Development of a disease risk perception assessment tool for first-degree relatives of patients with esophageal cancer in China: A study based on the modified Delphi method

Development of a disease risk perception assessment tool for first-degree relatives of patients with esophageal cancer in China: A study based on the modified Delphi method | 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 Development of a disease risk perception assessment tool for first-degree relatives of patients with esophageal cancer in China: A study based on the modified Delphi method Yan He, Xu Wang, Hong Yang, Yaya Wu, Yongbo Yang, Liang Dai, Shaohua Ma This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6132977/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : There remains a lack of specific instruments tailored to assess disease risk perception among first-degree relatives of patients with esophageal cancer. Therefore, this study aimed to develop an assessment tool for disease risk perception among first-degree relatives of patients with esophageal cancer in China. Methods : Using the framework of disease risk perception attitudes, we conducted a literature review, facilitated discussions within a research group, and employed the Delphi expert consultation method to screen items and quantify the dimensions and components of risk perception. A preliminary assessment tool was constructed to evaluate disease risk perception among first-degree relatives of patients with esophageal cancer. From November to December 2024, a two-round questionnaire survey was administered to 20 experts in China using the Delphi method. The enthusiasm, authority, concentration, and consensus of opinions among experts were evaluated; additionally, the Analytic Hierarchy Process was used to determine the item weights. Results : The response rates for both rounds of expert consultation questionnaires were 100%, with an expert authority coefficient of 0.938. Kendall's concordance coefficients for the two rounds were 0.303 and 0.438, respectively (P < 0.001). The final assessment tool comprised two dimensions and twenty-six items designed to evaluate disease risk perception among first-degree relatives of patients with esophageal cancer. Conclusions : The developed assessment tool demonstrated significant scientific rigor and practical applicability in evaluating disease risk perception among first-degree relatives of patients with esophageal cancer, thereby providing a reference standard for implementing interventions to mitigate disease risks. Risk assessment tool Esophageal cancer First-degree relatives Delphi method Analytic Hierarchy Process Background Esophageal cancer is a common malignant tumor. According to the 2022 Global Cancer Statistics, approximately 511,000 new cases and 445,000 deaths from esophageal cancer occur worldwide, ranking it as the 11th most common malignancy and the 7th leading cause of cancer-related mortality among all cancers [ 1 ]. In China, the annual incidence of esophageal cancer is reported to be approximately 224,000 cases, positioning it as the 7th most common malignancy. Concurrently, the annual mortality is approximately 187,500 cases, making it the 5th leading cause of death from malignant tumors [ 2 ]. The 5-year survival rate for patients with esophageal cancer remains below 30% in many countries [ 3 ]. Despite advancements in diagnostic and therapeutic techniques over the past decade, which have increased survival rates among Chinese patients—now ranging from 20.9–30.3% [ 4 ] —the aggressive nature of esophageal cancer contributes to poor prognosis for affected patients [ 5 ], with a significant proportion being diagnosed at advanced stages. This imposes a substantial burden on public health. Research conducted by He et al. indicated that only approximately 17.00% of patients with esophageal cancer in China were diagnosed at stage I; conversely, those diagnosed at stages II, III, and IV accounted for approximately 32.42%, 30.27%, and 20.31%, respectively [ 6 ]. This late-stage diagnosis can be attributed to several factors, including low awareness of early symptoms among high-risk populations, inadequate perception of disease risk, delays in seeking medical attention, and negative health beliefs—all of which contribute to suboptimal early detection rates for esophageal cancer [ 7 – 9 ]. Late diagnosis adversely affects patient survival rates, resulting in poorer treatment outcomes and higher healthcare costs [ 10 , 11 ]. Family history is a significant risk factor for the development of esophageal cancer. Individuals with a family history of upper gastrointestinal cancers face an increased risk—specifically, up to a 45% increase—of developing this condition [ 12 ]. First-degree relatives (including parents, siblings, and children) of patients with esophageal cancer represent particularly high-risk groups; their likelihood of developing this malignancy is twice that of other high-risk populations. Furthermore, having two or more first-degree relatives with a history of esophageal cancer nearly triples one’s own risk; if both parents have been previously diagnosed with this disease, an individual’s risk may increase almost eight-fold [ 13 ]. Consequently, the guidelines established by the Medical Emergency Department under China's National Health Commission regarding screening protocols for early diagnosis and treatment (2024 Edition) explicitly categorize first-degree relatives of patients with esophageal cancer within high-risk population management frameworks, necessitating regular screening and monitoring efforts [ 11 ]. Xie et al. indicated that risk perception encompasses an individual's awareness and understanding of various objective risks in the external environment, highlighting the influence of experiences derived from intuitive judgments and subjective feelings on cognition [ 14 ]. Currently, multiple factors affect cancer prevention, with cancer risk perception serving as a critical component [ 15 ]. Accurate risk perception is essential for high-risk populations because it enables them to assess their cancer risk objectively and encourages them to engage in health-promoting behaviors [ 16 ]. Research has demonstrated that enhancing disease perception among high-risk groups for esophageal cancer is crucial for improving early screening practices [ 12 ]. Consequently, increasing the risk perception of individuals at high risk for esophageal cancer constitutes a key strategy in preventive efforts. Risk perception assessment tools have been extensively used across various high-risk populations, including those affected by epidemics [ 17 ], patients with diabetes [ 18 ], stroke survivors [ 19 ], and first-degree relatives of patients with rectal cancer [ 20 ]. However, there remains a lack of specific instruments tailored to assess disease risk perception among first-degree relatives of patients with esophageal cancer. This study aimed to develop a disease risk perception assessment tool specifically designed for this population, based on the Risk Perception Attitude (RPA) framework [ 21 , 22 ] using methodologies such as the Delphi method and the Analytic Hierarchy Process (AHP). The goal was to evaluate these individuals’ ability to perceive disease-related risks and to provide foundational reference points for assessing intervention effectiveness regarding preventive measures aimed at this demographic. Methods Development of the initial entry pool Using a literature analysis method, we conducted a comprehensive search for relevant studies concerning disease risk perception among first-degree relatives of patients with esophageal cancer across several databases, including the Wanfang Database, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, PubMed, Web of Science, Ovid, Elsevier, and SpringerLink. The timeframe for this search extended from the establishment date of each electronic database to September 2024. The Chinese and English keywords used were “esophagus cancer,” “esophageal cancer,” “Esophageal neoplasms,” as well as “risk perception,” “disease risk perception,” “family history,” and “first-degree relatives.” Subject headings and free-text terms were used in our searches; free-text searches were restricted to titles and abstracts. Through systematic data analysis and discussions among research team members, we identified the RPA framework [ 21 , 22 ] as a foundational model for developing an assessment tool to evaluate disease risk perception among first-degree relatives of patients with esophageal cancer. This preliminary framework encompassed five dimensions: perceived susceptibility, perceived