Psychometric Evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS): A Methodological Study

Psychometric Evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS): A Methodological Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychometric Evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS): A Methodological Study Hadis Ashrafizadeh, Azam Shirinabadi Farahani, Maryam Karami, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3796351/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 30 Apr, 2024 Read the published version in Nursing Practice Today → Version 1 posted You are reading this latest preprint version Abstract Background Since family caregivers play an important role in providing care for the patients in need of palliative care, it is important to focus on and examine their care ability in fulfilling the expected roles. Therefore, this study was conducted with the aim of performing a psychometric evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS). Methods The present study is methodological research that evaluates the psychometric characteristics of the CAFCPNPCS by measuring face validity, content validity, construct validity (confirmatory factor analysis and divergent validity) and internal consistency in 412 family caregivers of the patients in need of palliative care, who were selected through convenient sampling. The data were analyzed using SPSS 24 and LISREL 8.8. Results According to the confirmatory factor analysis, the 5-factor model with 31 items was confirmed with the values RMSEA = 0.05, CFI = 0.95 and GFI = 0.88. The divergent validity was measured by estimation of correlation between the caring ability score with care burden score (which was measured by Zarit Burden Interview) of the family caregivers of the patients in need of palliative care. Cronbach's alpha (α) was reported to be 0.846 for the whole scale and 0.781–0.852 for other dimensions. Conclusion CAFCPNPCS is a valid and reliable tool that can evaluate the caring ability of the family caregivers of the patients in need of palliative care. Based on the results, it is recommended to utilize this scale to determine these caregivers’ ability in providing care and to examine the effectiveness of interventions with the aim of improving the dimensions of their caring ability. palliative care CAFCPCS caring ability caregivers informal caregivers Figures Figure 1 Figure 2 Background Palliative care is an important part of integrated and people-centered healthcare services, which aims to improve the quality of life among terminally ill patients and their families through prevention, screening, early diagnosis, suffering and pain relief, and the assessment and treatment of physical, mental, spiritual and social issues [ 1 ]. It is estimated that more than 56.8 million people need palliative care every year, 25.7 million of whom are in the last year of their lives. 78 percent of the latter group live in low- and middle-income countries [ 2 ]. According to World Health Organization statistics, in EMRO region, under 1% of the patients in need of palliative care receive this type of care [ 3 ]. Due to the complicated symptoms and problems, these patients gradually become dependent on the family caregivers who are the main source of support. The diagnosis of an incurable disease and the resulting changes sometimes disrupts the family system and requires changes to include the patient’s medical care needs in the daily routine [ 4 ]. Although the onset of a chronic disease impacts the entire family, the responsibility of care provision usually rests with one family member, who is the primary caregiver [ 5 ]. Besides having to fulfill multiple roles, the main caregiver has to manage his/her mental concerns as well as the patient’s concerns during the course of the disease [ 6 ]. This care activity is often provided unexpected, without prior knowledge and preparation, which can negatively affect the quality of care and lead to a variety of physical, mental, social, spiritual, and financial challenges for caregivers, which usually remain unaddressed [ 5 , 7 , 8 ]. In addition, the burden of care, limited activities, fear, insecurity, loneliness, the prospect of the patient’s death, and the lack of emotional support will increase the risk of fatigue, vulnerability, and burnout among family caregivers [ 9 ]. Therefore, neglecting caregivers’ needs may lead to a low quality of life in them [ 6 ]. Based on the results of a systematic review, it leads to physical and mental challenges, the lack of adaptation to caregiving challenges, and an information gap [ 10 ]. Therefore, providing these complicated types of care demands family’s high knowledge and skills, and family caregivers’ sufficient information on the disease and how to provide care for the sick family member [ 11 ]. Care providers should empower and support family caregivers and help them acquire the necessary knowledge and skills in order to provide quality care [ 11 ]. The first step in providing support for this group of caregivers is awareness of their education and care needs in the form of a concept called caring ability [ 12 ]. Measuring and evaluating their skills, as part of this concept, determines the required educational program [ 13 ]. Caring ability is defined as the degree of applying care strategies while maintaining physical and mental health, care competence and preparedness, spiritual coherence and economic status appropriate for addressing patients’ care and treatment needs, so that care burnout and confusion is avoided if the caregiver has the ability to provide care [ 11 ]. Obviously, to investigate these abilities in the form of caring ability, it is necessary to have valid tools for the target population. Measuring the family caregivers’ caring ability can determine their strengths and weaknesses and help professional staff to plan more precisely in this regard [ 11 , 14 ]. However, a suitable tool that can specifically measure the caring ability of family caregivers of patients in need of palliative care was not found. In 2020, Nemati et al. designed the Caring Ability of the Family Caregivers of the Patients with Cancer Scale (CAFCPCS) to measure the caring ability of family caregivers of patients with cancer in mixed methods research with an exploratory sequential approach. Since CAFCPCS is designed in accordance with the social and cultural characteristics of the family caregivers of the cancer patients in Iran and has acceptable psychometric properties, it seems that it can be used to examine the caring ability of the family caregivers of all patients in need of palliative care. The validation of this tool may lead to a better assessment of the caring ability of the family caregivers and identifying their strengths and weaknesses in the field of care provision which may help professional staff make more accurate plans for empowering the family to provide quality care at home. Therefore, this study was conducted with the aim of performing the psychometric assessment of the caring ability of the family caregivers of the patients in need of palliative care. Methods Study Design The current study is methodological research that investigates the psychometric properties of CAFCPCS among the family caregivers of the patients in need of palliative care based on face and content validity, confirmatory factor analysis, divergent validity, internal consistency, and stability. Study Settings and Participants Data collection was done from March to July 2022. The sample consisted of the family caregivers of the patients in need of palliative care, including patients with cancer, heart failure, heart attack, and stroke, which are considered common conditions requiring palliative care according to the Global Atlas of Palliative Care [ 3 ]. These caregivers were selected through convenient sampling. The inclusion criteria consisted of providing care for a patient in need of palliative care who was over 18 years of age with a Palliative Performance Scale (PPPS) ≤ 40 and at least 6 months’ experience of providing direct patient care at home. PPS is a tool designed to measure physical functional performance in palliative care patients. This tool evaluates five functional parameters including the namely degree of ambulation , the ability to do activities and extent of disease , the ability to do self-care , food and fluid intake , and the state of consciousness . There are 11 levels of PPS, ranging from 0 to 100% in 10 percent increments for measuring the scores. Any decrease by 10%, represents a relatively significant decrease in the physical functional performance. For example, a person with a score of 0 is passed away, and a score of 100% is completely ambulatory and healthy [ 15 ]. The exclusion criteria consisted of not fully completing the questionnaire and withdrawal from study. Instruments Data were collected through demographic variables questionnaire, CAFCPCS, and Zarit Burden Interview (ZBI). Demographic variables include age, gender, marital status, level of education, occupation, income, relationship with patient, the length of care provision, and the patient’s condition. CAFCPCS has been developed by Nemati et al. (2020) and consists of 31 items in 5 dimensions: effective role play (12 items), fatigue & surrender (8 items), trust (3 items), uncertainty (4 items) and caring ignorance (4 