{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:48:23Z","timestamp":1782190103305,"version":"3.54.5"},"reference-count":69,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:00:00Z","timestamp":1781568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Improving accrual to clinical trials is critical in oncology, particularly in studies evaluating treatment de-escalation or modification strategies, such as endocrine therapy (ET) switch trials in breast cancer. In disease-free patients who have completed an initial period of standard adjuvant ET, decision-making is shaped by individual, clinical, and contextual factors that may act as barriers and facilitators to trial participation. The lack of validated instruments complicates the comprehensive evaluation of these determinants. Therefore, our study aimed to develop and validate a scale for measuring barriers and facilitators to clinical trial participation in adjuvant endocrine therapy switch trials (CAMBRIA-1 and EMBER-4) among breast cancer patients. Therefore, a multiphase study was undertaken: phase one focused on item generation through literature review and expert consensus; phase two assessed preliminary validity through content and face validation (S-CVI and CVR) and pre-testing (Cronbach\u2019s alpha). The final scale encompassed 17 items and exhibited strong evidence of face and content validity (S-CVI = 0.78 and CVR &gt; 0.725 for all items) and internal consistency (Cronbach\u2019s alpha = 0.874). Since preliminary internal consistency has been established, this tool may support future psychometric refinement and large-scale investigations. An understanding of these determinants may inform trial enrolment and drug development in breast cancer management, as well as tailor patient engagement strategies.<\/jats:p>","DOI":"10.3390\/curroncol33060361","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T01:58:38Z","timestamp":1781661518000},"page":"361","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Preliminary Validation of a Tool to Assess Barriers and Facilitators to Participation in Adjuvant Endocrine Therapy Switch Trials"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5187-2410","authenticated-orcid":false,"given":"Silvia","family":"Belloni","sequence":"first","affiliation":[{"name":"Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9506-7010","authenticated-orcid":false,"given":"Paola","family":"Tiberio","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9290-735X","authenticated-orcid":false,"given":"Emanuela","family":"Mencaglia","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice Silvia","family":"Brera","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-4829-7640","authenticated-orcid":false,"given":"Chiara","family":"Giacon","sequence":"additional","affiliation":[{"name":"Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Benvenuti","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Medical Oncology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariangela","family":"Gaudio","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalba","family":"Torrisi","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1709-9492","authenticated-orcid":false,"given":"Armando","family":"Santoro","sequence":"additional","affiliation":[{"name":"Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7736-6209","authenticated-orcid":false,"given":"Rosario","family":"Caruso","sequence":"additional","affiliation":[{"name":"Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy"},{"name":"Health Professions Research and Evidence Transfer Unit, IRCCS MultiMedica, 20099 Sesto San Giovanni, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cristina","family":"Arrigoni","sequence":"additional","affiliation":[{"name":"Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alberto","family":"Zambelli","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3202-1933","authenticated-orcid":false,"given":"Rita","family":"De Sanctis","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy"},{"name":"Department of Biomedical Sciences, Humanitas University, 20072 Pieve Emanuele, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,16]]},"reference":[{"key":"ref_1","first-page":"10","article-title":"Cancer statistics, 2025","volume":"75","author":"Siegel","year":"2025","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","first-page":"477","article-title":"Breast cancer statistics 2024","volume":"74","author":"Giaquinto","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"104527","DOI":"10.1016\/j.critrevonc.2024.104527","article-title":"Prevalence of treatment-related adverse events (TRAEs) with antibody-drug conjugates in metastatic breast cancer patients: A systematic review and meta-analysis","volume":"204","author":"Belloni","year":"2024","journal-title":"Crit. Rev. Oncol. Hematol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1002\/cac2.12358","article-title":"Breast cancer: An up-to-date review and future perspectives","volume":"42","author":"Hong","year":"2022","journal-title":"Cancer Commun."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pont, M., Marqu\u00e9s, M., and Sorolla, A. (2024). Latest Therapeutical Approaches for Triple-Negative Breast Cancer: From Preclinical to Clinical Research. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms252413518"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1007\/s12609-024-00564-z","article-title":"Novel Therapeutics in Advanced Breast Cancer: A Review of Current Phase I Clinical Trials","volume":"17","author":"Vemuru","year":"2024","journal-title":"Curr. Breast Cancer Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"20","DOI":"10.21037\/tbcr-23-22","article-title":"Types and progress of clinical trial design for breast cancer: A narrative review","volume":"4","author":"Zhou","year":"2023","journal-title":"Transl. Breast Cancer Res."