MGHD 2022

Background Evaluating out-of-pocket (OOP) expenses is important to understand the financial burden incurred by patients undergoing breast cancer diagnostic evaluation in order to inform early detection programs. This study aimed at adapting and testing a tool to measure out-of-pocket (OOP) costs to individuals undergoing evaluation of breast concerns through the Breast Cancer Early Detection (BCED) program at the Butaro Cancer Center of Excellence (BCCOE). The tool adapted in this study, the Cost for Patients Questionnaire (CoPaQ), was originally developed and validated by Maude Laberge in 2021 to measure health-related OOP costs to patients (Laberge et al., 2021). Minor modifications and restructuring were made to the CoPaQ to fit the breast cancer and Rwandan settings. This study was completed in July 2022. Methods We adapted and tested a tool at the BCCOE to measure OOP costs to individuals undergoing evaluation of breast concerns through the BCED program. The CoPaQ, from which our tool was adapted, is made up of 32 questions. Upon review, items on the patient health insurance status were added and the tool was translated to Kinyarwanda language. The resulting adapted tool of 33 items was subjected to face and content validity test. A consensus in a selected panel of 13 experts was calculated to assess the relevance of the items in the adapted tool using the Delphi method. Of the 33 items, 33 were retained, and an additional 9 items were added by the experts. The resulting 42 items were subjected to a four-guideline cognitive test using a Likert-like scale in 4 breast cancer patients that were randomly selected. Results The data collected from the feedback of experts showed high validity of the adapted tool. Consensus in a Delphi method was calculated with a cut-off of 50% of experts’ agreement. However, 2 items that scored 46% in the consensus were retained after considering the specific settings that are unique to BCCOE. The items in the adapted tool were all retained, and the tool had 42 items at the end of the Delphi method. The cognitive testing showed that the participants highly agreed on the score of each guideline (SD<0.3). This means that the participants found the adapted tool to be comprehensible, easy to answer, with easily navigable response options, and well-structured