items), which are scored on a 5-point Likert scale ranging from completely agree (5), agree (4), no opinion (3), disagree (2), completely disagree (1). The total score of the instrument was 155 with a maximum score of 31. The Cronbach’s α is 0.93 for the whole scale and 0.705–0.933 for the dimensions. The internal consistency coefficient (ICC) of the instrument was 0.93 [ 11 ]. ZBI has been developed by Zarit et al. (1986) to determine the mental burden of disease and has 22 items on a 5-point Likert scale consisting of never (0), seldom (1), sometimes (2), most of the time (3), and always (4) [ 16 ]. The sum of the scores obtained by each caregiver will determine the disease burden [ 17 ]. This tool has been translated and validated in Iran, and the cut-off value for this questionnaire has been determined based on Iranian society standards. A score below 30 is classified as a mild disease burden, 31–60 as moderate, and 61–88 as severe. The minimum and maximum scores for each person are 0 and 88, respectively, where a higher score indicates more mental pressure and vice versa [ 17 ]. The Cronbach's alpha of the tool was calculated as 0.71 in the current study. Study Processes The research settings consisted of chronic disease clinics and the inpatient wards of the 3 selected referral hospitals. The family caregivers meeting the inclusion criteria were selected through convenience sampling to participate in the study. If they signed the written informed consent, they were given the demographic data questionnaire, the caring ability scale, and the burden scale. Content Validity and Cognitive Evaluation To examine the content validity, CAFCPCS was given to 8 experts in the fields of palliative care and scale development to check the scale in terms of the appropriateness of the items used for the patients in need of palliative care. For cognitive evaluation, the researchers asked 10 family caregivers of the patients in need of palliative care who met the research criteria to complete the scale and comment on the understandability of the items and the time required to answer them. Construct Validity The construct validity was examined through two methods: performing Confirmatory Factor Analysis (CFA) and measuring divergent validity. CFA is a technique for structural equation modeling [ 18 ]. In order to determine the goodness-of-fit, the maximum likelihood estimation (MLE) was done. There are several fit indices to decide about the appropriateness of the model [ 19 , 20 ]. To perform CFA, a number of at least 250 samples is necessary for an accurate data analysis. With this number of samples, the approximation test can be done with a power of 0.80 using the root mean square error of approximation (RMSEA) for a model with a degree of freedom of 100 in structural equation modeling [ 21 ]. In this study, the data of 412 samples were analyzed using LISREL V8.8 to determine whether the CAFCPCS items are valid indicators to examine the caring ability of family caregivers of patients in need of palliative care and the 5-factor model is approved to be used in this research population. Considering that, according to the studies, high caring ability is associated with a low score of the burden of care [ 22 , 23 ], the correlation coefficient between CAFCPCS scores and ZBI was calculated in order to evaluate the divergent validity. Reliability The internal consistency was investigated by calculating Cronbach’s alpha for the whole scale and each of the 5 dimensions. Data Analysis CFA-related data was analyzed through calculating the fit indices including CFI, GFI, and RMSEA using LISREL 8.8. all the data related to the reliability of scale such as Cronbach’s alpha and divergent validity coefficient were analyzed through SPSS 24. Results A total of 412 questionnaires were evaluated and statistically analyzed in this study. According to the data, 34.7% of the caregivers were 20–30 years old and 72.3% were female, of which 41.5% had 1 to 3 years’ caregiving experience. Other demographic characteristics of the subjects are shown in Table 1 . Table 1 Demographic and characteristics of participants Variables Frequency Percent Age (year) 20–30 143 34.7 31–40 109 26.5 41–50 87 21.1 51–60 53 12.9 ≥ 61 20 4.9 Gender Female 298 72.3 Male 114 27.7 Marital status Single 118 28.6 Married 185 44.9 Widow 72 17.5 Divorced 23 5.6 Deceased 14 3.4 Educational status High school 66 16 Diploma 152 36.9 Academic 194 47 Job Employed 145 35.2 Unemployed 197 47.8 Retired 42 10.02 Out of service 28 6.8 Relationship with patient Spouse 122 29.6 Child 147 35.7 Mother 50 12.1 Father 81 19.7 Other relatives 12 2.9 Times caring (year) Less than 1 171 41.5 1–3 142 34.5 3–5 58 14.1 5–10 21 5.1 More than 10 20 4.9 Type of disease Chronic heart failure 81 19.7 Cancer 149 36.2 MI 88 21.4 Stroke 66 16 Diabetes 6 1.5 Dementia/ Alzheimer 3 0.7 Multiple sclerosis (MS) 8 1.9 Other 11 2.7 According to the participants, no changes were made to the items while examining the content validity and cognitive evaluation of the tool. The results of the confirmatory factor analysis showed that according to the scores of goodness of fit indices, the model has a favorable fit (Table 2 ). As seen in Fig. 1 , CFA results for the 5-factor model show that all dimensions have an acceptable correlation coefficient. Furthermore, based on the T-value test, all the relationships between dimensions and their items are significant and there is no heterogeneity (Fig. 2 ). Therefore, the desired model and its constituent concepts are acceptable according to the fit indices, where χ 2 /df < 2 (25), RMSEA˂ 0.08, CFI ≥ 0.90, GFI ≥ 0.90 (26), and NNFI ≥ 0.90 (27). Table 2 The values of CFA fit indices for the 5-factor model with 31 items Goodness of Fit Indices Χ 2 df χ 2 /df CFI IFI RMSEA GFI NFI NNFI RFI SRMR 884.42 424 2.08 0.95 0.95 0.05 0.88 0.91 0.95 0.90 0.05 In order to investigate the divergent validity, the correlation between the caring ability score of the family caregivers of the patients in need of palliative care with the score of Zarit Burden Interview was determined as r=-0.451 (P < 0.001). The internal consistency of all items in the original version of the tool was determined for a number of 412 samples. Cronbach's alpha was reported as α = 0.846 for the whole scale and α = 0.781–0.852 for other dimensions. Discussion The increased number of the patients in need of palliative care has caused many issues in the health systems, which apparently may be partially addressed by using the capacity of family caregivers. Since the assessment of their caring ability is the first step to design empowerment programs, this study was conducted with the aim of the psychometric evaluation of the caring ability of the family caregivers of the patients in need of palliative care. Despite the fact that in the Iranian culture, taking care of sick people by family members is considered as a value [ 11 ], studies refer to caregivers’ lack of familiarity and preparedness to play the role of the caregiver, and the acquisition of care knowledge and skills as an unmet need among caregivers [ 24 , 25 ]. Therefore, awareness of their ability to provide care can help care providers better plan care based on their needs [ 26 ]. According to Global Atlas of Palliative Care, in 20 types of diseases, patients need palliative care [ 3 ]. In the present study, these diseases were selected from among the most common diseases that lead to the burden of disease in Iran [ 27 ]. The original version of CAFCPCS, which was developed by Nemati et al. to assess the caring ability of the caregivers of the patients with cancer, with 31 items and 5 dimensions [ 11 ] was the closest most appropriate tool available to evaluate the caring ability of the family caregivers of the patients in need of palliative care, because the patients with cancer are one of the largest groups with the indications of palliative care. CFA was used to check the construct validity of the instrument. The purpose of CFA is to discover whether or not the research data confirms the theoretical model presented by the original tool [ 28 ]. According to the findings, the measured indicators are satisfactory, and the model shows a proper fit. This tool was validated in 2020 to investigate the caring ability of the mothers of the children with cancer. In the version for the mothers of the children with cancer, 29 items remained in 5 dimensions, after removing an item from the dimension effective role play (item 10) and another one from the dimension caring ignorance (item 29) [ 14 ]. The first dimension of CAFCPNPCS is effective role play with 12 items, expressing the appropriate performance of the family caregivers of the patients in need of palliative care including detecting and addressing the patient’s care needs, emotional control over the family in the crisis caused by the disease and its outcomes, the ability to make decisions and solve problems, encouraging the patient to participate in social activities and motivating the patient through psychological support [ 11 ]. This dimension focuses on empowering the family and preparing them to play an effective role in care. Considering that patients need palliative care mostly at the end of life, the limited resources in healthcare centers for long-term care at the end-of-life stages as well as the absence of such centers (hospice) in the