Development and validation of the distress inventory for altered bowel functioning in patients undergoing sphincter-preserving surgery for rectal cancer.

Objective: Distress from altered bowel functioning was though as a tragic price of survival in patients underwent sphincter-preserving surgery for rectal cancer. Current questionnaire for assessing quality of life does not comprehensively match the patients' real concern related to the bowel dysfunction. This study aims to develop and validate an instrument for assessing distress from altered bowel functioning in post-operative patients with rectal cancer. Methods: This cross-sectional study was conducted in five phases: (1) definition of the measured concept and creation of the inventory; (2) content validity of the inventory was assessed by experts; (3) face validity was established by patients with altered bowel function after receiving sphincter-preserving surgery; (4) construct validity was validated by exploratory factor analysis and criterion-related validity was test by receiver operating characteristic curve; (5) reliability was assessed. Results: Final version of the inventory comprises 16 items, with a higher score indicating more severe distress from altered bowel functioning. Through exploratory factor analysis, it is across three domains of daily life, emotional regulation and social functioning. Receiver operating characteristic curve analysis for identifying patients with distress of altered bowel functioning revealed an area under the curve value of 0.797. The cutoff score is 9.5. The Cronbach's α coefficients for reliability and test-retest reliability were 0.880 and 0.933, respectively. Conclusions: Distress inventory of altered bowel functioning is a reliable and valid instrument, which can help health care professionals proactively identify patients with distress from altered bowel functioning following sphincter-preserving surgery and provide timely interventions and individualized care.