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Confirmatory factor analysis of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD–B) among Italian medical students

Published online by Cambridge University Press:  11 February 2015

Paolo Leombruni ,
Barbara Loera ,
Marco Miniotti ,
Francesca Zizzi ,
Lorys Castelli  and
Riccardo Torta
Paolo Leombruni
Affiliation:
Department of Neuroscience, University of Turin, Turin, Italy
Barbara Loera*
Affiliation:
Department of Psychology, University of Turin, Turin, Italy
Marco Miniotti
Affiliation:
Department of Neuroscience, University of Turin, Turin, Italy
Francesca Zizzi
Affiliation:
Department of Neuroscience, University of Turin, Turin, Italy
Lorys Castelli
Affiliation:
Department of Psychology, University of Turin, Turin, Italy
Riccardo Torta
Affiliation:
Department of Neuroscience, University of Turin, Turin, Italy
*
Address correspondence and reprint requests to: Barbara Loera, Department of Psychology, University of Turin, 8, via Verdi, 10124 Torino, Italy. E-Mail: [email protected]
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Abstract

Objective:

A steady increase in the number of patients requiring end-of-life care has been observed during the last decades. The assessment of healthcare students' attitudes toward end-of-life care is an important step in their curriculum, as it provides information about their disposition to practice palliative medicine. The Frommelt Attitude Toward Care of the Dying Scale (FATCOD–B) was developed to detect such a disposition, but its psychometric properties are yet to be clearly defined.

Method:

A convenience sample of 608 second-year medical students participated in our study in the 2012/2013 and 2013/2014 academic years. All participants completed the FATCOD–B. The sample was randomly divided in two subsamples. In the item analysis, reliability (Cronbach's α), internal consistency (item–total correlations), and an exploratory factor analysis (EFA) were conducted using the first subsample (n = 300). Using the second subsample (n = 308), confirmatory factor analysis (CFA) was performed using the robust ML method in the Lisrel program.

Results:

Reliability for all items was 0.699. Item–total correlations, ranging from 0.03 to 0.39, were weak. EFA identified a two-dimensional orthogonal solution, explaining 20% of total variance. CFA upheld the two-dimensional model, but the loadings on the dimensions and their respective indicators were weak and equal to zero for certain items.

Significance of Results:

The findings of the present study suggest that the FATCOD–B measures a two-dimensional construct and that several items seem in need of revision. Future research oriented toward building a revised version of the scale should pay attention to item ambiguity and take particular care to distinguish among items that concern emotions and beliefs related to end-of-life care, as well as their subjects (e.g., the healthcare provider, the patient, his family).

Keywords

FATCOD–BAttitudes toward the dyingConfirmatory factor analysis (CFA)Item validityMedical students
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 5 , October 2015 , pp. 1391 - 1398
Copyright
Copyright © Cambridge University Press 2015 