country on the one hand [ 29 ] and the patients’ desire to receive care at home on the other hand [ 30 ], empowering family members to play an effective role in this regard has become very important [ 31 ]. Items such as “I am able to take care of my patient and solve his/her problems” and “I am aware of my patient's needs” indicate the caregiver’s ability to provide care. Items such as “When there is a problem, I decide what needs to be done and do it.”, “I feel like I'm a good caregiver.”, and “I easily implement the trainings offered by professional caregivers while providing care for my patient and solving his/her problems” show family caregivers’ knowledge, skill, self-confidence, and capability regarding care provision and their need to receive training or advice from care providers in time of need. It is obvious that family caregiver’s playing an effective role in patient care requires physical, mental, social, and spiritual support to minimize the care burden and stress from the beginning of the care provision to the mourning period after the patient’s demise [ 32 ]. In the dimension fatigue and surrender , which represents the negative outcomes of care, 8 items of the original questionnaire were retained. This dimension has remained unchanged in CAFCPCS-mothers’ version [ 14 ]. Due to the patient’s stress and worry, this dimension covers a range of psychosocial and economic issues that can lead to fatigue and indifference in patient care [ 33 ]. The importance of this dimension in measuring care ability is that even if family caregivers have the necessary care knowledge and skills, they need full support from others in the care process. Failure to meet these needs will affect not only the caregivers, but also the entire care process. The pressure that caregivers experience as a result of the imbalance between care requirements and the available supportive resources to fulfill them [ 34 ] will cause a constant and increasing burden of care during the course of disease [ 35 ]. Therefore, the reactions related to the negative outcomes of care can be normal. In order to reduce these outcomes from an individual, mental, and social point of view, it seems necessary for other family members and the society to support family caregivers. The third dimension of CAFCPNPCS is trust with 3 items, which has remained unchanged compared to CAFCPCS. This dimension is a combination of spirituality and ability, and an item like “I believe that only God can help my patient” shows submission to divine destiny. This dimension is related to spirituality and finding meaning in life and indicates that one’s spiritual beliefs can have an impact on coping with crises and solving the related problems and help his/her grow [ 36 ]. Family caregivers use the meaning of life and trust in a higher power as a coping strategy to achieve goals, resolve conflicts, and adapt to the situation [ 37 , 38 ]. They create a meaningful framework for the disease and the resulting suffering, which makes it easier for them to accept the existing condition. In the study conducted on the family caregivers of cancer patients in Iran, a wide range of challenges was observed, from spiritual crisis to spiritual cohesion among the caregivers of this group of patients. Spiritual crisis is associated with the feeling of disharmony, detachment, and loss of meaning and purpose in life, and spiritual coherence refers to a uniform framework, a whole that encompasses harmony, and the search for meaning [ 36 ]. In Iran, due to the prevalence of Iranian-Islamic culture, patients and their caregivers somehow try to protect themselves from stress, disasters, and diseases by having confidence in spiritual resources [ 39 ]. A crisis may challenge one’s religious beliefs and faith, or on the contrary, force him/her to use faith as a coping resource (46), leading to spiritual stabilization or “awakening” and coherence [ 40 , 41 ]. The dimension uncertainty has 4 items. Things like worrying about the patient and waiting for bad news reflects this uncertainty. Uncertainty in illness scale [ 42 ] translated and validated by Sajjadi et al. [ 43 ] in Iran, includes concepts similar to this dimension, too. Uncertainty in disease includes “the patient or the family’s inability to determine the meaning of disease-related incidents when they are unable to process these events or cannot specifically predict the disease outcomes due to insufficient symptoms [ 43 ]. This is not simply the result of the complexity of the disease and its treatment; the lack of knowledge and not disclosing information about the disease [ 44 ] can limit involvement in decision-making and lead to “decision paralysis” [ 45 , 46 ]. Since the lack of knowledge and awareness about the course and prognosis of the disease and care provision will cause uncertainty among caregivers, it is necessary for caregivers to gain knowledge and be empowered in this regard. Caring ignorance with 4 items refers to the caregivers’ lack of awareness of the patient’s care needs and not addressing these needs due to insufficient care knowledge and skills, which is considered to be one of the factors affecting the quality of patient care [ 11 ]. The items “I don't know what to do in the next step of the treatment”, “I need to receive training and perceptible information to provide care for the patient”, “I don't have enough information on how to control the problems and the side effects of the patient’s treatment”, emphasize caregivers’ lack of information and skills regarding patient care. Meeting care needs depends on factors such as caregivers’ knowledge and skills. Therefore, in addition to examining the patient's care needs, professional caregivers should also guide the family in terms of access to proper and available resources and make a clear assessment of knowledge, skills, and the acceptance of caregiving role in the family. In order to investigate the divergent validity, the correlation between the scores of CAFCPNPCS and ZBI was defined, which showed that with an increase in caring ability, the burden of care decreases. The results of the study by Coppetti et al et al (2019) showed that family caregivers’ caring ability increases when there is reduced care burden and stress [ 22 ]. In addition, the burden of care among dialysis patients has an inverse relationship with the ability to provide care and the quality of life [ 47 ]. In addition, Abbasi et al. (2011) reported a significant and negative correlation between the burden of care and the ability to perform personal activities, which is consistent with the findings of the present study [ 48 ]. One of the most important factors impacting the burden of care is the lack of knowledge, awareness, and necessary skills for patient care [ 49 ]. Therefore, by teaching the caregivers how to provide care for the patient at home and problem-oriented coping skills, they can be empowered to fulfill caregiving roles, and adapt to the responsibilities and changes in their lifestyle following the provision of care for the patient at home, resulting in reduced burden of care. Reliability is the major concern while using a psychological test. Based on the results of the research, Cronbach's alpha was measured to be 0.78 for the whole tool, and 0.78–0.85 for its dimensions, which was acceptable. In the study of Khademi et al, Cronbach's alpha of CAFCPCS-mother’s version was reported to be 0.71, and in the study by Nemati et al, it was 0.93 [ 7 , 36 ]. According to the results, the items of the scale are accurate, reliable, repeatable, and acceptable [ 50 ]. Study Limitations Given that Iran is a vast country with different ethnicities and cultures, it should be noted that the cultural values of the society limit the generalization of the findings to the whole society. On the other hand, the patients in need of palliative care include a wide range of patients whose various needs may lead to differences in the dimensions of their family caregivers’ ability to provide care. Therefore, it is suggested to conduct a study in different groups in terms of the type of disease and the geographical region. Conclusion This study was conducted with the aim of psychometric evaluation of CAFCPNPCS. The desired scale contains 31 items and 5 dimensions and provides the opportunity to evaluate the care ability of the family caregivers of the patients in need of palliative care in the Iranian culture. Based on the results of the study, it is recommended to use this scale to determine the caring ability of the family caregivers of the patients in need of palliative care and the effective interventions, in order to improve each dimension of caring ability and, in turn, to enhance the caring ability itself. Since the purpose of providing palliative care is to improve the quality of life for the patient and the family, through measuring the care ability of the family caregivers of this group of patients, care providers will be able to identify the educational needs, to find out what needs to be improved, and to develop an appropriate care plan. Declarations Ethics approval and consent to participate in the study This study was confirmed by the Research Ethics Committee of the Cancer Research Center of Shahid Beheshti University of Medical Sciences under the code IR.SBMU.CRC.REC.1400.043. All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by