[Italian Version of Chemotherapy-induced Alopecia Distress Scale (I-CADS): linguistic cultural adaptation, content validity and psychometrics assessment.]

Distress could be often experienced by breast cancer patients with chemotherapy-induced alopecia. Those distress assessment is strategic to deliver care in a tailored way, enhancing the overall wellbeing. So far, those distress is measurable by the Chemotherapy-induced Alopecia Distress Scale (CADS), which is not yet available in Italian, due to there are no validation studies on this topic. For this reason, the aim of this study was to validate and adapt Chemotherapy-induced Alopecia Distress Scale within the Italian context (I-CADS). Specifically, the following validations were assessed: cultural-linguistic, qualitative and quantitative content validity, psychometrics and internal consistency (reliability) assessments. To answer to the specific aims, the study design was multiphase: 1) firstly, authors provided a linguistic and cultural validation; 2) then a panel of expert (n=16) was involved to assess qualitative and quantitative content validity, using CVR, I-CVIs, S-CVI; finally 3) a cross-sectional sampling was used to establish the psychometric proprieties and the internal consistency. In the third phase the data were analyzed through different exploratory factorial analysis models, using Maximum Likelihood Robust estimator and Geomin factor rotation. I-CADS has 16 items, measuring three domains, which are self-perception, emotivism and social engaging. The items internal consistency (α Cronbach was always major of 0.93) within their domain shows a good reliability. I-CADS could be routinely used to support clinical decision-making, due to it is useful to intercept distress related to low self-perception, emotivism and social engaging. Moreover, I-CAD clear psychometric structure could facilitate its usefulness in those researches where it is needed to measure distress amongst breast cancer patients with chemotherapy-induced alopecia.