risk factors associated with the disease, perceived warning symptoms related to the condition, perceived control over the risks involved, and perceived severity of the disease—resulting in a total of 42 items. Development of an index system using the Delphi method Selection by experts In accordance with the Delphi expert consultation method, the criteria for selecting consulted experts were as follows: (1) a minimum of 10 years of experience in clinical medicine or nursing related to esophageal cancer, nursing management, oncological psychology, social medicine, or health service management; (2) possession of at least a bachelor's degree or an equivalent qualification, such as a deputy senior technical title; and (3) willingness to voluntarily participate in this research study. Compilation of the expert letter questionnaire The expert consultation questionnaire was designed independently. Following a comprehensive literature review and collaborative discussions among the research team, the initial version of the expert consultation questionnaire was developed. The questionnaire consists of three sections: (1) A letter to experts: This section provides an overview of the study's background, objectives, and specific instructions for completion and emphasizes the significance of expert opinions in this research. (2) An expert information form: This includes basic personal information about the experts, an assessment of their familiarity with the study, and inquiries regarding their judgment criteria. (3) The main body of the questionnaire features a consultation form to assess disease risk perception among first-degree relatives of patients with esophageal cancer, along with items evaluating the importance of these assessment tools. A 5-point Likert scale is used for rating responses, where “very important” corresponds to a score of 5 and “not important” corresponds to a score of 1. Additionally, a comments section was provided for the experts to offer suggestions concerning modifications or adjustments to the indicators presented in the questionnaire (Additional Files 1 and 2). Distribution of the letter questionnaire and selection of items Before the implementation of expert consultation, the objectives and significance of this study were communicated to the experts, and informed consent was obtained. The expert consultation questionnaire was subsequently distributed to experts via WeChat in Word format. The research team administered and collected questionnaires from November to December 2024. On the basis of the statistical analyses and expert feedback, modifications were made to these items. For the initial round of results, item selection was conducted using the mean importance scores alongside the coefficients of variation. The inclusion criteria stipulated that the mean importance score must exceed 3.5 and that the coefficient of variation remains below 0.25 [ 23 ]. In instances where these conditions were not fully satisfied, items were removed on the basis of expert opinions following discussions within the research team. A revised version of the expert consultation questionnaire was developed and redistributed to experts. Following collection, a statistical analysis was performed, and data collection concluded when consensus among experts regarding their opinions was achieved. Data analysis Data analysis was performed using Statistical Package for the Social Sciences (SPSS) (version 29.0) and Excel version 16.92 software. Descriptive statistics for the experts' basic information were obtained using case numbers and composition ratios. The recovery rate of the expert questionnaire was used to evaluate expert engagement, and the authority coefficient (Cr) represented the level of expertise among the participants. The Cr is determined by two factors: familiarity degree and judgment basis. Importance scores for each item were statistically described using means ± standard deviations. Kendall's coefficient of concordance was used to assess the degree of agreement among expert opinions, with mean importance scores and full score rates reflecting the concentration of these opinions. SPSS AU software was used to determine item weights based on the AHP. A consistency coefficient below 0.1 indicated that the judgment matrix satisfied the consistency criteria, ensuring the calculated item weights were reliable. Statistical significance was set at a P value less than 0.05. Results Characteristics of the experts Twenty experts from China engaged in two rounds of correspondence consultations. More information about the demographics of the experts is available in Table 1 . Table 1 Characteristics of expert panelists (n = 23) Categories Characteristics Number Percentage (%) Sex male 4 20.00 female 16 80.00 Age 30–40 5 25.00 42–50 14 70.00 51–60 1 5.00 Professional years 1–10 1 5.00 11–20 8 40.00 21–30 11 55.00 Types of expertise Nursing 15 75.00 Clinical 3 15.00 psychology 1 5.00 Social medicine and health service administration 1 5.00 Professional title Intermediate 5 25.00 Deputy Senior 10 50.00 Senior 5 25.00 Educational attainment Doctor’s degree 9 45.00 Master’s degree 8 40.00 Bachelor’s degree 3 15.00 Expert positive coefficient and expert authority coefficient The effective response rates for both rounds of the expert questionnaires were 100%. In the first round of expert consultation, the opinion contribution rate was 65%, whereas in the second round, it decreased to 15%, indicating a high level of engagement among the experts. The authority coefficient of the consulted experts was 0.938, reflecting their substantial expertise and authority in the research domain. Concentration of expert opinions Kendall’s coefficient of concordance for the two rounds of expert consultation was found to be 0.303 and 0.438, respectively, indicating a statistically significant difference (χ2 = 278.831, P < 0.001; χ2 = 236.751, P < 0.001). Degree of coordination of expert opinions The mean importance scores obtained from the first round of expert consultation varied between 3.25–5.00, whereas those from the second round ranged from 4.25–5.00. The full score rates for expert consultation ranged between 10.00–100.00% in the first round and 25.00–100.00% in the second round, with standard deviations ranging between 0.00–1.40% in the first round and 0.00–0.51 in the second round. Results of expert consultation Following the initial round of expert consultations, the research team systematically organized and analyzed the feedback received. By integrating the statistical results with expert opinions, it became apparent that certain items within the assessment tool exhibited significant overlap and redundancy, leading to excessive items. To enhance patient response efficiency and account for the characteristics of the item measurement content, this dimension was consolidated into two categories: perceived susceptibility and perceived severity. Consequently, six items were eliminated, eight new items were introduced, and eighteen items were removed during this process. After these modifications in the first round, 26 items remained unchanged. In the second round of consultations, there was a notable reduction in the feedback volume from experts; most comments pertained to issues related to language expression. Over time, the experts’ perspectives on the questionnaire items aligned more closely. Ultimately, this led to the development of a disease risk perception assessment tool specifically designed for Chinese patients with esophageal cancer and their relatives, comprising two dimensions and 26 items (Additional File 3). Weight consistency test results The consistency index (CI) of the second-order judgment matrix derived from the dimensions of perceived disease susceptibility and perceived disease severity was 0.000, with a corresponding random index (RI) of 0.000. Given that these data represent a second-order matrix (with RI = 0, rendering it impossible to calculate the consistency ratio [CR]), all second-order data fulfilled the consistency test; therefore, the final calculated weights demonstrated internal consistency. Regarding perceived disease susceptibility, the CI obtained from the tenth-order judgment matrix was 0.000, accompanied by an associated RI of 1.490. Consequently, the computed CR was determined to be 0.000 (CR < 0.1), indicating that this judgment matrix meets the established criteria for consistency and that its calculated weights are reliable. Similarly, regarding perceived disease severity, the CI for the sixteenth-order judgment matrix was again found to be 0.000, with a corresponding RI of 1.594; therefore, we obtained a CR value of 0.000 (CR < 0.1). This confirms that the judgment matrix satisfies the consistency requirements and yields consistent weighted values (Table 2 ). Table 2 Item importance, coefficient of variation, and weight value Item Weight value Vector of features Maximum eigenvalue CI 1. Perceived disease susceptibility. 