Cancer Research Center of Shahid Beheshti University of Medical Sciences. After the code of ethics was approved, the researchers obtained the necessary permits for sampling and presented it to the selected related centers. Then the research objectives were explained to all the participants. Data confidentiality and privacy, and anonymous data analysis were observed in all the phases of the research. Consent for publication Not applicable. Availability of data and materials The data sets generated during the current study are not available for public reasons since they are based on the statements of nursing policymakers; however, they are available at the reasonable request of the author. Competing interests The authors declare that they have no competing interests. Funding No funding was received for this article. Authors' contributions Study design: HA, MR, ASHF; Data collection: MK, HA, FKH; Data analysis: ASD, MN, LKH; Study supervision: AS, HA, FKH; Manuscript writing: HA, MR, ASD. Critical revisions for important intellectual content: HA, MR, ASD, ASHF. All authors read and approved the final manuscript. Acknowledgement The authors would like to appreciate the Deputy of Research of Shahid Beheshti University of Medical Science for their support and thank all the Family Caregivers of the Patients in Need of Palliative Care participating in this study. References Assessing the development of palliative care worldwide: a set of actionable indicators [https://www.who.int/publications/i/item/9789240033351] Quality health services and palliative care: practical approaches and resources to support policy, strategy and practice [https://www.who.int/publications/i/item/9789240035164] World Health Organization: Global Atlas of Palliative Care , 2nd Edition edn. 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Hashemlu L, Esmaeili R, Bahramnezhad F, Rohani C: The experiences of home care team members regarding the needs of family caregivers of heart failure patients in home health care services in Iran: A qualitative study . ARYA atherosclerosis 2022, 18 (4):1-10. Glajchen M: Family caregivers in palliative care and hospice: minimizing burden and maximizing support . Alexandria, VA: National Hospice and Palliative Care Organization Palliative Care Resource Series 2016. Bevans M, Sternberg EM: Caregiving burden, stress, and health effects among family caregivers of adult cancer patients . Jama 2012, 307 (4):398-403. Kim Y, Given BA: Quality of life of family caregivers of cancer survivors: across the trajectory of the illness . Cancer 2008, 112 (S11):2556-2568. Bijnsdorp FM, Onwuteaka-Philipsen BD, Boot CRL, van der Beek AJ, Pasman HRW: Caregiver’s burden at the end of life of their loved one: insights from a longitudinal qualitative study among working family caregivers . BMC Palliative Care 2022, 21 (1):142. Nemati S, Rassouli M, Baghestani AR: The spiritual challenges faced by family caregivers of patients with cancer: A qualitative study . Holistic nursing practice 2017, 31 (2):110-117. Lalani N, Duggleby W, Olson J: Spirituality among family caregivers in palliative care: an integrative literature review . Int J Palliat Nurs 2018, 24 (2):80-91. Rocha RCNP, Pereira ER, Silva RMCRA, Medeiros AYBBVd, Refrande SM, Refrande NA: Spiritual needs experienced by the patient's family caregiver under Oncology palliative care . Revista brasileira de enfermagem 2018, 71 :2635-2642. Zand, rafiei: Patients' Religious Care: A Neglected Need in Medical Education . Journal of Medical Education Development 2016, 8 (20):50-58. Lips‐Wiersma M: The influence of spiritual “meaning‐making” on career behavior . Journal of Management Development 2002, 21 (7):497-520. Weber SR, Pargament KI: The role of religion and spirituality in mental health . Current opinion in psychiatry 2014, 27 (5):358-363. Mishel MH: Uncertainty in illness . Image: The Journal of Nursing Scholarship 1988, 20 (4):225-232. Sajjadi M, Rassouli M, Abbaszadeh A, Majd HA, Zendehdel K: Psychometric properties of the Persian version of the Mishel's Uncertainty in Illness Scale in patients with cancer . European Journal of Oncology Nursing 2014, 18 (1):52-57. Sajjadi M, Rassouli M, Abbaszadeh A, Brant J, Majd HA: Lived experiences of “illness uncertainty” of Iranian cancer patients: A phenomenological hermeneutic study . Cancer nursing 2016, 39 (4):E1-E9. Oksavik JD, Solbjør M, Kirchhoff R, Sogstad MKR: Games of uncertainty: the participation of older patients with multimorbidity in care planning meetings–a qualitative study . BMC geriatrics 2021, 21 (1):1-11. Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, McInerney F, Sinclair C, Detering KM: Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies . Palliative medicine 2019, 33 (3):274-290. Jafari H, Ebrahimi A, Aghaei A, Khatony A: The relationship between care burden and quality of life in caregivers of hemodialysis patients . BMC nephrology 2018, 19 (1):321. Abbasi a, Asayesh h, Rhariati a, Hosseini sa, Rouhi g, Molaie e: The Burden on Cargivers from Hemodialysis Patients and Related Factors . Journal of Research Development in Nursing and Midwifery 2011, 8 (1):26-33. Sabzalipoor f, Fotoukian Z, Ahmadi h, Jannat Alipour Z: Factors related to the care burden in family caregivers of the elderly with chronic diseases - a review study . Journal of Caspian Health and Aging 2021, 6 (1):29-52. Shirinabadi Farahani A, Bussing A, Akbari ME, Ashrafizadeh H, Heidarzadeh M, Hatamipour K, Tabatabaee A, Ansari M, Karami M, Fallahi S et al : The Translation and Psychometric Evaluation of the Persian Version of Brief Multidimensional Life Satisfaction Scale for Iranian Patients with Cancer . Int J Cancer Manag 2021, 14 (7):e113588. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 30 Apr, 2024 Read the published version in Nursing Practice Today → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3796351","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":263657409,"identity":"647335dd-d728-4907-aa99-0952494beff7","order_by":0,"name":"Hadis Ashrafizadeh","email":"","orcid":"","institution":"Dezful University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hadis","middleName":"","lastName":"Ashrafizadeh","suffix":""},{"id":263657412,"identity":"bd2e8281-cc66-4624-8585-41cf264703d2","order_by":1,"name":"Azam Shirinabadi Farahani","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Azam","middleName":"Shirinabadi","lastName":"Farahani","suffix":""},{"id":263657416,"identity":"b86fe462-9369-4398-bde5-2f63eb322f45","order_by":2,"name":"Maryam Karami","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Karami","suffix":""},{"id":263657417,"identity":"6ce850a8-f5e3-4846-8342-305c0ca2b1d3","order_by":3,"name":"Fatemeh Khademi","email":"","orcid":"","institution":"Arak University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Fatemeh","middleName":"","lastName":"Khademi","suffix":""},{"id":263657419,"identity":"52500ccd-3ffc-43d7-a5c7-6613e41e256c","order_by":4,"name":"Azam Eshaghian Dorcheh","email":"","orcid":"","institution":"Isfahan University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Azam","middleName":"Eshaghian","lastName":"Dorcheh","suffix":""},{"id":263657420,"identity":"b7a6e963-d878-4970-961e-2abfc4f46b2b","order_by":5,"name":"Leila Khanali Mojen","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Leila","middleName":"Khanali","lastName":"Mojen","suffix":""},{"id":263657421,"identity":"1988b0da-fdb6-46b2-976d-3f67c85a27fa","order_by":6,"name":"Maliheh Nasiri","email":"","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Maliheh","middleName":"","lastName":"Nasiri","suffix":""},{"id":263657422,"identity":"2763d57b-892f-4a4b-b0d8-f9e45d8057c9","order_by":7,"name":"Maryam Rassouli","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyUlEQVRIiWNgGAWjYPACCx4GBuYDQIaEDLFaJIBa2BKgDCK1ADGPAYhFWIt5+/HHHz62Ad0jdubzqxs1QBeyHz66AZ8WmTM5ZpIz24Dukc7dZp1zDMjgSUu7gd9FOWzMvFAtxjlsQIYEjxl+LfzPH3+GaMl5ZpzzjxgtEgkG0lAtzI9z24jS8sZMcsY5CR426TQz5tw+IIOgX/jTH3/4UGZjzy+d/Phzzrc6OX72w8fwaoEDNiCSgDKIB8wfSFE9CkbBKBgFIwcAANNzOcmr2jLgAAAAAElFTkSuQmCC","orcid":"","institution":"Shahid Beheshti University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Maryam","middleName":"","lastName":"Rassouli","suffix":""}],"badges":[],"createdAt":"2023-12-23 12:29:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3796351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3796351/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.18502/npt.v11i2.15412","type":"published","date":"2024-04-30T23:56:34+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":49079698,"identity":"f59b46bd-7d39-43b6-a115-dd9a3ec394ee","added_by":"auto","created_at":"2024-01-02 19:50:51","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":35632,"visible":true,"origin":"","legend":"\u003cp\u003eCAFCPCS standard estimation model for the 5-factor model with 31 items\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3796351/v1/2937226393ddd2c6aef4dc9d.png"},{"id":49079699,"identity":"c6ed5ca2-eda1-4c65-b4c5-b83b006a91bc","added_by":"auto","created_at":"2024-01-02 19:50:51","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":37230,"visible":true,"origin":"","legend":"\u003cp\u003eT-value for the 5-factor model with 31 items\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3796351/v1/1394985c7a279dc23a22f17d.png"},{"id":55697028,"identity":"5580f00b-dc56-4980-a4ed-064f4761c847","added_by":"auto","created_at":"2024-05-02 02:02:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1829199,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3796351/v1/f83e5b44-7e67-44ad-87ca-11773e26e6af.