Posttraumatic Growth Measures in Breast Cancer Survivors: A Systematic Review

Sung Hae Kim; JuHee Lee

doi:10.7475/kjan.2017.29.4.343

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Kim and Lee: Posttraumatic Growth Measures in Breast Cancer Survivors: A Systematic Review

Original Article

Korean J Adult Nurs 2017;29(4):343-362.

Published online: 9 August 2017

DOI: https://doi.org/10.7475/kjan.2017.29.4.343

Posttraumatic Growth Measures in Breast Cancer Survivors: A Systematic Review

Sung Hae Kim, MSM, RN^1,, JuHee Lee, Ph.D., APRN-GNP²

¹College of Nursing, Yonsei University, Seoul, Korea

²College of Nursing, Yonsei University • Mo-Im Kim Nursing Research Institute, Seoul, Korea

Corresponding author: Kim, Sung Hae College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea. Tel: +82-2-2228-3318, Fax: +82-2-392-5027, E-mail: franciscoasclara@gmail.com

Received 29 March 201729 July 2017 Accepted 20 August 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The objective of this study was to identify and evaluate the measures used for assessment of posttraumatic growth (PTG) for women survivors with breast cancer and to evaluate the psychometric properties of each instrument.

Methods

A systematic review was conducted to identify measurement instruments used for assessment of PTG using electronic databases such as KoreaMed, DBpia, PubMed, Embase, PsycINFO, CINAHL, and Cochrane Library. Studied published both in Korean and/or English were included for the analysis. Studies were examined by two independent reviewers and eighty-nine studies met the inclusion criteria. The selection of the eighty-nine studies was evaluated on methodological and psychometric properties including validity and reliability of the instruments.

Results

Three instruments were identified in the review of the eighty-nine studies. The three instruments were identified as 1) Posttraumatic Growth Inventory (PTGI), 2) Benefit Finding Scale, and 3) Positive Meaning Scale. The PTGI was the most frequently reported instrument used in the review. The majority of the reported studies were used translation and back-translation, but some of the studies did not report translation methods. Most studies (71.9%) reported reliability, but only 29.2% studies reported validity of the instruments used in the study.

Conclusion

This study was conducted to provide an evidence for selection and development of measurement instruments of PTG for breast cancer survivors.

Keywords: Breast neoplasms, Trauma, Growth, Psychometrics

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Figure 1.

Flow diagram for selected studies.

Figure 2.

Quality of measurement properties according to COSMIN checklist.

Table 1.

Characteristics of Measurement Assessing Posttraumatic Growth in Breast Cancer Survivors according to PTGI (N=83)

Measurements	Adminstration mode	Participants (n)	Contents			Reliability	Validity	Source language	Target language	k	(%)
Measurements	Adminstration mode	Participants (n)	Total item	Domains (number of items)	Scoring (range/ total score)	Reliability	Validity	Source language	Target language	k	(%)
Posttraumatic Growth Inventory (Tedeschi & Calhoun, 1996)	Self-reported	Undergraduate students (504)	21	5 New possibilities (5) Relating to others (7) Personal strength (4) Spiritual change (2) Appreciation of life (3)	6-point^† Likert scale (0~5/0~105)	⍺=.90 subscale ⍺=.67~.85	Factor analysis (factor ranged= .62~.83) test-retest (r=.71) discriminant (r=-.17~.20)	English	Original measurement (NA)	46	(51.7)
Translation version of PTGI	Self-reported	NA	21	5 New possibilities (5) Relating to others (7) Personal strength (4) Spiritual change (2) Appreciation of life (3)	6-point^† Likert scale (0~5/0~105)	NA	NA	English	Chinese (Mandarin Danish, Dutch, French, Greece, Hungarian, Hebrew Korean, Spanish, Slovenian Turkish, Urdu	), w, n, 25	(28.2)
German version of PTGI (Maercker & Langner, 2001)	UK	UK	21	5 New possibilities (5) Relating to others (7) Personal strength (4) Spiritual change (2) Appreciation of life (3)	3-point^‡ Likert scale (0~2/0~42)	subscale ⍺=.93~.94	UK	English	German	2	(2.2)
Portuguese version of PTGI (Silva et al., 2009)	UK	UK	21	4 Personal resources and skills (6) New possibilities and life appreciation (6) Strengthening of social relationships (6) Spiritual development (3)	6-point^† Likert scale (0~5/0~105)	⍺=.94 subscale ⍺=.80~.90	UK	English	Portuguese	4	(4.5)
Hong Kong Chinese version of PTGI (CPTGI; Ho et al., 2004)	Self-reported	Chinese cancer survivors (188)	15	2 Interpersonal growth (3) Intrapersonal growth (12) - including 3 sub-dimension: self (7), spiritual (3), life orientation (2)	6-point^† Likert scale (0~5/0~75)	subscale ⍺=.65~.90	Factor analysis AGFI=.89, CFI=.96, TLI=.95 RMSEA=0.05	English	Chinese	2	(2.2)
Korean version of PTGI (K-PTGI; Song et al., 2009)	Self-reported	People who have experienced traumatic event (n=300), Normal adult (269) PTSD people(144)	, 16	4 Changed perception of self (6) Rating to others (5) New possibilities (3) Spiritual change (2) Excepted 4 items from original PTGI (2,4,9,14,20)	6-point^† Likert scale (0~5/0~80)	⍺=.71~.94 test-retest r=.71	Factor analysis GFI=.90, CFI=.95, TLI=.94 RMSEA=0.06 discriminant (r=-.51~-.25)	English	Korean	4	(4.5)

