Development and Evaluation of the Supportive Needs Assessment Tool for Cirrhosis (SNAC)

Patricia C Valery,1,2 Christina M Bernardes,1 Katherine A Stuart,3 Gunter F Hartel,1 Steven M McPhail,4 Richard Skoien,5 Tony Rahman,6 Paul J Clark,7 Leigh U Horsfall,2,3 Kelly L Hayward,2 Rohit Gupta,8 Elizabeth E Powell2,3 1QIMR Berghofer Medical Research Institute, Herston, QLD, Australia; 2Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; 3Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia; 4Centre for Functioning and Health Research, Queensland Health and the School of Public Health and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia; 5Department of Gastroenterology, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia; 6Gastroenterology & Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia; 7Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia; 8Department of Gastroenterology and Hepatology, Sunshine Coast University Hospital, Birtinya, QLD, AustraliaCorrespondence: Patricia C ValeryQIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, AustraliaTel +61 7 33620376Email Patricia.Valery@qimrberghofer.edu.auBackground: We report the development and psychometric testing of a Supportive Needs Assessment tool for Cirrhosis (SNAC).Methods: The 50-item SNAC was administered to patients (n=465) diagnosed with cirrhosis recruited from five metropolitan hospitals in Queensland, Australia. Items were assessed for ceiling and floor effects, and exploratory factor analysis was used to assess the factor structure. Identified factors were assessed for internal consistency and convergent validity to validated psychosocial tools.Results: Exploratory factor analysis identified 4 factors (39 items), which together accounted for 49.2% of the total variance. The 39-item SNAC met the requirements of a needs assessment tool and identified a range of needs important to patients with cirrhosis that were grouped in four subscales: “Psychosocial issues”, “Practical and physical needs”, “Information needs”, and “Lifestyle changes”. Cronbach’s alpha values for the four subscales ranged from 0.64 to 0.92. Convergent validity was supported by a strong correlation between the total SNAC score and that of the Chronic Liver Disease Questionnaire (CLDQ; Spearman rho − 0.68; p< 0.001), and moderate correlations with the Distress Thermometer (Spearman rho 0.53; p< 0.001) and seven subscales of a generic health-related quality of life instrument (Short Form 36; Spearman rho ranged from − 0.48 to − 0.57; p< 0.001). The SNAC discriminated patient groups with respect to sex (p=0.013), age group (p< 0.001), and hospital admission status (admitted vs not; p< 0.001).Conclusion: These data provide initial evidence for the validity and reliability of the SNAC, an instrument designed to measure type and amount of perceived unmet practical and psychological needs of people diagnosed with cirrhosis.Keywords: chronic liver disease, perceived needs, instrument validation, psychometric properties