Patient empowerment in the context of familial cancer burden: Development and psychometric evaluation of the Familial Cancer Empowerment Scale (FCES)

Klein, Katharina, Schüürhuis, Stephen, Thomas, Paula, Stegen, Steffi, McAllister, Marion, Speiser, Dorothee, Feufel, Markus A., Kowalski, Christoph and Kendel, Friederike 2027. Patient empowerment in the context of familial cancer burden: Development and psychometric evaluation of the Familial Cancer Empowerment Scale (FCES). Patient Education and Counseling 154 , 110365. 10.1016/j.pec.2026.110365

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Abstract

Objectives Individuals with familial cancer risk often experience emotional strain and face complex decisions. Empowerment enables patients to engage actively and make informed choices. Although the Genetic Counselling Outcome Scale (GCOS-24) measures empowerment in genetic counseling, no tailored instrument exists for individuals with familial cancer risk. The aim of this study was to develop and evaluate a concise scale for this purpose based on the GCOS. Methods The Familial Cancer Empowerment Scale (FCES) was developed using the TRAPD method. The GCOS-24 was translated, adapted and shortened by an expert panel including patient representatives. Comprehensibility and relevance were assessed in cognitive interviews and were analysed using structured content analysis. The final FCES was evaluated in a cross-sectional online survey. Acceptability was assessed alongside a psychometric evaluation comprising item characteristics, exploratory factor analysis, and internal consistency. Results The FCES comprised ten items. Seven cognitive interviews indicated high comprehensibility and relevance. Evaluation in the cross-sectional survey (n = 194) showed good acceptability and generally satisfactory item performance. Overall internal consistency was satisfactory (ω = 0.82). Exploratory factor analysis supported a three-factor solution, although the factorial allocation of Items 7 and 10 remained ambiguous. Internal consistency was satisfactory for factors 2 and 3 (ω = 0.80 and ω = 0.74, respectively), while the two items defining factor 1 showed a moderate correlation (ρ = 0.53). Conclusion The FCES is the first brief German-language instrument specifically developed to assess empowerment in individuals with familial cancer risk. Initial psychometric findings support its potential utility, while independent validation of the factorial structure and further psychometric evaluation are warranted. Practice implications The FCES can support systematic assessment of patient empowerment in clinical counselling and research, helping identify areas where individuals may need additional information or support. It may also support evaluation of genetic counselling outcomes and inform patient-centred care.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Schools > Medicine
Publisher:	Elsevier
ISSN:	0738-3991
Date of First Compliant Deposit:	12 November 2026
Date of Acceptance:	23 October 2026
Last Modified:	12 Nov 2026 10:00
URI:	https://orca.cardiff.ac.uk/id/eprint/190877

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