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1200\/EDBK_156686","article-title":"The Role of Clinical Trial Participation in Cancer Research: Barriers, Evidence, and Strategies","volume":"35","author":"Unger","year":"2016","journal-title":"Am. Soc. Clin. Oncol. Educ. Book"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"100513","DOI":"10.1016\/j.esmoop.2022.100513","article-title":"Factors associated with enrolment in clinical trials among women with early-stage breast cancer","volume":"7","author":"Presti","year":"2022","journal-title":"ESMO Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1158\/1078-0432.CCR-11-1633","article-title":"Achieving sufficient accrual to address the primary endpoint in phase III clinical trials from U.S. Cooperative Oncology Groups","volume":"18","author":"Schroen","year":"2012","journal-title":"Clin. Cancer Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5517","DOI":"10.1002\/cam4.5385","article-title":"Early Termination of Oncology Clinical Trials in the United States","volume":"12","author":"Zhang","year":"2023","journal-title":"Cancer Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2038","DOI":"10.1245\/s10434-024-16607-9","article-title":"Therapeutic Clinical Trial Eligibility and Enrollment among Women with Breast Cancer: Implications for Understanding Trial Disparities","volume":"32","author":"Reh","year":"2025","journal-title":"Ann. Surg. Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ueda, R., Nishizaki, Y., Nojiri, S., Iwata, H., Miyauchi, K., Matsuyama, K., Sanada, S., Minamino, T., and Daida, H. (2021). Factors Associated With the Acceleration of Patient Enrollment in Clinical Studies: A Cross-Sectional Study. Front. Pharmacol., 12.","DOI":"10.3389\/fphar.2021.753067"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1093\/jnci\/djy221","article-title":"Systematic Review and Meta-Analysis of the Magnitude of Structural, Clinical, and Physician and Patient Barriers to Cancer Clinical Trial Participation","volume":"111","author":"Unger","year":"2019","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e055165","DOI":"10.1136\/bmjopen-2021-055165","article-title":"Barriers to patient enrolment in phase III cancer clinical trials: Interviews with clinicians and pharmaceutical industry representatives","volume":"12","author":"Dane","year":"2022","journal-title":"BMJ Open"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Alotaibi, M., Alsolami, L., AlHarbi, S., Alagha, A., Alqurashi, L., Badr, R., Almatrafi, N., Aladwani, G., Alotaibi, A., and Shahbar, A. (2025). Clinical Trial Awareness, Perceptions, and Participation Among Cancer Patients in Saudi Arabia. Healthcare, 13.","DOI":"10.3390\/healthcare13091044"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s13063-015-1105-3","article-title":"Patients\u2019 willingness to participate in clinical trials and their views on aspects of cancer research: Results of a prospective patient survey","volume":"17","author":"Moorcraft","year":"2016","journal-title":"Trials"},{"key":"ref_18","first-page":"1169","article-title":"Cancer patient decision making related to clinical trial participation: An integrative review with implications for patients\u2019 relational autonomy","volume":"23","author":"Bell","year":"2015","journal-title":"Support Care Cancer"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"E387","DOI":"10.1188\/10.ONF.E387-E399","article-title":"Decision making for cancer clinical trial participation: A systematic review","volume":"37","author":"Biedrzycki","year":"2010","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"100829","DOI":"10.1016\/j.conctc.2021.100829","article-title":"Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews","volume":"23","year":"2021","journal-title":"Contemp. Clin. Trials Commun."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Garcia, L., Mendon\u00e7a, G., Benedetti, T.R.B., Borges, L.J., Streit, I.A., Christofoletti, M., Silva-J\u00fanior, F.L.E., Papini, C.B., and Binotto, M.A. (2022). Barriers and facilitators of domain-specific physical activity: A systematic review of reviews. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-14385-1"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1080\/14796694.2025.2459548","article-title":"CAMBRIA-1 & CAMBRIA-2 phase III trials: Camizestrant versus standard endocrine therapy in ER+\/HER2\u2212 early breast cancer","volume":"21","author":"Hamilton","year":"2025","journal-title":"Future Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1000281","DOI":"10.4172\/2161-0711.1000281","article-title":"Promoting Factors and Barriers to Participation in Early Phase Clinical Trials: Patients Perspectives","volume":"4","author":"Chalela","year":"2014","journal-title":"J. Community Med. Health Educ."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Lee, G.E., Ow, M., Lie, D., and Dent, R. (2016). Barriers and facilitators for clinical trial participation among diverse Asian patients with breast cancer: A qualitative study. BMC Womens Health, 16.","DOI":"10.1186\/s12905-016-0319-1"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1016\/j.cct.2007.03.001","article-title":"Decision-making and breast cancer clinical trials: How experience challenges attitudes","volume":"28","author":"Mancini","year":"2007","journal-title":"Contemp. Clin. Trials"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1111\/j.1365-2702.2006.01573.x","article-title":"Essential elements of questionnaire design and development","volume":"16","author":"Rattray","year":"2007","journal-title":"J. Clin. Nurs."