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References

REFERENCES

Akaike, H. (1987). Factor analysis and AIC. Psychometrika, 52, 317–332.Google Scholar
Bentler, P.M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238–246.CrossRefGoogle ScholarPubMed
Bentler, P.M. (1995). EQS structural equations program manual. Encino, CA: Multivariate Software.Google Scholar
Braun, U.K., Gill, A.C., Teal, C.R., et al. (2013). The utility of reflective writing after a palliative care experience: Can we assess medical students' professionalism? Journal of Palliative Medicine, 16(11), 1342–1349.CrossRefGoogle ScholarPubMed
Browne, M.W. & Cudeck, R. (1993). Alternative ways of assessing model fit. In Testing structural equation models. Bollen, K.A. & Long, J.S. (eds.), pp.136–162. Newbury Park , CA: Sage.Google Scholar
Bryant, F.B. & Satorra, A. (2012). Principles and practice of scaled difference chi-square testing. Structural Equation Modeling: A Multidisciplinary Journal, 19(3), 372–398.Google Scholar
Edwards, J.R. & Bagozzi, R.P. (2000). On the nature and direction of relationships between constructs and measures. Psychological Methods, 5(2), 155–174.CrossRefGoogle ScholarPubMed
Frommelt, K.H. (1991). The effects of death education on nurses' attitudes toward caring for terminally ill persons and their families. The American Journal of Hospice & Palliative Care, 8(5), 37–43.Google Scholar
Frommelt, K.H. (2003). Attitudes toward care of the terminally ill: An educational intervention. The American Journal of Hospice & Palliative Care, 20(1), 13–22.Google Scholar
Henoch, I., Browall, M., Melin-Johansson, C., et al. (2013 a). The Swedish version of the Frommelt Attitude Toward Care of the Dying Scale: Aspects of validity and factors influencing nurses' and nursing students' attitudes. Cancer Nursing, 37(1), E1–E11.CrossRefGoogle Scholar
Henoch, I., Danielson, E., Strang, et al. (2013 b). Training intervention for healthcare staff in provision of existential support in patients cancer: A randomized, controlled study. Journal of Pain and Symptom Management, 46(6), 785–794.CrossRefGoogle Scholar
Hu, L. & Bentler, F.B. (1999). Cut-off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.Google Scholar
Jöreskog, K.G. & Sörbom, D. (1981). LISREL user's guide. Chicago: National Educational Services.Google Scholar
Jöreskog, K.G. & Sörbom, D. (2004). LISREL 8.7 for Windows [computer software]. Lincolnwood, IL: Scientific Software International.Google Scholar
Leombruni, P., Miniotti, M., Bovero, A., et al. (2012). Second-year Italian medical students' attitudes toward the care of the dying patient: An exploratory study. Journal of Cancer Education, 27(4), 759–763.CrossRefGoogle ScholarPubMed
Leombruni, P., Miniotti, M. & Torta, R.G. (2013). Personality and attitudes towards dying patients: An Italian pilot study among medical students. Medical Teacher, 35(9), 790.Google Scholar
Leombruni, P., Miniotti, M., Bovero, A., et al. (2014 a). Attitudes toward caring for dying patients: An overview among Italian nursing students and preliminary psychometrics of the FATCOD–B scale. Journal of Nursing Education and Practice, 4(3), 188–196.Google Scholar
Leombruni, P., Miniotti, M., Zizzi, F., et al. (2014 b). Attitudes of medical students' toward the care of the dying in relation to personality traits: Harm avoidance and self-directedness make a difference. The American Journal of Hospice & Palliative Care. Epub ahead of print July 7.CrossRefGoogle Scholar
Mallory, J.L. (2003). The impact of a palliative care educational component on attitudes toward care of the dying in undergraduate nursing students. Journal of Professional Nursing, 19(5), 305–312.Google Scholar
Mastroianni, C., Piredda, M., Frommelt, K.H.M., et al. (2009). Validazione italiana del Frommelt Attitude Toward Care of the Dying Scale (FATCOD Form B–I). International Nursing Perspectives, 9, 11–6.Google Scholar
Merrill, J., Lorimor, R., Thornby, J., et al. (1998). Caring for terminally ill persons: Comparative analysis of attitudes (thanatophobia) of practicing physicians, student nurses and medical students. Psychological Reports, 83(1), 123–128.Google Scholar
Miyashita, M., Nakai, Y., Sasahara, T., et al. (2007). Nursing autonomy plays an important role in nurses' attitudes toward caring for dying patients. The American Journal of Hospice & Palliative Care, 24(3), 202–210.Google Scholar
Morrison, L.J., Thompson, B.M. & Gill, A.C. (2012). A required third-year medical student palliative care curriculum impacts knowledge and attitudes. Journal of Palliative Medicine, 15(7), 784–789.Google Scholar
Nakai, Y., Miyashita, M., Sasahara, T., et al. (2006). Factor structure and reliability of the Japanese version of the Frommelt Attitude Toward Care of the Dying Scale (FATCOD–B–J) [in Japanese]. Japanese Journal of Cancer Nursing, 11(6), 723–729.Google Scholar
Neimeyer, R.A. (1994). Death anxiety handbook: Research, instrumentation and application. Washington, DC: Taylor & Francis.Google Scholar
Satorra, A. & Bentler, P.M. (2001). A scaled difference chi-square test statistic for moment structure analysis. Psychometrika, 66, 507–514.Google Scholar
Schillerstrom, J.E., Sanchez-Reilly, S. & O'Donnell, L. (2012). Improving student comfort with death and dying discussions through facilitated family encounters. Academic Psychiatry, 36(3), 188–190.Google Scholar
Smith, G.T., McCarty, D.M. & Anderson, K.G. (2000). On the sins of short-form development. Psychological Assessment, 12(1), 102–111.Google Scholar
von Gunten, C.F., Mullan, P., Nelesen, R.A., et al. (2012). Development and evaluation of a palliative medicine curriculum for third-year medical students. Journal of Palliative Medicine, 15(11), 1198–1217.Google Scholar
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