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Psychometric Evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS): A Methodological Study","fulltext":[{"header":"Background","content":"\u003cp\u003ePalliative care is an important part of integrated and people-centered healthcare services, which aims to improve the quality of life among terminally ill patients and their families through prevention, screening, early diagnosis, suffering and pain relief, and the assessment and treatment of physical, mental, spiritual and social issues [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It is estimated that more than 56.8\u0026nbsp;million people need palliative care every year, 25.7\u0026nbsp;million of whom are in the last year of their lives. 78 percent of the latter group live in low- and middle-income countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to World Health Organization statistics, in EMRO region, under 1% of the patients in need of palliative care receive this type of care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDue to the complicated symptoms and problems, these patients gradually become dependent on the family caregivers who are the main source of support. The diagnosis of an incurable disease and the resulting changes sometimes disrupts the family system and requires changes to include the patient\u0026rsquo;s medical care needs in the daily routine [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Although the onset of a chronic disease impacts the entire family, the responsibility of care provision usually rests with one family member, who is the primary caregiver [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Besides having to fulfill multiple roles, the main caregiver has to manage his/her mental concerns as well as the patient\u0026rsquo;s concerns during the course of the disease [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis care activity is often provided unexpected, without prior knowledge and preparation, which can negatively affect the quality of care and lead to a variety of physical, mental, social, spiritual, and financial challenges for caregivers, which usually remain unaddressed [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In addition, the burden of care, limited activities, fear, insecurity, loneliness, the prospect of the patient\u0026rsquo;s death, and the lack of emotional support will increase the risk of fatigue, vulnerability, and burnout among family caregivers [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Therefore, neglecting caregivers\u0026rsquo; needs may lead to a low quality of life in them [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Based on the results of a systematic review, it leads to physical and mental challenges, the lack of adaptation to caregiving challenges, and an information gap [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, providing these complicated types of care demands family\u0026rsquo;s high knowledge and skills, and family caregivers\u0026rsquo; sufficient information on the disease and how to provide care for the sick family member [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCare providers should empower and support family caregivers and help them acquire the necessary knowledge and skills in order to provide quality care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The first step in providing support for this group of caregivers is awareness of their education and care needs in the form of a concept called caring ability [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Measuring and evaluating their skills, as part of this concept, determines the required educational program [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Caring ability is defined as the degree of applying care strategies while maintaining physical and mental health, care competence and preparedness, spiritual coherence and economic status appropriate for addressing patients\u0026rsquo; care and treatment needs, so that care burnout and confusion is avoided if the caregiver has the ability to provide care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObviously, to investigate these abilities in the form of caring ability, it is necessary to have valid tools for the target population. Measuring the family caregivers\u0026rsquo; caring ability can determine their strengths and weaknesses and help professional staff to plan more precisely in this regard [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. However, a suitable tool that can specifically measure the caring ability of family caregivers of patients in need of palliative care was not found. In 2020, Nemati et al. designed \u003cem\u003ethe Caring Ability of the Family Caregivers of the Patients with Cancer Scale (CAFCPCS)\u003c/em\u003e to measure the caring ability of family caregivers of patients with cancer in mixed methods research with an exploratory sequential approach. Since CAFCPCS is designed in accordance with the social and cultural characteristics of the family caregivers of the cancer patients in Iran and has acceptable psychometric properties, it seems that it can be used to examine the caring ability of the family caregivers of all patients in need of palliative care. The validation of this tool may lead to a better assessment of the caring ability of the family caregivers and identifying their strengths and weaknesses in the field of care provision which may help professional staff make more accurate plans for empowering the family to provide quality care at home. Therefore, this study was conducted with the aim of performing the psychometric assessment of the caring ability of the family caregivers of the patients in need of palliative care.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThe current study is methodological research that investigates the psychometric properties of CAFCPCS among the family caregivers of the patients in need of palliative care based on face and content validity, confirmatory factor analysis, divergent validity, internal consistency, and stability.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Settings and Participants\u003c/h2\u003e \u003cp\u003eData collection was done from March to July 2022. The sample consisted of the family caregivers of the patients in need of palliative care, including patients with cancer, heart failure, heart attack, and stroke, which are considered common conditions requiring palliative care according to the Global Atlas of Palliative Care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These caregivers were selected through convenient sampling. The inclusion criteria consisted of providing care for a patient in need of palliative care who was over 18 years of age with a Palliative Performance Scale (PPPS)\u0026thinsp;\u0026le;\u0026thinsp;40 and at least 6 months\u0026rsquo; experience of providing direct patient care at home.\u003c/p\u003e \u003cp\u003ePPS is a tool designed to measure physical functional performance in palliative care patients. This tool evaluates five functional parameters including \u003cem\u003ethe namely degree of ambulation\u003c/em\u003e, \u003cem\u003ethe ability to do activities and extent of disease\u003c/em\u003e, \u003cem\u003ethe ability to do self-care\u003c/em\u003e, \u003cem\u003efood and fluid intake\u003c/em\u003e, and \u003cem\u003ethe state of consciousness\u003c/em\u003e. There are 11 levels of PPS, ranging from 0 to 100% in 10 percent increments for measuring the scores. Any decrease by 10%, represents a relatively significant decrease in the physical functional performance. For example, a person with a score of 0 is passed away, and a score of 100% is completely ambulatory and healthy [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe exclusion criteria consisted of not fully completing the questionnaire and withdrawal from study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eInstruments\u003c/h2\u003e \u003cp\u003eData were collected through demographic variables questionnaire, CAFCPCS, and Zarit Burden Interview (ZBI).\u003c/p\u003e \u003cp\u003eDemographic variables include age, gender, marital status, level of education, occupation, income, relationship with patient, the length of care provision, and the patient\u0026rsquo;s condition.