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"S80","DOI":"10.4103\/sja.SJA_203_17","article-title":"Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine","volume":"11","author":"Tsang","year":"2017","journal-title":"Saudi J. Anaesth."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Streiner, D.L., Norman, G.R., and Cairney, J. (2015). Health Measurement Scales: A Practical Guide to Their Development and Use, Oxford University Press. [5th ed.].","DOI":"10.1093\/med\/9780199685219.001.0001"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Boateng, G.O., Neilands, T.B., Frongillo, E.A., Melgar-Qui\u00f1onez, H.R., and Young, S.L. (2018). Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer. Front. Public Health, 6.","DOI":"10.3389\/fpubh.2018.00149"},{"key":"ref_30","unstructured":"Nunnally, J.C. (1978). Psychometric Theory, McGraw-Hill. [2nd ed.]."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2676","DOI":"10.1002\/cncr.1994.2820740918","article-title":"Behavioral aspects of clinical trials. An integrated framework from behavior theory","volume":"74","author":"Morrow","year":"1994","journal-title":"Cancer"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/S0738-3991(98)00060-3","article-title":"Determinants of patient participation in clinical studies requiring informed consent: Why patients enter a clinical trial","volume":"35","author":"Verheggen","year":"1998","journal-title":"Patient Educ. Couns."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.apnr.2005.06.001","article-title":"Is verbatim transcription of interview data always necessary?","volume":"19","author":"Halcomb","year":"2006","journal-title":"Appl. Nurs. Res."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1177\/1049732303259804","article-title":"Improving accuracy of transcripts in qualitative research","volume":"14","author":"MacLean","year":"2004","journal-title":"Qual. Health Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1037\/1040-3590.7.3.238","article-title":"Content Validity in Psychological Assessment: A Functional Approach to Concepts and Methods","volume":"7","author":"Haynes","year":"1995","journal-title":"Psychol. Assess."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1002\/jrsm.1447","article-title":"Barriers and facilitators systematic reviews in health: A methodological review and recommendations for reviewers","volume":"11","author":"Verboom","year":"2020","journal-title":"Res. Synth. Methods"},{"key":"ref_37","first-page":"967","article-title":"A review of scale development practices in the study of organisations","volume":"21","author":"Hinkin","year":"1995","journal-title":"J. Manag."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1016\/j.sapharm.2018.03.066","article-title":"Evaluation of methods used for estimating content validity","volume":"15","author":"Almanasreh","year":"2019","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/S0016-3287(69)80025-X","article-title":"An experimental study of group opinion: The Delphi method","volume":"1","author":"Dalkey","year":"1969","journal-title":"Futures"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"116","DOI":"10.5662\/wjm.v11.i4.116","article-title":"Delphi methodology in healthcare research: How to decide its appropriateness","volume":"11","author":"Nasa","year":"2021","journal-title":"World J. Methodol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"356","DOI":"10.33546\/bnj.1927","article-title":"Establishing appropriate sample size for developing and validating a questionnaire in nursing research","volume":"7","author":"Gunawan","year":"2021","journal-title":"Belitung Nurs. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1177\/0748175612440286","article-title":"Recalculation of the Critical Values for Lawshe\u2019s Content Validity Ratio","volume":"45","author":"Wilson","year":"2012","journal-title":"Meas. Eval. Couns. Dev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1002\/nur.20147","article-title":"The content validity index: Are you sure you know what\u2019s being reported? Critique and recommendations","volume":"29","author":"Polit","year":"2006","journal-title":"Res. Nurs. Health"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1093\/poq\/nfm006","article-title":"Research Synthesis: The Practice of Cognitive Interviewing","volume":"71","author":"Beatty","year":"2009","journal-title":"Public Opin. Q."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Willis, G. (2005). Cognitive Interviewing: A Tool For Improving Questionnaire Design, Sage Publications.","DOI":"10.1037\/e538062007-001"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Converse, J.M., and Presser, S. (1986). Survey Questions: Handcrafting the Standardised Questionnaire, Sage Publications, Inc.","DOI":"10.4135\/9781412986045"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1093\/pan\/mpg004","article-title":"Response Latency Methodology for Survey Research: Measurement and Modeling Strategies","volume":"11","author":"Mulligan","year":"2003","journal-title":"Polit. Anal."},{"key":"ref_48","unstructured":"Rossi, P.H., Wright, J.D., and Anderson, A.B. (1983). Chapter 6\u2014Questionnaire Construction and Item Writing. Handbook of Survey Research, Academic Press."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1002\/nur.4770160310","article-title":"Focus on psychometrics. Development and administration of a survey instrument for cross-cultural research","volume":"16","author":"Ferketich","year":"1993","journal-title":"Res. Nurs. Health"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1007\/s11165-016-9602-2","article-title":"The Use of Cronbach\u2019s Alpha When Developing and Reporting Research Instruments in Science Education","volume":"48","author":"Taber","year":"2018","journal-title":"Res. Sci. Educ."