0.529 1.058 2.000 0.000 1.1 Having an immediate family member with esophageal cancer increases the risk of developing esophageal cancer. 0.107 1.066 10.000 0.000 1.2 The risk of developing esophageal cancer increases with age. 0.092 0.017 1.3 Having an esophageal condition (such as chronic esophagitis, esophageal intraepithelial neoplasia, Barrett's esophagus, etc.) increases the risk of developing esophageal cancer. 0.094 0.938 1.4 Poor oral hygiene or having oral disease can increase the risk of developing esophageal cancer. 0.107 1.066 1.5 Alcohol consumption increases the risk of developing esophageal cancer. 0.107 1.066 1.6 Smoking increases the risk of esophageal cancer. 0.098 0.981 1.7 Long-term unreasonable diet (such as consumption of pickled food, hot food, etc.) can increase the risk of esophageal cancer. 0.093 0.928 1.8 Long-term poor eating habits (such as eating too fast, eating irregularly, etc.) increase the risk of developing esophageal cancer. 0.107 1.066 1.9 Living in a poor living environment (exposure to chemical pollutants, radiation, etc.) can increase the risk of developing esophageal cancer. 0.001 0.906 1.10 Long-term residence in an area with a high incidence of esophageal cancer increases the risk of developing esophageal cancer. 0.107 1.066 2. Perceive the severity of illness. 0.471 0.942 2.000 0.000 2.1 Esophageal cancer is a serious disease. 0.066 1.057 16.000 0.000 2.2 Esophageal cancer can present with the sensation of a foreign body or stagnation in the esophagus. 0.058 0.930 2.3 Esophageal cancer can present with progressive difficulty in swallowing. 0.059 0.941 2.4 Esophageal cancer may be accompanied by gastrointestinal symptoms such as belching and reflux. 0.066 1.057 2.5 Esophageal cancer can present with pain in the retrosternal or interscapular region. 0.066 1.057 2.6 Esophageal cancer can cause malnutrition and weight loss. 0.059 0.951 2.7 Esophageal cancer carries a risk of metastasis and spread. 0.066 1.057 2.8 Esophageal cancer carries a risk of recurrence. 0.059 0.951 2.9 Multiple complications may occur during the treatment of esophageal cancer. 0.057 0.909 2.10 Delayed treatment of esophageal cancer is associated with poor efficacy. 0.066 1.057 2.11 The treatment of esophageal cancer can cause physical discomfort. 0.061 0.972 2.12 Esophageal cancer can lead to a decreased quality of life. 0.066 1.057 2.13 Esophageal cancer can lead to reduced social participation. 0.058 0.930 2.14 Esophageal cancer can interfere with taking on original family responsibilities. 0.066 1.057 2.15 Treatment of esophageal cancer can cause a financial burden to the family. 0.066 1.057 2.16 A diagnosis of esophageal cancer can place a psychological burden on family members. 0.060 0.962 CI, Consistency Index; CV, coefficient of variation [Table 2 near here] Discussion The necessity of developing assessment tools Numerous scholars have developed a range of universal and specific scales to assess risk perception levels among populations at a high risk of cancer. However, while universal scales [ 24 , 25 ] are applicable across diverse demographics, they often lack the precision needed to accurately evaluate individuals’ perceptions of disease risk. Existing assessment tools primarily concentrate on patients with colorectal and breast cancer [ 26 – 28 ]. In the context of esophageal cancer, particularly regarding disease risk perception assessments for first-degree relatives of patients with esophageal cancer, a significant gap persists in developing a scientifically validated, comprehensive, and effective evaluation system. Research indicates that inaccuracies in risk perception can lead to psychological symptoms, and underestimating cancer risk may foster an optimistic bias that results in missed opportunities to use genetic counseling and chemoprevention strategies aimed at reducing such risks. Conversely, overestimating these risks may provoke excessive concern and anxiety, potentially leading to unnecessary preventive measures and screening behaviors [ 29 , 30 ]. Therefore, it is imperative to select scientific and reliable tools to accurately assess the level of cancer risk perception among high-risk groups to effectively understand their current status regarding perceived cancer risks. The scientific rigor in the development of assessment tools This study's construction of research indicators is firmly rooted in the theoretical framework of risk perception attitudes, which conceptualizes risk perception as a two-dimensional motivational factor encompassing perceived susceptibility and severity [ 21 , 22 ]. Moreover, this motivation must be accompanied by strong efficacy beliefs that encourage individuals to undertake measures aimed at mitigating threats. This theoretical approach facilitates an understanding of how individuals perceive risks, process risk-related information, make decisions, and implement changes in health behaviors [ 22 , 31 ]. Zhang et al. developed a scale for assessing the risk perception of sarcopenia among older adults based on the disease RPA ramework and health belief model [ 32 ]. Similarly, Yang et al. created a fall risk perception scale for patients with Parkinson's disease, using both the disease RPA framework and active health theory [ 33 ]. The item pool serves as the foundation for developing assessment tool items, and expert consultation is essential to enhance item reliability [ 34 ]. The development of the assessment tool in this study comprised two primary stages: constructing an item pool and conducting expert consultations. The entire process was executed rigorously and systematically to maximize the rationality of the assessment tool development. The experts held educational qualifications ranging from bachelor's degrees to doctoral degrees, with 95% possessing over 10 years of professional experience, indicating their substantial theoretical knowledge and practical expertise. In terms of data collection efficiency, both rounds of questionnaires achieved a 100% effective response rate, with all experts returning their responses within 1 week, reflecting their high engagement in this research endeavor. The authority coefficient among the consulted experts was 0.938, signifying considerable authority within this field of study. Regarding the consensus levels among expert opinions during consultations, the Kendall coefficients were 0.303 for round one and 0.438 for round two. Additionally, mean importance ratings assigned by experts during round one ranged from 3.25–5.00 points, whereas those from round two ranged from 4.25–5.00 points. The specificity and clinical applicability of assessment tools The assessment tool developed in this study encompasses two critical dimensions of disease risk perception regarding esophageal cancer among first-degree relatives: understanding disease susceptibility and severity. The items related to perceived susceptibility included high-risk factors specific to esophageal cancer, whereas the section addressing perceived severity incorporated common early clinical symptoms associated with the disease and its adverse impacts on society, family dynamics, and individual well-being. This tool facilitates a comprehensive evaluation of disease risk perception characteristics among first-degree relatives of patients with esophageal cancer, providing an integrated consideration of both susceptibility and severity. The selection of an appropriate assessment instrument not only aids high-risk individuals in gaining a clearer understanding of their health status—thereby enhancing their proactive engagement and self-management capabilities in preventing esophageal cancer—but also enables healthcare professionals to assess risk perception levels among first-degree relatives effectively. This insight will allow the development of targeted prevention strategies and more precise and holistic management measures for esophageal cancer prevention. Ultimately, these efforts may contribute to reducing both the incidence and mortality rates of this malignancy, thus yielding positive implications for public health. Nevertheless, this study has some limitations. First, it involved consultations with only 20 experts from China; thus, generalizability may be limited because of the exclusion of perspectives from potential