\u003c/p\u003e \u003cp\u003eCAFCPCS has been developed by Nemati et al. (2020) and consists of 31 items in 5 dimensions: \u003cem\u003eeffective role play\u003c/em\u003e (12 items), \u003cem\u003efatigue \u0026amp; surrender\u003c/em\u003e (8 items), \u003cem\u003etrust\u003c/em\u003e (3 items), \u003cem\u003euncertainty\u003c/em\u003e (4 items) and \u003cem\u003ecaring ignorance\u003c/em\u003e (4 items), which are scored on a 5-point Likert scale ranging from \u003cem\u003ecompletely agree\u003c/em\u003e (5), \u003cem\u003eagree\u003c/em\u003e (4), \u003cem\u003eno opinion\u003c/em\u003e (3), \u003cem\u003edisagree\u003c/em\u003e (2), \u003cem\u003ecompletely disagree\u003c/em\u003e (1). The total score of the instrument was 155 with a maximum score of 31. The Cronbach\u0026rsquo;s α is 0.93 for the whole scale and 0.705\u0026ndash;0.933 for the dimensions. The internal consistency coefficient (ICC) of the instrument was 0.93 [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eZBI has been developed by Zarit et al. (1986) to determine the mental burden of disease and has 22 items on a 5-point Likert scale consisting of \u003cem\u003enever\u003c/em\u003e (0), \u003cem\u003eseldom\u003c/em\u003e (1), \u003cem\u003esometimes\u003c/em\u003e (2), \u003cem\u003emost of the time\u003c/em\u003e (3), and \u003cem\u003ealways\u003c/em\u003e (4) [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The sum of the scores obtained by each caregiver will determine the disease burden [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This tool has been translated and validated in Iran, and the cut-off value for this questionnaire has been determined based on Iranian society standards. A score below 30 is classified as a mild disease burden, 31\u0026ndash;60 as moderate, and 61\u0026ndash;88 as severe. The minimum and maximum scores for each person are 0 and 88, respectively, where a higher score indicates more mental pressure and vice versa [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The Cronbach's alpha of the tool was calculated as 0.71 in the current study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy Processes\u003c/h2\u003e \u003cp\u003eThe research settings consisted of chronic disease clinics and the inpatient wards of the 3 selected referral hospitals. The family caregivers meeting the inclusion criteria were selected through convenience sampling to participate in the study. If they signed the written informed consent, they were given the demographic data questionnaire, the caring ability scale, and the burden scale.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eContent Validity and Cognitive Evaluation\u003c/h2\u003e \u003cp\u003eTo examine the content validity, CAFCPCS was given to 8 experts in the fields of palliative care and scale development to check the scale in terms of the appropriateness of the items used for the patients in need of palliative care. For cognitive evaluation, the researchers asked 10 family caregivers of the patients in need of palliative care who met the research criteria to complete the scale and comment on the understandability of the items and the time required to answer them.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eConstruct Validity\u003c/h2\u003e \u003cp\u003eThe construct validity was examined through two methods: performing Confirmatory Factor Analysis (CFA) and measuring divergent validity. CFA is a technique for structural equation modeling [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In order to determine the goodness-of-fit, the maximum likelihood estimation (MLE) was done. There are several fit indices to decide about the appropriateness of the model [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To perform CFA, a number of at least 250 samples is necessary for an accurate data analysis. With this number of samples, the approximation test can be done with a power of 0.80 using the root mean square error of approximation (RMSEA) for a model with a degree of freedom of 100 in structural equation modeling [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In this study, the data of 412 samples were analyzed using LISREL V8.8 to determine whether the CAFCPCS items are valid indicators to examine the caring ability of family caregivers of patients in need of palliative care and the 5-factor model is approved to be used in this research population.\u003c/p\u003e \u003cp\u003eConsidering that, according to the studies, high caring ability is associated with a low score of the burden of care [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], the correlation coefficient between CAFCPCS scores and ZBI was calculated in order to evaluate the divergent validity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eReliability\u003c/h2\u003e \u003cp\u003eThe internal consistency was investigated by calculating Cronbach\u0026rsquo;s alpha for the whole scale and each of the 5 dimensions.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eCFA-related data was analyzed through calculating the fit indices including CFI, GFI, and RMSEA using LISREL 8.8. all the data related to the reliability of scale such as Cronbach\u0026rsquo;s alpha and divergent validity coefficient were analyzed through SPSS 24.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 412 questionnaires were evaluated and statistically analyzed in this study. According to the data, 34.7% of the caregivers were 20\u0026ndash;30 years old and 72.3% were female, of which 41.5% had 1 to 3 years\u0026rsquo; caregiving experience. Other demographic characteristics of the subjects are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eAge (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e72.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeceased\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiploma\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAcademic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eJob\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOut of service\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eRelationship with patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpouse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther relatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eTimes caring (year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eType of disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChronic heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStroke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDementia/ Alzheimer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMultiple sclerosis (MS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to the participants, no changes were made to the items while examining the content validity and cognitive evaluation of the tool.\u003c/p\u003e \u003cp\u003eThe results of the confirmatory factor analysis showed that according to the scores of goodness of fit indices, the model has a favorable fit (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). As seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, CFA results for the 5-factor model show that all dimensions have an acceptable correlation coefficient. Furthermore, based on the T-value test, all the relationships between dimensions and their items are significant and there is no heterogeneity (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Therefore, the desired model and its constituent concepts are acceptable according to the fit indices, where χ\u003csup\u003e2\u003c/sup\u003e/df\u0026thinsp;\u0026lt;\u0026thinsp;2 (25), RMSEA˂ 0.08, CFI\u0026thinsp;\u0026ge;\u0026thinsp;0.90, GFI\u0026thinsp;\u0026ge;\u0026thinsp;0.90 (26), and NNFI\u0026thinsp;\u0026ge;\u0026thinsp;0.90 (27).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe values of CFA fit indices for the 5-factor model with 31 items\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"12\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGoodness of Fit Indices\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eΧ\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/df\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRMSEA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eGFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eNFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eNNFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eRFI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003eSRMR\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e884.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e0.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e0.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn order to investigate the divergent validity, the correlation between the caring ability score of the family caregivers of the patients in need of palliative care with the score of Zarit Burden Interview was determined as r=-0.451 (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eThe internal consistency of all items in the original version of the tool was determined for a number of 412 samples. Cronbach's alpha was reported as α\u0026thinsp;=\u0026thinsp;0.846 for the whole scale and α\u0026thinsp;=\u0026thinsp;0.781\u0026ndash;0.852 for other dimensions.