Validation of the knowledge of care options instrument to measure knowledge of curative, palliative, and hospice care

Objective: Treatment decision-making may be hindered by a lack of knowledge about the care options of curative, palliative, and hospice care. Our purpose was to create and validate an instrument to measure knowledge of these care options, the Knowledge of Care Options (KOCO) instrument. Methods: We began by generating a pool of true-false items. Experts (n=32) evaluated items in two rounds of review. For each round, we calculated Content Validity Indexes for each item and for the total scale (S-CVI). Items were revised or dropped as indicated. The clarity and acceptability of KOCO were assessed through cognitive interviews with 10 men and women with cancer. We pilot-tested KOCO with a target population sample of 23 women with metastatic breast cancer as part of larger study testing self-management training materials that included a module on care options. Results: Following expert review, the S-CVI was 85.2%, and the KOCO consisted of 11 items. Cognitive interviews showed KOCO to be clear and acceptable. The KR-20 test revealed high internal consistency of 0.89. In the pilot test, the mean pre-test score was 9.3 items correct (SD 1.29). The mean post-test score was 10.21 items correct (SD 0.92). KOCO captured change in knowledge of care options (signed rank test=42.5, p<0.006). Conclusions: KOCO is a brief, acceptable instrument capable of assessing knowledge of curative, palliative, and hospice care. Additional testing is needed with larger samples to assess the utility of KOCO for use with various patient populations, family caregivers, and clinicians.