For patients with cancer, sleep disturbance is commonplace. Using classical test theory and Rasch analyses, the present study compared two commonly used psychometric instruments for insomnia-Athens Insomnia Scale (AIS) and Insomnia Severity Index (ISI)-among patients with advanced cancer. Through convenience sampling, patients with cancer at stage III or IV (n=573; 326 males; mean age=61.3 years; SD=10.7) from eight oncology units of university hospitals in Iran participated in the study. All the participants completed the AIS, ISI, Edmonton Symptom Assessment Scale (ESAS), Hospital Anxiety and Depression Scale (HADS), General Health Questionnaire-12 (GHQ-12), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI). Additionally, 433 participants wore an Actigraph device for two continuous weekdays. Classical test theory and Rasch analysis both supported the construct validity for AIS (factor loadings from confirmatory factor analysis [CFA] = 0.61 to 0.87; test-retest reliability = 0.72 to 0.82; infit mean square [MnSq] = 0.81 to 1.17; outfit MnSq = 0.79 to 1.14) and for ISI (factor loadings from CFA = 0.61 to 0.81; test-retest reliability = 0.72 to 0.82; infit MnSq = 0.72 to 1.14; outfit MnSq = 0.76 to 1.11). Both AIS and ISI had significant associations with ESAS, HADS, GHQ-12, ESS, and PSQI, as well as having good sensitivity and specificity. Significant differences in the actigraphy measure were found between insomniacs and non-insomniacs based on AIS or ISI score. With promising results, healthcare providers can use either AIS or ISI to understand the insomnia of patients with advanced cancer.

Women with breast cancer are at risk of being overweight/obese which may consequently increase mortality. Intuitive eating is an adaptive eating behavior which might be beneficial for weight outcomes. The present study validated the Persian Intuitive Eating Scale-2 (IES-2) among overweight/obese Iranian females with breast cancer. Women who were overweight/obese with breast cancer (n = 762; mean ± SD age = 55.1 ± 5.7 years) completed the following questionnaires: IES-2, General Self-Efficacy Scale (GSE-6), Hospital Anxiety and Depression Scale (HADS), Short Form-12 (SF-12), Weight Bias Internalization Scale (WBIS), Body Appreciation Scale-2 (BAS-2), and Eating Attitudes Test (EAT-26). Confirmatory factor analysis (CFA) and Rasch analysis were applied to examine the psychometric properties of the IES-2. Associations between IES-2 score and other scale scores were assessed. CFA and Rasch analysis suggested that the Persian IES-2 had robust psychometric properties and all IES-2 items were meaningful in their embedded domains. The four-factor structure of the Persian IES-2 was confirmed. Concurrent validity was supported by the positive correlations between the IES-2 score and scores on the GSE-6, SF-12 mental component, and BAS-2. Negative correlations were found between the IES-2 score and the HADS (anxiety and depression subscales), WBIS, and EAT-26. The present study demonstrated that the Persian IES-2 is a well-designed instrument and is applicable for women who are overweight/obese with breast cancer.

Objective To identify determinants of shared decision making in patients with multiple myeloma (MM) to facilitate the design of a program to maximize the effects of shared decision making. Methods This prospective longitudinal study recruited 276 adult patients (52% male, mean age 62.86 y, SD 15.45). Each patient completed the eHealth Literacy Scale (eHEALS), Multidimensional Trust in Health Care Systems Scale (MTHCSS), Patient Communication Pattern Scale (PCPS), and 9‐Item Shared Decision‐Making Questionnaire (SDM‐Q‐9) at baseline and the SDM‐Q‐9 again 6 months later. One family member of the patient completed the Family Decision‐Making Self‐Efficacy (FDMSE) at baseline. Structural equation modeling (SEM) was used to investigate the associations between eHealth literacy (eHEALS), trust in the health care system (MTHCSS), self‐efficacy in family decision making (FDMSE), patient communication pattern (PCPS), and shared decision making (SDM‐Q‐9). Results SEM showed satisfactory fit (comparative fit index = 0.988) and significant correlations between the following: eHealth literacy and trust in the health care system (β = 0.723, P < 0.001); eHealth literacy and patient communication pattern (β = 0.242, P < 0.001); trust in the health care system and patient communication pattern (β = 0.397, P < 0.001); self‐efficacy in family decision making and patient communication pattern (β = 0.264, P < 0.001); eHealth literacy and shared decision making (β = 0.267, P < 0.001); and patient communication pattern and shared decision making (β = 0.349, P < 0.001). Conclusions Patient communication and eHealth literacy were found to be important determinants of shared decision making. These factors should be taken into consideration when developing strategies to enhance the level of shared decision making.

Background: Systemic lupus erythematosus (SLE) is a systemic autoimmune disease characterized by activation of T and polyclonal B lymphocytes. IL-18 was originally identified as a factor which enhances IFN-γ production and is a potent inducer of the inflammatory mediators by T cells, causing severe inflammatory disorders in SLE. Objectives: This study aimed to evaluate the association of plasma interlukine-18 (IL-18) concentration and severity of lupus nephritis (LN) and disease activity in SLE patients. Patients and Methods: In this cross-sectional study, 113 patients with SLE and 50 healthy individuals were examined. Serum level of IL-18 was measured. The severity and activity of the disease was determined by Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. The severity of kidney involvement was studied by renal biopsy, serum creatinine and 24 hours urine protein level. Results: The mean level of serum IL-18 was significantly higher in the patients than controls (577.67 ± 649.95 versus 60.48 ± 19.53 pg/ml; P < 0.001). In SLE patients with active disease level of serum IL-18 was significantly higher than chronic disease (622.77 ± 716.54 versus 182 ± 184.37 pg/ml; P < 0.001). The serum level of IL-18 was significantly higher in stage IV (P < 0.001) and V (P < 0.001) of patients with LN, than other stages. Conclusions: The current study showed that the serum IL-18 is significantly higher in the patients than controls and it significantly correlated with sever renal involvement and disease activity in SLE patients.

Background: This study investigated the psychometric properties of the 9-Item Shared DecisionMaking Questionnaire (SDM-Q-9) and the 9-Item Shared Decision-Making Questionnaire–Physician version (SDM-Q-Doc) using comprehensive and thorough psychometric methods in an oncology setting. Methods: Cancer survivors (n=1783; 928 [52.05%] males) and physicians (n=154; 121[78.58%] males) participated in this study. Each cancer survivor completed the SDM-Q-9. Physicians completed the SDM-Q-Doc for each of their cancer patient. Confirmatory factor analysis (CFA) and Rasch model were used to test the psychometric properties of SDM-Q-9 and SDM-Q-Doc. Results: SDM-Q-9 and SDM-Q-Doc demonstrated unidimensional structure in CFA and Rasch model. In addition, the measurement invariance was supported for both SDM-Q-9 and SDM-QDoc across sex using the multigroup CFA. Rash analysis indicates no differential item functioning(DIF)across sex for all the SDM-Q-9 and SDM-Q-Doc items. SDM-Q-9 and SDM-Q-Doc were moderately correlated (r=0.41; P<0.001). Conclusion: SDM-Q-9 and SDM-Q-Doc are valid instruments to assess shared decision making in the oncology setting.