patients — F. Guglielmucci, M. Bonafede, et al. (2022)
• Psychological Distress after a Diagnosis of Malignant Mesothelioma in a Group of Patients and Caregivers at the National Priority Contaminated Site of Casale Monferrato — M. Bonafede, A. Granieri, et al. (2020)
• The provision of psychological care for patients with mesothelioma and their caregivers: an Italian survey — A. Granieri, I.G. Franzoi, et al. (2026)
• The psychological impact of asbestos exposure: risk perception and emotional distress among former workers in Tuscany — M. Bonafede, E. Chellini, et al. (2025)
• Psychological Distress in Patients With Asbestos-Related Diseases and Their Families: A Systematic Literature Review — I.G. Franzoi, M.D. Sauta, et al. (2025)

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