ObjectiveTo 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. MethodsPatients 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. ResultsA 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. ConclusionThe 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.
ObjectiveTo explore the distribution pattern of respiratory symptoms and relevant factors in patients with pulmonary nodules. MethodsDemographic and clinical information were collected from patients who visited the Thoracic Surgery Outpatient Clinic of Guangdong Provincial People’s Hospital from January 2021 to January 2022. Hospital Anxiety and Depression Scale (HADS) was used to assess their anxiety and depression level. ResultsA total of 1173 patients were enrolled, including 449 males and 724 females, with an average age of 46.94±11.43 years. Among the patients with pulmonary nodules, 37.7% of them had at least one respiratory symptom; 24.4% had cough, 14.0% had expectoration, 1.3% had hemoptysis and 14.9% had chest pain. Old age, male, exposure to second-hand smoking or environmental smoke, hair coloring and history of tuberculosis were major risk factors for respiratory symptoms (P<0.05). Middle age, old age, male, exposure to environmental smoke were major risk factors for cough (P<0.05); old age, smoking, larger maximum nodules diameters, exposure to environmental smoke and history of pneumonia were major risk factors for expectoration (P<0.05); male, multiple nodules, hair coloring, exposure to second-hand smoking and history of tuberculosis were major risk factors for chest pain (P<0.05). Symptomatic patients showed generally higher HADS scores than asymptomatic patients (P<0.001). ConclusionCough, expectoration and chest pain are the predominant respiratory symptoms for patients with pulmonary nodules. The presentation of respiratory symptoms increases patients' anxiety and depression.