experts in other regions. Second, despite striving for clarity in item formulation within the assessment tool, some items may still lack sufficient accessibility due to constraints related to expression accuracy. Therefore, further validation through large-scale multicenter studies is necessary to establish the reliability and validity of this assessment tool and enhance its applicability in broader contexts. Conclusions This study developed a tool to assess disease risk perception for first-degree relatives of patients with esophageal cancer in China, employing a comprehensive methodology that included a literature review, research group discussions, Delphi expert consultations, and the AHP. The tool encompasses two dimensions: perceived disease susceptibility and perceived disease severity, comprising 26 items. The methodology employed demonstrated scientific rigor, whereas the indicators within the tool exhibited relevance and clinical applicability. This assessment instrument serves as a valuable resource for evaluating disease risk perception among first-degree relatives of patients with esophageal cancer. Its implications are for designing early screening programs and intervention strategies targeted at populations at high risk of esophageal cancer. Abbreviations AHP Analytic Hierarchy Process Cr Expert Authority Coefficient CI Consistency Index CR Consistency Ratio RI Random Index RPA Risk Perception Attitude SPSS Statistical Package for the Social Sciences Declarations Ethics approval and consent to participate : This study was approved by the Ethics Committee of the Beijing Cancer Hospital (No. 2024KT196), and verbal informed consent was obtained from all subjects. Consent for publication : Not applicable. Availability of data and materials : All data generated or analyzed during this study are included in this published article. Competing interests : The authors declare that they have no competing interests. Funding : This research was funded the Beijing Research Ward Excellence Program, BRWEP (BRWEP2024W032150100 and BRWEP2024W032150116); the efficacy and safety of slulizumab in the perioperative treatment of locally advanced resectable thoracic esophageal squamous cell carcinoma (CPS ≥10): a prospective, single-arm, phase Ⅱ clinical trial (2023YJZ64). The funders had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript. Authors' contributions : Yan He and Xu Wang drafted and critically revised the manuscript for important intellectual content. Hong Yang, Yaya Wu and Yongbo Yang: Data collection and evaluation. Liang Dai and Shaohua Ma: Study design and conception. All authors read and approved the final manuscript. Acknowledgements : We thank all the experts who participated in our Delphi study for sharing their time and expertise. References Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. 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Front Psychol. 2024;15:1289067. Yan J, Ning S, Shufang Z. Chinese. J Nurs Educ. 2005;2:174–6. Additional Declarations No competing interests reported. Supplementary Files AdditionalFile1.docx File name: Additional File 1 File format: .docx Title of data: Expert consultation form for assessing esophageal cancer risk perception among first-degree relatives of patients. Description of data: The First Round of Expert Consultation Questionnaire AdditionalFile2.docx File name: Additional File 2 File format: .docx Title of data: Expert inquiry questionnaire on perceived risk of esophageal cancer for first-degree relatives of patients. Description of data: The Second Round of Expert Consultation Questionnaire AdditionalFile3.docx File name: Additional File 3 File format: .docx Title of data: Table S1. Results of the first of expert consultation on the proposed items and Table S2. Results of the second of expert consultation on the proposed items Description of data: The results of two rounds of expert consultation by letter Cite Share Download PDF Status: Posted 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. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-6132977","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":447558480,"identity":"87f9b182-8921-457b-a0bb-3f06b9e170b5","order_by":0,"name":"Yan He","email":"","orcid":"","institution":"Peking University Cancer Hospital \u0026 Institute","correspondingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"He","suffix":""},{"id":447558481,"identity":"47a41634-246b-40d8-b144-2ac92bd98a4a","order_by":1,"name":"Xu Wang","email":"","orcid":"","institution":"Peking University Cancer Hospital \u0026 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09:42:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":905870,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6132977/v1/36f6ec0f-6d2c-484e-9702-230cca1babf7.pdf"},{"id":81623250,"identity":"62f69ced-7ed4-462c-832d-534a48adf7da","added_by":"auto","created_at":"2025-04-29 09:43:33","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":37930,"visible":true,"origin":"","legend":"\u003cp\u003eFile name: Additional File 1\u003c/p\u003e\n\u003cp\u003eFile format: .docx\u003c/p\u003e\n\u003cp\u003eTitle of data: Expert consultation form for assessing esophageal cancer risk perception among first-degree relatives of patients.\u003c/p\u003e\n\u003cp\u003eDescription of data: The First Round of Expert Consultation Questionnaire\u003c/p\u003e","description":"","filename":"AdditionalFile1.docx","url":"https://assets-eu.researchsquare.com/files/rs-6132977/v1/22588e7db156b37daa18aeea.docx"},{"id":81623246,"identity":"d867150a-726e-4bbe-b82f-9ee213ee1751","added_by":"auto","created_at":"2025-04-29 09:43:33","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":29447,"visible":true,"origin":"","legend":"\u003cp\u003eFile name: Additional File 2\u003c/p\u003e\n\u003cp\u003eFile format: .docx\u003c/p\u003e\n\u003cp\u003eTitle of data: Expert inquiry questionnaire on perceived risk of esophageal cancer for first-degree relatives of patients.\u003c/p\u003e\n\u003cp\u003eDescription of data: The Second Round of Expert Consultation Questionnaire\u003c/p\u003e","description":"","filename":"AdditionalFile2.docx","url":"https://assets-eu.researchsquare.com/files/rs-6132977/v1/75d07defaa5508eee2186a1c.docx"},{"id":81623520,"identity":"b81a5e4d-669e-4766-afbb-f7a5f7ca5279","added_by":"auto","created_at":"2025-04-29 09:51:33","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":45214,"visible":true,"origin":"","legend":"\u003cp\u003eFile name: Additional File 3\u003c/p\u003e\n\u003cp\u003eFile format: .docx\u003c/p\u003e\n\u003cp\u003eTitle of data: Table S1. Results of the first of expert consultation on the proposed items and Table S2. Results of the second of expert consultation on the proposed items\u003c/p\u003e\n\u003cp\u003eDescription of data: The results of two rounds of expert consultation by letter\u003c/p\u003e","description":"","filename":"AdditionalFile3.docx","url":"https://assets-eu.researchsquare.com/files/rs-6132977/v1/b10fb6a96f1580f1a38f7df4.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of a disease risk perception assessment tool for first-degree relatives of patients with esophageal cancer in China: A study based on the modified Delphi method","fulltext":[{"header":"Background","content":"\u003cp\u003eEsophageal cancer is a common malignant tumor. According to the 2022 Global Cancer Statistics, approximately 511,000 new cases and 445,000 deaths from esophageal cancer occur worldwide, ranking it as the 11th most common malignancy and the 7th leading cause of cancer-related mortality among all cancers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In China, the annual incidence of esophageal cancer is reported to be approximately 224,000 cases, positioning it as the 7th most common malignancy. Concurrently, the annual mortality is approximately 187,500 cases, making it the 5th leading cause of death from malignant tumors [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The 5-year survival rate for patients with esophageal cancer remains below 30% in many countries [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Despite advancements in diagnostic and therapeutic techniques over the past decade, which have increased survival rates among Chinese patients\u0026mdash;now ranging from 20.9\u0026ndash;30.3% [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] \u0026mdash;the aggressive nature of esophageal cancer contributes to poor prognosis for affected patients [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], with a significant proportion being diagnosed at advanced stages. This imposes a substantial burden on public health. Research