LI Yanlong 1,2 , YU Ling 3,4,5 , HUANG Zijing 3,4,5 , ZHENG Xinze 1,3 , HUANG Junjie 1,6 , WANG Jingrui 1,7 , LIN Jietao 3,4,5 , SUN Lingling 3,4,5 , AN Bo 3,4,5 , GUAN Minyi 3,4,5 , LIN Lizhu 3,4,5
  • 1. The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, 510000, P. R. China;
  • 2. National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 100000, P. R. China;
  • 3. Oncology Center, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510000, P. R. China;
  • 4. Guangdong Clinical Research Academy of Chinese Medicine, Guangzhou, 510000, P. R. China;
  • 5. Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, 510000, P. R. China;
  • 6. Department of Integrated Traditional Chinese and Western Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400000, P. R. China;
  • 7. The Seventh Clinical Medical School of Guangzhou University of Chinese Medicine, Shenzhen, 518000, Guangdong, P. R. China;
LIN Lizhu, Email: linlizhu@gzucm.edu.cn
Pulmonary nodule symptom scale; item analysis; reliability and validity testing; Delphi consultation; respiratory symptoms; systemic manifestations; psychological state; integrated traditional Chinese and Western medicine
10.7507/1007-4848.202511024
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Objective To conduct item analysis on the Pulmonary Nodule Symptom Scale preliminarily developed through Delphi consultation, establish the final version of the scale, and evaluate its reliability and validity. Methods Patients with pulmonary nodules who visited the outpatient department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from May to October 2024 were enrolled according to diagnostic criteria for pulmonary nodules and predefined inclusion/exclusion standards. Demographic data, medical history, and imaging characteristics of pulmonary nodules were collected, and participants completed the preliminary Pulmonary Nodule Symptom Scale developed through Delphi consultation. Four item analysis methods, including discrete trend method, critical ration method, correlation coefficient method, and Cronbach’s α coefficient, were employed for final item screening to determine the definitive version of the scale. Reliability and validity were systematically assessed via Cronbach’s α, split-half reliability, content validity, and construct validity. Results A total of 153 patients with pulmonary nodules were included, comprising 56 (36.60%) males and 97 (63.40%) females, with a mean age of (53.77±12.61) years. The median disease duration was 6 (1, 20) months, and mean nodule diameter was (7.64±4.37) mm, including 38 (24.84%) solitary patients and 115 (75.16%) multiple patients, as well as 39 (25.49%) solid nodules and 114 (74.51%) ground-glass nodules. Based on comprehensive results from four item analysis methods and core group discussion, two items ("symptom severity" and "quality of life") in the overall evaluation dimension were removed. The final scale comprised 15 items across three dimensions: respiratory symptoms, systemic manifestations, and psychological state. The Cronbach’s α coefficient was 0.84, with a Spearman-Brown coefficient of 0.912. Item-level content validity indices ranged from 0.824 to 1.000, while the scale-level content validity index reached 0.933. Kaiser-Meyer-Olkin (KMO) measure was 0.803, with Bartlett’s test of sphericity showing statistical significance (P<0.001). Exploratory factor analysis extracted three factors explaining 52.48% of total variance, and the rotated component matrix distribution generally aligned with the predefined three dimensions. Conclusion The definitive version of the Pulmonary Nodule Symptom Scale contains 15 items across three dimensions (respiratory symptoms, systemic manifestations, and psychological state). Reliability and validity evaluations demonstrate good reliability and satisfactory validity for the scale.

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