Development and Assessment of the 8-item Chronic Pain Acceptance Questionnaire to Measure Disease Acceptance in Women With Breast Cancer

This measure assesses the underlying factor structure of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC). Structural Validity is evaluated using Confirmatory Factor Analysis (CFA) to verify the hypothesized two-factor model consisting of Activity Engagement and Disease Receptivity. Success is defined by achieving predefined model fit indices, including a Comparative Fit Index (CFI) ≥ 0.90, a Tucker Lewis Index (TLI) ≥ 0.90, and a Root Mean Square Error of Approximation (RMSEA) ≤ 0.08.

• Scale Description: The Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) is a self-administered tool consisting of 8 items.
• Scale Scoring: Each item is rated on a 7-point Likert scale ranging from 0 ("never true") to 6 ("always true").
• Minimum and Maximum Values: The total score ranges from a minimum of 0 to a maximum of 48.
• Intrepretation: Higher scores indicate a higher level of disease acceptance.

This measure evaluates the consistency and stability of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC). It includes the assessment of Internal Consistency for each factor (Activity Engagement and Disease Receptivity) and Test-Retest Stability.

• Scale Description: The Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) is a self-administered questionnaire designed to quantify disease acceptance.
• Scale Scoring: The instrument consists of 8 items, each rated on a scale of 0 ("never true") to 6 ("always true").
• Minimum and Maximum Values: The total score ranges from a minimum of 0 to a maximum of 48.
• Interpretation: Higher scores indicate a higher level of disease acceptance.
• Stability Assessment: Test-Retest Stability is calculated using the Intraclass Correlation Coefficient (ICC2,1).

This measure determines the smallest change in the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) score that can be considered a true change rather than measurement error. This is assessed by calculating the Minimum Detectable Change (MDC) at a 95% confidence level.

• Scale Description: The Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) is a self-administered questionnaire adapted from the 8-item Chronic Pain Acceptance Questionnaire (CPAQ-8).
• Scale Scoring: 8 items rated on a 7-point scale (0 to 6).
• Minimum and Maximum Values: Total scores range from 0 to 48.
• Interpretation: Higher scores reflect greater disease acceptance. The Minimum Detectable Change (MDC) value provides the threshold for identifying clinically relevant changes in an individual patient's score.

This measure is used to establish the convergent validity of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) by assessing its association with the construct of psychological inflexibility (the opposite of psychological flexibility).

• Scale Description: The Acceptance and Action Questionnaire - II (AAQ-II) is a widely used 7-item self-report instrument designed to measure psychological inflexibility and experiential avoidance.
• Scale Scoring: Each item is rated on a 7-point Likert scale ranging from 1 ("never true") to 7 ("always true").
• Minimum and Maximum Values: The total score ranges from a minimum of 7 to a maximum of 49.
• Interpretation: Higher scores on the Acceptance and Action Questionnaire - II (AAQ-II) indicate greater levels of psychological inflexibility.

This measure is used to evaluate the concurrent validity of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) by assessing its association with general levels of psychological distress.

• Scale Description: The Depression, Anxiety, and Stress Scale - 21 (DASS-21) is a 21-item self-report instrument designed to measure the three related negative emotional states of depression, anxiety, and tension/stress.
• Scale Scoring: The scale consists of three subscales (7 items each). Each item is rated on a 4-point Likert scale ranging from 0 ("did not apply to me at all") to 3 ("applied to me very much or most of the time").
• Minimum and Maximum Values: The total score for the Depression, Anxiety, and Stress Scale - 21 (DASS-21) ranges from a minimum of 0 to a maximum of 126 (or 0 to 42 for each subscale if not multiplied.
• Interpretation: Higher scores on the Depression, Anxiety, and Stress Scale-21 (DASS-21) indicate higher levels of psychological distress.

This measure is used to evaluate the convergent validity of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) by assessing its association with catastrophizing, a maladaptive cognitive-emotional response to illness or pain characterized by magnification, rumination, and helplessness.

• Scale Description: The Pain Catastrophizing Scale (PCS) is a 13-item self-report instrument that measures three dimensions of catastrophizing: rumination, magnification, and helplessness.
• Scale Scoring: Each item is rated on a 5-point Likert scale ranging from 0 ("not at all") to 4 ("all the time").
• Minimum and Maximum Values: The total score ranges from a minimum of 0 to a maximum of 52.
• Interpretation: Higher scores on the Pain Catastrophizing Scale (PCS) indicate higher levels of catastrophizing (a worse outcome).

This measure is used to evaluate the concurrent validity of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) by assessing its association with the quality of life and physical, psychological, and social functioning of cancer patients.

• Scale Scoring: Most items are rated on a 4-point Likert scale (1 = "not at all" to 4 = "very much"), except for the global health status which uses a 7-point scale. All scores are linearly transformed to a scale of 0 to 100.
• Minimum and Maximum Values: The score for each subscale ranges from a minimum of 0 to a maximum of 100.

Interpretation:

For the Functional scales and the Global Health Status scale, a higher score represents a higher (better) level of functioning or quality of life.

For the Symptom scales and items, a higher score represents a higher (worse) level of symptomatology or problems.

This measure is used to evaluate the concurrent validity of the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) by assessing its association with quality of life issues specifically related to Breast Cancer (BC), such as body image, sexual functioning, and treatment side effects.

Scale Scoring: Items are rated on a 4-point Likert scale (1 = "not at all" to 4 = "very much"). All scores are linearly transformed to a scale of 0 to 100.

Minimum and Maximum Values: The score for each subscale ranges from a minimum of 0 to a maximum of 100.

Interpretation:

For the Functional scales (e.g., Body Image), a higher score represents a higher (better) level of functioning.

For the Symptom scales (e.g., Systemic Therapy Side Effects), a higher score represents a higher (worse) level of symptomatology or distress. It is expected that higher acceptance scores on the Cancer Pathology Acceptance Questionnaire for Breast Cancer (CPAQ-8-BC) will correlate with better functionality