conducted by He et al. indicated that only approximately 17.00% of patients with esophageal cancer in China were diagnosed at stage I; conversely, those diagnosed at stages II, III, and IV accounted for approximately 32.42%, 30.27%, and 20.31%, respectively [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This late-stage diagnosis can be attributed to several factors, including low awareness of early symptoms among high-risk populations, inadequate perception of disease risk, delays in seeking medical attention, and negative health beliefs\u0026mdash;all of which contribute to suboptimal early detection rates for esophageal cancer [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Late diagnosis adversely affects patient survival rates, resulting in poorer treatment outcomes and higher healthcare costs [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFamily history is a significant risk factor for the development of esophageal cancer. Individuals with a family history of upper gastrointestinal cancers face an increased risk\u0026mdash;specifically, up to a 45% increase\u0026mdash;of developing this condition [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. First-degree relatives (including parents, siblings, and children) of patients with esophageal cancer represent particularly high-risk groups; their likelihood of developing this malignancy is twice that of other high-risk populations. Furthermore, having two or more first-degree relatives with a history of esophageal cancer nearly triples one\u0026rsquo;s own risk; if both parents have been previously diagnosed with this disease, an individual\u0026rsquo;s risk may increase almost eight-fold [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Consequently, the guidelines established by the Medical Emergency Department under China's National Health Commission regarding screening protocols for early diagnosis and treatment (2024 Edition) explicitly categorize first-degree relatives of patients with esophageal cancer within high-risk population management frameworks, necessitating regular screening and monitoring efforts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eXie et al. indicated that risk perception encompasses an individual's awareness and understanding of various objective risks in the external environment, highlighting the influence of experiences derived from intuitive judgments and subjective feelings on cognition [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Currently, multiple factors affect cancer prevention, with cancer risk perception serving as a critical component [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Accurate risk perception is essential for high-risk populations because it enables them to assess their cancer risk objectively and encourages them to engage in health-promoting behaviors [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Research has demonstrated that enhancing disease perception among high-risk groups for esophageal cancer is crucial for improving early screening practices [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Consequently, increasing the risk perception of individuals at high risk for esophageal cancer constitutes a key strategy in preventive efforts. Risk perception assessment tools have been extensively used across various high-risk populations, including those affected by epidemics [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], patients with diabetes [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], stroke survivors [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], and first-degree relatives of patients with rectal cancer [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, there remains a lack of specific instruments tailored to assess disease risk perception among first-degree relatives of patients with esophageal cancer. This study aimed to develop a disease risk perception assessment tool specifically designed for this population, based on the Risk Perception Attitude (RPA) framework [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] using methodologies such as the Delphi method and the Analytic Hierarchy Process (AHP). The goal was to evaluate these individuals\u0026rsquo; ability to perceive disease-related risks and to provide foundational reference points for assessing intervention effectiveness regarding preventive measures aimed at this demographic.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment of the initial entry pool\u003c/h2\u003e \u003cp\u003e Using a literature analysis method, we conducted a comprehensive search for relevant studies concerning disease risk perception among first-degree relatives of patients with esophageal cancer across several databases, including the Wanfang Database, China National Knowledge Infrastructure, China Biomedical Literature Database, VIP Database, PubMed, Web of Science, Ovid, Elsevier, and SpringerLink. The timeframe for this search extended from the establishment date of each electronic database to September 2024. The Chinese and English keywords used were \u0026ldquo;esophagus cancer,\u0026rdquo; \u0026ldquo;esophageal cancer,\u0026rdquo; \u0026ldquo;Esophageal neoplasms,\u0026rdquo; as well as \u0026ldquo;risk perception,\u0026rdquo; \u0026ldquo;disease risk perception,\u0026rdquo; \u0026ldquo;family history,\u0026rdquo; and \u0026ldquo;first-degree relatives.\u0026rdquo; Subject headings and free-text terms were used in our searches; free-text searches were restricted to titles and abstracts. Through systematic data analysis and discussions among research team members, we identified the RPA framework [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] as a foundational model for developing an assessment tool to evaluate disease risk perception among first-degree relatives of patients with esophageal cancer. This preliminary framework encompassed five dimensions: perceived susceptibility, perceived risk factors associated with the disease, perceived warning symptoms related to the condition, perceived control over the risks involved, and perceived severity of the disease\u0026mdash;resulting in a total of 42 items.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eDevelopment of an index system using the Delphi method\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSelection by experts\u003c/h2\u003e \u003cp\u003eIn accordance with the Delphi expert consultation method, the criteria for selecting consulted experts were as follows: (1) a minimum of 10 years of experience in clinical medicine or nursing related to esophageal cancer, nursing management, oncological psychology, social medicine, or health service management; (2) possession of at least a bachelor's degree or an equivalent qualification, such as a deputy senior technical title; and (3) willingness to voluntarily participate in this research study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eCompilation of the expert letter questionnaire\u003c/h3\u003e\n\u003cp\u003eThe expert consultation questionnaire was designed independently. Following a comprehensive literature review and collaborative discussions among the research team, the initial version of the expert consultation questionnaire was developed. The questionnaire consists of three sections: (1) A letter to experts: This section provides an overview of the study's background, objectives, and specific instructions for completion and emphasizes the significance of expert opinions in this research. (2) An expert information form: This includes basic personal information about the experts, an assessment of their familiarity with the study, and inquiries regarding their judgment criteria. (3) The main body of the questionnaire features a consultation form to assess disease risk perception among first-degree relatives of patients with esophageal cancer, along with items evaluating the importance of these assessment tools. A 5-point Likert scale is used for rating responses, where \u0026ldquo;very important\u0026rdquo; corresponds to a score of 5 and \u0026ldquo;not important\u0026rdquo; corresponds to a score of 1. Additionally, a comments section was provided for the experts to offer suggestions concerning modifications or adjustments to the indicators presented in the questionnaire (Additional Files 1 and 2).