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe increased number of the patients in need of palliative care has caused many issues in the health systems, which apparently may be partially addressed by using the capacity of family caregivers. Since the assessment of their caring ability is the first step to design empowerment programs, this study was conducted with the aim of the psychometric evaluation of the caring ability of the family caregivers of the patients in need of palliative care. Despite the fact that in the Iranian culture, taking care of sick people by family members is considered as a value [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], studies refer to caregivers\u0026rsquo; lack of familiarity and preparedness to play the role of the caregiver, and the acquisition of care knowledge and skills as an unmet need among caregivers [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Therefore, awareness of their ability to provide care can help care providers better plan care based on their needs [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. According to Global Atlas of Palliative Care, in 20 types of diseases, patients need palliative care [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. In the present study, these diseases were selected from among the most common diseases that lead to the burden of disease in Iran [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe original version of CAFCPCS, which was developed by Nemati et al. to assess the caring ability of the caregivers of the patients with cancer, with 31 items and 5 dimensions [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] was the closest most appropriate tool available to evaluate the caring ability of the family caregivers of the patients in need of palliative care, because the patients with cancer are one of the largest groups with the indications of palliative care. CFA was used to check the construct validity of the instrument. The purpose of CFA is to discover whether or not the research data confirms the theoretical model presented by the original tool [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. According to the findings, the measured indicators are satisfactory, and the model shows a proper fit. This tool was validated in 2020 to investigate the caring ability of the mothers of the children with cancer. In the version for the mothers of the children with cancer, 29 items remained in 5 dimensions, after removing an item from the dimension \u003cem\u003eeffective role play\u003c/em\u003e (item 10) and another one from the dimension \u003cem\u003ecaring ignorance\u003c/em\u003e (item 29) [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe first dimension of CAFCPNPCS is \u003cem\u003eeffective role play\u003c/em\u003e with 12 items, expressing the appropriate performance of the family caregivers of the patients in need of palliative care including detecting and addressing the patient\u0026rsquo;s care needs, emotional control over the family in the crisis caused by the disease and its outcomes, the ability to make decisions and solve problems, encouraging the patient to participate in social activities and motivating the patient through psychological support [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This dimension focuses on empowering the family and preparing them to play an effective role in care. Considering that patients need palliative care mostly at the end of life, the limited resources in healthcare centers for long-term care at the end-of-life stages as well as the absence of such centers (hospice) in the country on the one hand [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] and the patients\u0026rsquo; desire to receive care at home on the other hand [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], empowering family members to play an effective role in this regard has become very important [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Items such as \u0026ldquo;I am able to take care of my patient and solve his/her problems\u0026rdquo; and \u0026ldquo;I am aware of my patient's needs\u0026rdquo; indicate the caregiver\u0026rsquo;s ability to provide care.\u003c/p\u003e \u003cp\u003eItems such as \u0026ldquo;When there is a problem, I decide what needs to be done and do it.\u0026rdquo;, \u0026ldquo;I feel like I'm a good caregiver.\u0026rdquo;, and \u0026ldquo;I easily implement the trainings offered by professional caregivers while providing care for my patient and solving his/her problems\u0026rdquo; show family caregivers\u0026rsquo; knowledge, skill, self-confidence, and capability regarding care provision and their need to receive training or advice from care providers in time of need. It is obvious that family caregiver\u0026rsquo;s playing an effective role in patient care requires physical, mental, social, and spiritual support to minimize the care burden and stress from the beginning of the care provision to the mourning period after the patient\u0026rsquo;s demise [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the dimension \u003cem\u003efatigue and surrender\u003c/em\u003e, which represents the negative outcomes of care, 8 items of the original questionnaire were retained. This dimension has remained unchanged in \u003cem\u003eCAFCPCS-mothers\u0026rsquo; version\u003c/em\u003e [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Due to the patient\u0026rsquo;s stress and worry, this dimension covers a range of psychosocial and economic issues that can lead to fatigue and indifference in patient care [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The importance of this dimension in measuring care ability is that even if family caregivers have the necessary care knowledge and skills, they need full support from others in the care process. Failure to meet these needs will affect not only the caregivers, but also the entire care process. The pressure that caregivers experience as a result of the imbalance between care requirements and the available supportive resources to fulfill them [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] will cause a constant and increasing burden of care during the course of disease [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Therefore, the reactions related to the negative outcomes of care can be normal. In order to reduce these outcomes from an individual, mental, and social point of view, it seems necessary for other family members and the society to support family caregivers.\u003c/p\u003e \u003cp\u003eThe third dimension of CAFCPNPCS is \u003cem\u003etrust\u003c/em\u003e with 3 items, which has remained unchanged compared to CAFCPCS. This dimension is a combination of spirituality and ability, and an item like \u0026ldquo;I believe that only God can help my patient\u0026rdquo; shows submission to divine destiny. This dimension is related to spirituality and finding meaning in life and indicates that one\u0026rsquo;s spiritual beliefs can have an impact on coping with crises and solving the related problems and help his/her grow [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Family caregivers use the meaning of life and trust in a higher power as a coping strategy to achieve goals, resolve conflicts, and adapt to the situation [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. They create a meaningful framework for the disease and the resulting suffering, which makes it easier for them to accept the existing condition. In the study conducted on the family caregivers of cancer patients in Iran, a wide range of challenges was observed, from spiritual crisis to spiritual cohesion among the caregivers of this group of patients. Spiritual crisis is associated with the feeling of disharmony, detachment, and loss of meaning and purpose in life, and spiritual coherence refers to a uniform framework, a whole that encompasses harmony, and the search for meaning [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. In Iran, due to the prevalence of Iranian-Islamic culture, patients and their caregivers somehow try to protect themselves from stress, disasters, and diseases by having confidence in spiritual resources [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. A crisis may challenge one\u0026rsquo;s religious beliefs and faith, or on the contrary, force him/her to use faith as a coping resource (46), leading to spiritual stabilization or \u0026ldquo;awakening\u0026rdquo; and coherence [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe dimension \u003cem\u003euncertainty\u003c/em\u003e has 4 items. Things like worrying about the patient and waiting for bad news reflects this uncertainty. \u003cem\u003eUncertainty in illness scale\u003c/em\u003e [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e] translated and validated by Sajjadi et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e] in Iran, includes concepts similar to this dimension, too. Uncertainty in disease includes \u0026ldquo;the patient or the family\u0026rsquo;s inability to determine the meaning of disease-related incidents when they are unable to process these events or cannot specifically predict the disease outcomes due to insufficient symptoms [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. This is not simply the result of the complexity of the disease and its treatment; the lack of knowledge and not disclosing information about the disease [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] can limit involvement in decision-making and lead to \u0026ldquo;decision paralysis\u0026rdquo; [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Since the lack of knowledge and awareness about the course and prognosis of the disease and care provision will cause uncertainty among caregivers, it is necessary for caregivers to gain knowledge and be empowered in this regard.