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1037\/met0000121","article-title":"A diagnostic procedure to detect departures from local independence in item response theory models","volume":"23","author":"Edwards","year":"2018","journal-title":"Psychol. Methods"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1007\/s11136-018-1798-3","article-title":"COSMIN guideline for systematic reviews of patient-reported outcome measures","volume":"27","author":"Prinsen","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"166.e7","DOI":"10.1016\/j.amjmed.2005.10.036","article-title":"Current concepts in validity and reliability for psychometric instruments: Theory and application","volume":"119","author":"Cook","year":"2006","journal-title":"Am. J. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1111\/j.1547-5069.2007.00161.x","article-title":"A psychometric toolbox for testing validity and reliability","volume":"39","author":"DeVon","year":"2007","journal-title":"J. Nurs. Scholarsh."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"1737","DOI":"10.1111\/hex.13313","article-title":"Barriers and facilitators of shared decision making in acutely ill inpatients with schizophrenia-Qualitative findings from the intervention group of a randomised-controlled trial","volume":"24","author":"Becher","year":"2021","journal-title":"Health Expect."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Kaminskiy, E., Zisman-Ilani, Y., Morant, N., and Ramon, S. (2021). Barriers and Enablers to Shared Decision Making in Psychiatric Medication Management: A Qualitative Investigation of Clinician and Service Users\u2019 Views. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.678005"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/jep.12734","article-title":"Guidance on guidelines: Understanding the evidence on the uptake of health care guidelines","volume":"24","author":"Brennan","year":"2018","journal-title":"J. Eval. Clin. Pract."},{"key":"ref_58","unstructured":"Fink, A.G., and Kosecoff, J. (1996). How to Conduct Surveys: A Step-by-Step Guide, SAGE Publications, Inc.. [2nd ed.]."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"O\u2019Cathain, A., and Thomas, K.J. (2004). Any other comments?\u201d Open questions on questionnaires\u2014A bane or a bonus to research?. BMC Med. Res. Methodol., 4.","DOI":"10.1186\/1471-2288-4-25"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1007\/s11136-018-1829-0","article-title":"COSMIN methodology for evaluating the content validity of patient-reported outcome measures: A Delphi study","volume":"27","author":"Terwee","year":"2018","journal-title":"Qual. Life Res."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1177\/0748175613513808","article-title":"Critical Values for Lawshe\u2019s Content Validity Ratio: Revisiting the Original Methods of Calculation","volume":"47","author":"Ayre","year":"2014","journal-title":"Meas. Eval. Couns. Dev."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1002\/nur.20199","article-title":"Is the CVI an acceptable indicator of content validity? Appraisal and recommendations","volume":"30","author":"Polit","year":"2007","journal-title":"Res. Nurs. Health"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"119","DOI":"10.4300\/JGME-D-11-00075.1","article-title":"A primer on the validity of assessment instruments","volume":"3","author":"Sullivan","year":"2011","journal-title":"J. Grad. Med. Educ."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/j.1745-3992.1991.tb00183.x","article-title":"Understanding Reliability","volume":"10","author":"Traub","year":"1991","journal-title":"Educ. Meas. Issues Pract."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1111\/j.1365-2929.2004.01932.x","article-title":"Reliability: On the reproducibility of assessment data","volume":"38","author":"Downing","year":"2004","journal-title":"Med. Educ."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1136\/bmj.314.7080.572","article-title":"Cronbach\u2019s alpha","volume":"314","author":"Bland","year":"1997","journal-title":"BMJ"},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.2147\/PPA.S141391","article-title":"Internal consistency and item-total correlation of patient-reported outcome instruments and hemophilia joint health score v2.1 in US adult people with hemophilia: Results from the Pain, Functional Impairment, and Quality of life (P-FiQ) study","volume":"11","author":"Wang","year":"2017","journal-title":"Patient Prefer. Adherence"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1177\/0193945903252998","article-title":"Two quantitative approaches for estimating content validity","volume":"25","author":"Wynd","year":"2003","journal-title":"West J. Nurs. Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1097\/00006199-198611000-00017","article-title":"Determination and quantification of content validity","volume":"35","author":"Lynn","year":"1986","journal-title":"Nurs. Res."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/6\/361\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T04:14:31Z","timestamp":1782188071000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/6\/361"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,16]]},"references-count":69,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["curroncol33060361"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33060361","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,16]]}}}