\u003c/p\u003e\n\u003ch3\u003eDistribution of the letter questionnaire and selection of items\u003c/h3\u003e\n\u003cp\u003eBefore the implementation of expert consultation, the objectives and significance of this study were communicated to the experts, and informed consent was obtained. The expert consultation questionnaire was subsequently distributed to experts via WeChat in Word format. The research team administered and collected questionnaires from November to December 2024. On the basis of the statistical analyses and expert feedback, modifications were made to these items. For the initial round of results, item selection was conducted using the mean importance scores alongside the coefficients of variation. The inclusion criteria stipulated that the mean importance score must exceed 3.5 and that the coefficient of variation remains below 0.25 [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In instances where these conditions were not fully satisfied, items were removed on the basis of expert opinions following discussions within the research team. A revised version of the expert consultation questionnaire was developed and redistributed to experts. Following collection, a statistical analysis was performed, and data collection concluded when consensus among experts regarding their opinions was achieved.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData analysis was performed using Statistical Package for the Social Sciences\u003c/p\u003e \u003cp\u003e(SPSS) (version 29.0) and Excel version 16.92 software. Descriptive statistics for the experts' basic information were obtained using case numbers and composition ratios. The recovery rate of the expert questionnaire was used to evaluate expert engagement, and the authority coefficient (Cr) represented the level of expertise among the participants. The Cr is determined by two factors: familiarity degree and judgment basis. Importance scores for each item were statistically described using means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations. Kendall's coefficient of concordance was used to assess the degree of agreement among expert opinions, with mean importance scores and full score rates reflecting the concentration of these opinions. SPSS AU software was used to determine item weights based on the AHP. A consistency coefficient below 0.1 indicated that the judgment matrix satisfied the consistency criteria, ensuring the calculated item weights were reliable. Statistical significance was set at a P value less than 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eCharacteristics of the experts\u003c/h2\u003e \u003cp\u003eTwenty experts from China engaged in two rounds of correspondence consultations. More information about the demographics of the experts is available 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\u003eCharacteristics of expert panelists (n\u0026thinsp;=\u0026thinsp;23)\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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\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\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\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\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTypes of expertise\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNursing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e75.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClinical\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003epsychology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial medicine and health service administration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional title\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntermediate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDeputy Senior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSenior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducational attainment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDoctor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMaster\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBachelor\u0026rsquo;s degree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.00\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eExpert positive coefficient and expert authority coefficient\u003c/h2\u003e \u003cp\u003eThe effective response rates for both rounds of the expert questionnaires were 100%. In the first round of expert consultation, the opinion contribution rate was 65%, whereas in the second round, it decreased to 15%, indicating a high level of engagement among the experts. The authority coefficient of the consulted experts was 0.938, reflecting their substantial expertise and authority in the research domain.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eConcentration of expert opinions\u003c/h2\u003e \u003cp\u003eKendall\u0026rsquo;s coefficient of concordance for the two rounds of expert consultation was found to be 0.303 and 0.438, respectively, indicating a statistically significant difference (χ2\u0026thinsp;=\u0026thinsp;278.831, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001; χ2\u0026thinsp;=\u0026thinsp;236.751, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eDegree of coordination of expert opinions\u003c/h2\u003e \u003cp\u003eThe mean importance scores obtained from the first round of expert consultation varied between 3.25\u0026ndash;5.00, whereas those from the second round ranged from 4.25\u0026ndash;5.00. The full score rates for expert consultation ranged between 10.00\u0026ndash;100.00% in the first round and 25.00\u0026ndash;100.00% in the second round, with standard deviations ranging between 0.00\u0026ndash;1.40% in the first round and 0.00\u0026ndash;0.51 in the second round.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eResults of expert consultation\u003c/h2\u003e \u003cp\u003eFollowing the initial round of expert consultations, the research team systematically organized and analyzed the feedback received. By integrating the statistical results with expert opinions, it became apparent that certain items within the assessment tool exhibited significant overlap and redundancy, leading to excessive items. To enhance patient response efficiency and account for the characteristics of the item measurement content, this dimension was consolidated into two categories: perceived susceptibility and perceived severity. Consequently, six items were eliminated, eight new items were introduced, and eighteen items were removed during this process. After these modifications in the first round, 26 items remained unchanged. In the second round of consultations, there was a notable reduction in the feedback volume from experts; most comments pertained to issues related to language expression. Over time, the experts\u0026rsquo; perspectives on the questionnaire items aligned more closely. Ultimately, this led to the development of a disease risk perception assessment tool specifically designed for Chinese patients with esophageal cancer and their relatives, comprising two dimensions and 26 items (Additional File 3).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eWeight consistency test results\u003c/h2\u003e \u003cp\u003eThe consistency index (CI) of the second-order judgment matrix derived from the dimensions of perceived disease susceptibility and perceived disease severity was 0.000, with a corresponding random index (RI) of 0.000. Given that these data represent a second-order matrix (with RI\u0026thinsp;=\u0026thinsp;0, rendering it impossible to calculate the consistency ratio [CR]), all second-order data fulfilled the consistency test; therefore, the final calculated weights demonstrated internal consistency. Regarding perceived disease susceptibility, the CI obtained from the tenth-order judgment matrix was 0.000, accompanied by an associated RI of 1.490. Consequently, the computed CR was determined to be 0.000 (CR\u0026thinsp;\u0026lt;\u0026thinsp;0.1), indicating that this judgment matrix meets the established criteria for consistency and that its calculated weights are reliable. Similarly, regarding perceived disease severity, the CI for the sixteenth-order judgment matrix was again found to be 0.000, with a corresponding RI of 1.594; therefore, we obtained a CR value of 0.000 (CR\u0026thinsp;\u0026lt;\u0026thinsp;0.1). This confirms that the judgment matrix satisfies the consistency requirements and yields consistent weighted values (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\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\u003eItem importance, coefficient of variation, and weight value\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItem\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWeight value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVector of features\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eMaximum eigenvalue\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eCI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Perceived disease susceptibility.