PTGI=posttraumatic growth inventory; ⍺=Cronbach's ⍺, NA=not applicable; NR=not reported; UK=unknown; Score interpretation of all measurements=high scores indicating positive growth or higher benefit finding;

^† Score option from 'I did not experience this change as a result of my crisis (0)' to 'I experienced this change to a very great degree as a result of my crisis (5)';

^‡ Score option from 'Not at all (o)' to 'Very much (2)'.

Table 2.

Characteristics of Measurement Assessing Posttraumatic Growth in Breast Cancer Survivors according to BFS and PMS (N=6)

Measurements	Adminstration mode	Participants (n)	Contents				Reliability	Validity	Source language	Target language	k	(%)
Measurements	Adminstration mode	Participants (n)	Total item		Domains (number of items)	Scoring (range/ total score)	Reliability	Validity	Source language	Target language	k	(%)
Benefit finding scale (Antoni et al., 2001)	Self-reported	Stage I-II breast cancer women (100)	17	3	Acceptance Interpersonal growth Stronger sense of purpose in life	5-point^† Likert scale (1~5/17~85)	⍺=.95 test-retest r=.79	Discriminant (r=from -.25~.23)	English	Original measurement	3	(3.4)
Benefit finding scale (Tomich & Helgeson, 2004)	Self-reported	Stage I-II breast cancer women (364)	20	5	Personal priorities Daily activities Family World views Relationships	5-point^† Likert scale (0~4/0~80)	⍺=.95	Factor analysis (factor ranged= .62~.82)	English	Original measurement	1	(1.1)
Benefit finding scale (Lechner et., 2006)	Self-reported	Breast cancer survivors (366)	17	6	Family and social relations Life priorities Spirituality, Career goals Self-control	4-point^‡ Likert scale (0~3/0~51)	NR	NR	English	Original measurement	1	(1.1)
					Acceptance of life- circumstances
					This item set overlaps extensively (11 items) with that of Tomich & Helgeson (2004), though not completely.
Positive meaning scale (Bower et al., 2005)	Self-reported	Breast cancer survivors since diagnosed 1 to 10 years (763)	6	1	Positive meaning (6)	5-point^† Likert scale (0~4/0~24)	⍺=.84	Factor analysis (factor ranged= from .57~.83) convergent (r=.71)	English	Original measurement	1	(1.1)

BFS=benefit finding scale, PMS=positive meaning scale; ⍺=Cronbach's ⍺; NA=not applicable; NR=not reported; UK=unknown; Score interpretation of all measurements=high scores indicating positive growth or higher benefit finding;

^† Score options from 'Not at all (0)' to 'Very much (4)';

^‡ Score options from 'I disagree a lot (0)' to 'I agree a lot (3)'.

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