Validation of the Chinese Version of the Pittsburgh Sleep Quality Index in Hong Kong Childhood Cancer Survivors
Condition: Health-Related Quality Of Life
Study type: Observational

Summary: 
      Cancer is one of the major causes of death in pediatric population. In Hong Kong, childhood
      cancer remains a significant concern in healthcare system because of its damaging impacts on
      adolescent's physical and psychological functions throughout their lifespan. Particularly,
      adolescents surviving cancer still have to bear the health burden of numerous sequelae, even
      their treatment is completed for months and even years.

      One of the most prevalent symptoms reported by patients surviving cancer is sleep
      disturbance. The causes of sleep disturbance are multifactorial. However, it can largely be
      attributed to disruption of circadian rhythm by prolonged use of medications and long-term
      hospitalization. Experiencing sleep disturbance can be devastating for survivors of cancer
      and precipitates inflammation and oxidative stress, which are known to be a contributing
      factor of neurocognitive impairment. Sleep disturbance can also lead to fatigue, which in
      turn limits patients' capacity in engaging in daily activities and even results in
      depression, severely compromising patients' quality of life in the long run. Having a
      reliable and valid instrument that can precisely assess the problem of sleep disturbance of
      cancer survivors is therefore crucial for the development and evaluation of the intervention.

      The Pittsburgh Sleep Quality Index (PSQI) is the most commonly and frequently used instrument
      to assess sleep disturbance. Because of differences in culture and language, some concepts or
      items in the English version may be inappropriate for adolescents living in Hong Kong.
      Moreover, the psychometrics of the PSQI has only been established in adolescents undergoing
      active treatment for cancer, when they experienced the most severe problem. It is therefore
      unclear whether the PSQI can also be used to assess sleep disturbance of adolescents who have
      completed cancer treatment. This lack of validated instruments precludes us from
      understanding the severity of the problem. Also, it hinders the development of appropriate
      interventions that promote sleep quality. This study aims to bridge the gap in existing
      literature by translating the PSQI from English into Chinese, and examining the psychometrics
      of the translated PSQI in Hong Kong Chinese childhood cancer survivors.
    

Detailed description: 
      Cancer is one of the major causes of death in pediatric population. In Hong Kong, 46 patients
      aged 0 - 19 died from cancer in 2016. Childhood cancer is not common. According to Hong Kong
      Cancer Registry, there are approximately 190 newly diagnosed cases of childhood cancer each
      year. Despite this figure is not as high as that in adults, childhood cancer remains a
      significant concern in healthcare system because of its damaging impacts on children's
      physical and psychological functions throughout their lifespan. Particularly, children
      surviving cancer still have to pay a high price for numerous sequelae, notwithstanding their
      treatment is completed after months and even years.

      One of the most prevalent symptoms reported by patients surviving cancer is sleep
      disturbance. A systematic review indicates 25 - 59 % adults reporting sleep disturbance after
      their treatment for cancer. A retrospective cohort study in the West also pointed out that
      16.7% of childhood cancer survivors complained of disrupted sleep. The causes of sleep
      disturbance are multifactorial. However, it can largely be attributed to disruption of
      circadian rhythm by prolonged use of medications and longterm hospitalization. In fact,
      experiencing sleep disturbance can be devastating for survivors of cancer. Previous
      literature indicates that sleep disturbance precipitates inflammation and oxidative stress,
      which are known to be a contributing factor of neurocognitive impairment. Sleep disturbance
      can also lead to fatigue, which in turn limits patients' capacity in engaging in daily
      activities and even results in depression, severely compromising patients' quality of life in
      the long run. In this regard, healthcare professionals, particularly oncology nurses should
      bear unshrinkable responsibility to intervene this symptom with appropriate interventions,
      with an aim of improving the survivors' sleep quality and quality of life. Having a reliable
      and valid instrument that can precisely assess the problem of sleep disturbance of cancer
      survivors is therefore crucial for the development and evaluation of the intervention.

      The Pittsburgh Sleep Quality Index (PSQI) is the most commonly used instrument to assess
      sleep disturbance. Although this instrument was originally developed to collect subjective
      information about sleep habits of psychiatric patients, it has been translated into different
      languages, and has been extensively applied in studies on adult cancer survivors. The results
      of these studies generally support this instrument to be reliable and valid in assessing
      sleep disturbance for this group of population. Despite the growing popularity of using this
      instrument in adults, no studies has so far been conducted to validate the PSQI in the
      pediatric population, thus limiting its usefulness for children and adolescents. In fact, a
      comprehensive review of the literature indicated that no validated instrument is currently
      available for assessing sleep disturbance of childhood cancer survivors, especially in the
      Hong Kong Chinese context. This lack of validated instruments precludes us from understanding
      the severity of the problem. Also, it hinders the development of appropriate interventions
      that promote sleep quality.
    

Intervention name(s): questionnaires set
Intervention type(s): Other
Intervention description(s): questionnaires set: The Chinese version of the Pittsburgh Sleep Quality Index (PSQI)+The Chinese version of the Center for Epidemiologic Studies Depression Scale for Children (CES-DC)+ The Chinese version of the Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL 4.0)
Observational model: Cohort
Time perspective: Cross-Sectional
Sampling method: Probability Sample
Study population: 
        To assess the known-group validity, 50 pediatric cancer patients and 50 healthy children
        will be recruited in a pediatric oncology ward and a community center, respectively. The
        inclusion and exclusion for the pediatric cancer patients and healthy children will be the
        same as those for the childhood cancer survivors.
      
Keywords: Psychometric properties; Sleep disturbance; Childhood cancer survivors; Quality of life,; Confirmatory factor analysis