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.1 Having an immediate family member with esophageal cancer increases the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e10.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.2 The risk of developing esophageal cancer increases with age.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.092\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.3 Having an esophageal condition (such as chronic esophagitis, esophageal intraepithelial neoplasia, Barrett's esophagus, etc.) increases the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.938\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.4 Poor oral hygiene or having oral disease can increase the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.5 Alcohol consumption increases the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.6 Smoking increases the risk of esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.098\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.7 Long-term unreasonable diet (such as consumption of pickled food, hot food, etc.) can increase the risk of esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.928\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.8 Long-term poor eating habits (such as eating too fast, eating irregularly, etc.) increase the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.9 Living in a poor living environment (exposure to chemical pollutants, radiation, etc.) can increase the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1.10 Long-term residence in an area with a high incidence of esophageal cancer increases the risk of developing esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.066\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Perceive the severity of illness.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.471\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.942\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.1 Esophageal cancer is a serious disease.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003e16.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"15\" rowspan=\"16\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.2 Esophageal cancer can present with the sensation of a foreign body or stagnation in the esophagus.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.3 Esophageal cancer can present with progressive difficulty in swallowing.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.941\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.4 Esophageal cancer may be accompanied by gastrointestinal symptoms such as belching and reflux.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.5 Esophageal cancer can present with pain in the retrosternal or interscapular region.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.6 Esophageal cancer can cause malnutrition and weight loss.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.7 Esophageal cancer carries a risk of metastasis and spread.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.8 Esophageal cancer carries a risk of recurrence.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.951\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.9 Multiple complications may occur during the treatment of esophageal cancer.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.909\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.10 Delayed treatment of esophageal cancer is associated with poor efficacy.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.11 The treatment of esophageal cancer can cause physical discomfort.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.972\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.12 Esophageal cancer can lead to a decreased quality of life.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.13 Esophageal cancer can lead to reduced social participation.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.930\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.14 Esophageal cancer can interfere with taking on original family responsibilities.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.15 Treatment of esophageal cancer can cause a financial burden to the family.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.066\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.057\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2.16 A diagnosis of esophageal cancer can place a psychological burden on family members.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCI, Consistency Index; CV, coefficient of variation\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e[Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e near here]\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eThe necessity of developing assessment tools\u003c/h2\u003e \u003cp\u003eNumerous scholars have developed a range of universal and specific scales to assess risk perception levels among populations at a high risk of cancer. However, while universal scales [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] are applicable across diverse demographics, they often lack the precision needed to accurately evaluate individuals\u0026rsquo; perceptions of disease risk. Existing assessment tools primarily concentrate on patients with colorectal and breast cancer [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In the context of esophageal cancer, particularly regarding disease risk perception assessments for first-degree relatives of patients with esophageal cancer, a significant gap persists in developing a scientifically validated, comprehensive, and effective evaluation system. Research indicates that inaccuracies in risk perception can lead to psychological symptoms, and underestimating cancer risk may foster an optimistic bias that results in missed opportunities to use genetic counseling and chemoprevention strategies aimed at reducing such risks. Conversely, overestimating these risks may provoke excessive concern and anxiety, potentially leading to unnecessary preventive measures and screening behaviors [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Therefore, it is imperative to select scientific and reliable tools to accurately assess the level of cancer risk perception among high-risk groups to effectively understand their current status regarding perceived cancer risks.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eThe scientific rigor in the development of assessment tools\u003c/h2\u003e \u003cp\u003eThis study's construction of research indicators is firmly rooted in the theoretical framework of risk perception attitudes, which conceptualizes risk perception as a two-dimensional motivational factor encompassing perceived susceptibility and severity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, this motivation must be accompanied by strong efficacy beliefs that encourage individuals to undertake measures aimed at mitigating threats. This theoretical approach facilitates an understanding of how individuals perceive risks, process risk-related information, make decisions, and implement changes in health behaviors [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Zhang et al. developed a scale for assessing the risk perception of sarcopenia among older adults based on the disease RPA ramework and health belief model [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Similarly, Yang et al. created a fall risk perception scale for patients with Parkinson's disease, using both the disease RPA framework and active health theory [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The item pool serves as the foundation for developing assessment tool items, and expert consultation is essential to enhance item reliability [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. The development of the assessment tool in this study comprised two primary stages: constructing an item pool and conducting expert consultations. The entire process was executed rigorously and systematically to maximize the rationality of the assessment tool development. The experts held educational qualifications ranging from bachelor's degrees to doctoral degrees, with 95% possessing over 10 years of professional experience, indicating their substantial theoretical knowledge and practical expertise. In terms of data collection efficiency, both rounds of questionnaires achieved a 100% effective response rate, with all experts returning their responses within 1 week, reflecting their high engagement in this research endeavor. The authority coefficient among the consulted experts was 0.938, signifying considerable authority within this field of study. Regarding the consensus levels among expert opinions during consultations, the Kendall coefficients were 0.303 for round one and 0.438 for round two. Additionally, mean importance ratings assigned by experts during round one ranged from 3.25\u0026ndash;5.00 points, whereas those from round two ranged from 4.25\u0026ndash;5.00 points.