\u003c/p\u003e \u003cp\u003e \u003cem\u003eCaring ignorance\u003c/em\u003e with 4 items refers to the caregivers\u0026rsquo; lack of awareness of the patient\u0026rsquo;s care needs and not addressing these needs due to insufficient care knowledge and skills, which is considered to be one of the factors affecting the quality of patient care [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The items \u0026ldquo;I don't know what to do in the next step of the treatment\u0026rdquo;, \u0026ldquo;I need to receive training and perceptible information to provide care for the patient\u0026rdquo;, \u0026ldquo;I don't have enough information on how to control the problems and the side effects of the patient\u0026rsquo;s treatment\u0026rdquo;, emphasize caregivers\u0026rsquo; lack of information and skills regarding patient care. Meeting care needs depends on factors such as caregivers\u0026rsquo; knowledge and skills. Therefore, in addition to examining the patient's care needs, professional caregivers should also guide the family in terms of access to proper and available resources and make a clear assessment of knowledge, skills, and the acceptance of caregiving role in the family.\u003c/p\u003e \u003cp\u003eIn order to investigate the divergent validity, the correlation between the scores of CAFCPNPCS and ZBI was defined, which showed that with an increase in caring ability, the burden of care decreases. The results of the study by Coppetti et al et al (2019) showed that family caregivers\u0026rsquo; caring ability increases when there is reduced care burden and stress [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, the burden of care among dialysis patients has an inverse relationship with the ability to provide care and the quality of life [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. In addition, Abbasi et al. (2011) reported a significant and negative correlation between the burden of care and the ability to perform personal activities, which is consistent with the findings of the present study [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. One of the most important factors impacting the burden of care is the lack of knowledge, awareness, and necessary skills for patient care [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. Therefore, by teaching the caregivers how to provide care for the patient at home and problem-oriented coping skills, they can be empowered to fulfill caregiving roles, and adapt to the responsibilities and changes in their lifestyle following the provision of care for the patient at home, resulting in reduced burden of care.\u003c/p\u003e \u003cp\u003eReliability is the major concern while using a psychological test. Based on the results of the research, Cronbach's alpha was measured to be 0.78 for the whole tool, and 0.78\u0026ndash;0.85 for its dimensions, which was acceptable. In the study of Khademi et al, Cronbach's alpha of \u003cem\u003eCAFCPCS-mother\u0026rsquo;s version\u003c/em\u003e was reported to be 0.71, and in the study by Nemati et al, it was 0.93 [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. According to the results, the items of the scale are accurate, reliable, repeatable, and acceptable [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eGiven that Iran is a vast country with different ethnicities and cultures, it should be noted that the cultural values of the society limit the generalization of the findings to the whole society. On the other hand, the patients in need of palliative care include a wide range of patients whose various needs may lead to differences in the dimensions of their family caregivers\u0026rsquo; ability to provide care. Therefore, it is suggested to conduct a study in different groups in terms of the type of disease and the geographical region.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study was conducted with the aim of psychometric evaluation of CAFCPNPCS. The desired scale contains 31 items and 5 dimensions and provides the opportunity to evaluate the care ability of the family caregivers of the patients in need of palliative care in the Iranian culture. Based on the results of the study, it is recommended to use this scale to determine the caring ability of the family caregivers of the patients in need of palliative care and the effective interventions, in order to improve each dimension of caring ability and, in turn, to enhance the caring ability itself. Since the purpose of providing palliative care is to improve the quality of life for the patient and the family, through measuring the care ability of the family caregivers of this group of patients, care providers will be able to identify the educational needs, to find out what needs to be improved, and to develop an appropriate care plan.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate in the study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was confirmed by the Research Ethics Committee of the Cancer Research Center of Shahid Beheshti University of Medical Sciences under the code IR.SBMU.CRC.REC.1400.043. All methods were carried out in accordance with relevant guidelines and regulations. All experimental protocols were approved by Cancer Research Center of Shahid Beheshti University of Medical Sciences. After the code of ethics was approved, the researchers obtained the necessary permits for sampling and presented it to the selected related centers. Then the research objectives were explained to all the participants. Data confidentiality and privacy, and anonymous data analysis were observed in all the phases of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets generated during the current study are not available for public reasons since they are based on the statements of nursing policymakers; however, they are available at the reasonable request of the author.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: HA, MR, ASHF; Data collection: MK, HA, FKH; Data analysis: ASD, MN, LKH; Study supervision: AS, HA, FKH; Manuscript writing: HA, MR, ASD. Critical revisions for important intellectual content: HA, MR, ASD, ASHF. All authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to appreciate the Deputy of Research of Shahid Beheshti University of Medical Science for their support and thank all the Family Caregivers of the Patients in Need of Palliative Care participating in this study.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e\u003cstrong\u003eAssessing the development of palliative care worldwide: a set of actionable indicators \u003c/strong\u003e[https://www.who.int/publications/i/item/9789240033351]\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eQuality health services and palliative care: practical approaches and resources to support policy, strategy and practice \u003c/strong\u003e[https://www.who.int/publications/i/item/9789240035164]\u003c/li\u003e\n\u003cli\u003eWorld Health Organization: \u003cstrong\u003eGlobal Atlas of Palliative Care\u003c/strong\u003e, 2nd Edition edn. 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Therefore, this study was conducted with the aim of performing a psychometric evaluation of the \u003cem\u003eCaring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale\u003c/em\u003e (CAFCPNPCS).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e The present study is methodological research that evaluates the psychometric characteristics of the CAFCPNPCS by measuring face validity, content validity, construct validity (confirmatory factor analysis and divergent validity) and internal consistency in 412 family caregivers of the patients in need of palliative care, who were selected through convenient sampling. The data were analyzed using SPSS 24 and LISREL 8.8.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAccording to the confirmatory factor analysis, the 5-factor model with 31 items was confirmed with the values RMSEA\u0026thinsp;=\u0026thinsp;0.05, CFI\u0026thinsp;=\u0026thinsp;0.95 and GFI\u0026thinsp;=\u0026thinsp;0.88. The divergent validity was measured by estimation of correlation between the caring ability score with care burden score (which was measured by Zarit Burden Interview) of the family caregivers of the patients in need of palliative care. Cronbach's alpha (α) was reported to be 0.846 for the whole scale and 0.781\u0026ndash;0.852 for other dimensions.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eCAFCPNPCS is a valid and reliable tool that can evaluate the caring ability of the family caregivers of the patients in need of palliative care. Based on the results, it is recommended to utilize this scale to determine these caregivers\u0026rsquo; ability in providing care and to examine the effectiveness of interventions with the aim of improving the dimensions of their caring ability.\u003c/p\u003e","manuscriptTitle":"Psychometric Evaluation of the Caring Ability of the Family Caregivers of the Patients in Need of Palliative Care Scale (CAFCPNPCS): A Methodological Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-01-02 19:50:46","doi":"10.21203/rs.3.rs-3796351/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b7325ba2-ce86-459b-8fb0-c5aed1f84547","owner":[],"postedDate":"January 2nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-05-01T23:56:34+00:00","versionOfRecord":{"articleIdentity":"rs-3796351","link":"https://doi.org/10.18502/npt.v11i2.15412","journal":{"identity":"nursing-practice-today","isVorOnly":true,"title":"Nursing Practice Today"},"publishedOn":"2024-04-30 23:56:34","publishedOnDateReadable":"April 30th, 2024"},"versionCreatedAt":"2024-01-02 19:50:46","video":"","vorDoi":"10.18502/npt.v11i2.15412","vorDoiUrl":"https://doi.org/10.18502/npt.v11i2.15412","workflowStages":[]},"version":"v1","identity":"rs-3796351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3796351","identity":"rs-3796351","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}