Cross-cultural Adaptation and Psychometric Validation of the Chinese Version of the Personal Financial Wellness Scale and Levels of Psychological Financial Hardship in Lung Cancer Patients and Caregivers at Treatment Initiation

Background: The Personal Financial Wellness Scale (PFW) is a potential instrument for screening psychological financial hardship in the Chinese cancer population. Objective: To culturally adapt and validate the Chinese version of the PFW (CPFW) and assess the level of psychological financial hardship. Methods: One hundred and twenty-eight lung cancer patient-caregiver dyads participated in this cross-sectional study. The CPFW was adapted using the Functional Assessment of Chronic Illness Therapy translation method. Both classical test theory and item response theory analysis were used for validation. Results: The CPFW demonstrated good content and face validity. Internal consistency was high (Cronbach's α = .933 for patients, .943 for caregivers). A single-factor structure explained 70.032% and 71.727% of the variance in patients and caregivers, respectively. Mean CPFW scores positively correlated with Comprehensive Score for Financial Toxicity ( r = 0.870 in patients, r = 0.849 in caregivers, P < .001), and negatively correlated with National Comprehensive Cancer Network Distress Thermometer ( r = −0.484 in patients, r = −0.438 in caregivers, P < .001). Mean scores differed significantly based on insurance schemes and monthly household incomes ( P < .001). The most informative and discriminative items were items 8, 4, and 3. Mean CPFW scores were 4.68 ± 2.10 in patients and 5.17 ± 1.98 in caregivers. Conclusions: The CPFW is a valid and reliable tool for assessing psychological financial hardship in the Chinese cancer population. Future research should screen and manage financial hardship at treatment initiation. Implications for Practice: The CPFW may help clinical professionals gain initiative for alleviating cancer-related financial hardship. What is Foundational: The validated and reliable CPFW may help effectively screen and manage financial hardship from a family level along the cancer journey in China.