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eThe specificity and clinical applicability of assessment tools\u003c/h2\u003e \u003cp\u003eThe assessment tool developed in this study encompasses two critical dimensions of disease risk perception regarding esophageal cancer among first-degree relatives: understanding disease susceptibility and severity. The items related to perceived susceptibility included high-risk factors specific to esophageal cancer, whereas the section addressing perceived severity incorporated common early clinical symptoms associated with the disease and its adverse impacts on society, family dynamics, and individual well-being. This tool facilitates a comprehensive evaluation of disease risk perception characteristics among first-degree relatives of patients with esophageal cancer, providing an integrated consideration of both susceptibility and severity. The selection of an appropriate assessment instrument not only aids high-risk individuals in gaining a clearer understanding of their health status\u0026mdash;thereby enhancing their proactive engagement and self-management capabilities in preventing esophageal cancer\u0026mdash;but also enables healthcare professionals to assess risk perception levels among first-degree relatives effectively. This insight will allow the development of targeted prevention strategies and more precise and holistic management measures for esophageal cancer prevention. Ultimately, these efforts may contribute to reducing both the incidence and mortality rates of this malignancy, thus yielding positive implications for public health.\u003c/p\u003e \u003cp\u003eNevertheless, this study has some limitations. First, it involved consultations with only 20 experts from China; thus, generalizability may be limited because of the exclusion of perspectives from potential experts in other regions. Second, despite striving for clarity in item formulation within the assessment tool, some items may still lack sufficient accessibility due to constraints related to expression accuracy. Therefore, further validation through large-scale multicenter studies is necessary to establish the reliability and validity of this assessment tool and enhance its applicability in broader contexts.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003e This study developed a tool to assess disease risk perception for first-degree relatives of patients with esophageal cancer in China, employing a comprehensive methodology that included a literature review, research group discussions, Delphi expert consultations, and the AHP. The tool encompasses two dimensions: perceived disease susceptibility and perceived disease severity, comprising 26 items. The methodology employed demonstrated scientific rigor, whereas the indicators within the tool exhibited relevance and clinical applicability. This assessment instrument serves as a valuable resource for evaluating disease risk perception among first-degree relatives of patients with esophageal cancer. Its implications are for designing early screening programs and intervention strategies targeted at populations at high risk of esophageal cancer.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAHP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnalytic Hierarchy Process\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCr\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eExpert Authority Coefficient\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConsistency Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eConsistency Ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRandom Index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRPA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRisk Perception Attitude\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e: This study was approved by the Ethics Committee of the Beijing Cancer Hospital (No. 2024KT196), and verbal informed consent was obtained from all subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: All data generated or analyzed during this study are included in this published article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e: The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research was funded the Beijing Research Ward Excellence Program, BRWEP (BRWEP2024W032150100 and BRWEP2024W032150116); the efficacy and safety of slulizumab in the perioperative treatment of locally advanced resectable thoracic esophageal squamous cell carcinoma (CPS ≥10): a prospective, single-arm, phase Ⅱ clinical trial (2023YJZ64). The funders had no role in the conceptualization, design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e: Yan He and Xu Wang drafted and critically revised the manuscript for important intellectual content. Hong Yang, Yaya Wu and Yongbo Yang: Data collection and evaluation. Liang Dai and Shaohua Ma: Study design and conception. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e: We thank all the experts who participated in our Delphi study for sharing their time and expertise.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. 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J Nurs Educ. 2005;2:174\u0026ndash;6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"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},"keywords":"Risk assessment tool, Esophageal cancer, First-degree relatives, Delphi method, Analytic Hierarchy Process","lastPublishedDoi":"10.21203/rs.3.rs-6132977/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6132977/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: There remains a lack of specific instruments tailored to assess disease risk perception among first-degree relatives of patients with esophageal cancer. Therefore, this study aimed to develop an assessment tool for disease risk perception among first-degree relatives of patients with esophageal cancer in China.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Using the framework of disease risk perception attitudes, we conducted a literature review, facilitated discussions within a research group, and employed the Delphi expert consultation method to screen items and quantify the dimensions and components of risk perception. A preliminary assessment tool was constructed to evaluate disease risk perception among first-degree relatives of patients with esophageal cancer. From November to December 2024, a two-round questionnaire survey was administered to 20 experts in China using the Delphi method. The enthusiasm, authority, concentration, and consensus of opinions among experts were evaluated; additionally, the Analytic Hierarchy Process was used to determine the item weights.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The response rates for both rounds of expert consultation questionnaires were 100%, with an expert authority coefficient of 0.938. Kendall's concordance coefficients for the two rounds were 0.303 and 0.438, respectively (P \u0026lt; 0.001). The final assessment tool comprised two dimensions and twenty-six items designed to evaluate disease risk perception among first-degree relatives of patients with esophageal cancer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The developed assessment tool demonstrated significant scientific rigor and practical applicability in evaluating disease risk perception among first-degree relatives of patients with esophageal cancer, thereby providing a reference standard for implementing interventions to mitigate disease risks.\u003c/p\u003e","manuscriptTitle":"Development of a disease risk perception assessment tool for first-degree relatives of patients with esophageal cancer in China: A study based on the modified Delphi method","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-29 09:35:28","doi":"10.21203/rs.3.rs-6132977/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":"27fe5b0c-04a8-4262-acb9-38fbd145719d","owner":[],"postedDate":"April 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-08T05:08:44+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-29 09:35:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6132977","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6132977","identity":"rs-6132977","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}