Development and validation and risk factor analysis of the colorectal cancer psychosocial distress scale

Psychosocial distress is a key factor affecting the quality of life (QOL) and treatment outcomes of colorectal cancer (CRC) patients. Owing to the lack of clinically integrated and validated screening tools, the current practice of screening CRC patients for psychosocial distress is inconsistent. This study aimed to create and assess a CRC Psychosocial Distress Scale (CRCPDS) as a working standard for the clinical screening of psychosocial distress levels in CRC patients. Based on the improved classical test theory, 59 patients with CRC were recruited to develop the CRCPDS and 441 patients were recruited to validate the CRCPDS. Delphi expert consultation and item analysis were used to improve the CRCPDS, and validate its reliability and validity using factor analysis and structural equation model. The CRCPDS consisted of 14 items and was divided into three subscales: 7 items for ostomy pouch stigma, 3 items for self-deprecation, and 4 items for social isolation. The CRCPDS demonstrated strong validity (I-FVIs > 0.85, I-CVIs > 0.80; CVCR = 76.832%, AVE > 0.50, CR > 0.70; RMSEA = 0.062, GFI = 0.923, CFI = 0.972, NFI = 0.942, IFI = 0.973, TLI = 0.964) and reliability (Cronbach’s α = 0.949, Spearman-Brown coefficient = 0.929, ICC = 0.865). Patients under 60 years old, economically disadvantaged, post colostomy, and introverted had stronger psychosocial distress (P < 0.05), and those with greater psychosocial distress reported a lower QOL (P < 0.01). CRC patients generally experience significant psychosocial distress, and the CRCPDS is effective and reliable in the early identification of psychosocial distress. It provides a standard for assessing the level of psychosocial distress and is suitable for implementation into clinical screening workflows.