Development and Validation of the Chinese Physicians' Reactions to Uncertainty Scale for Endoscopy: A Mixed-Methods Approach.

OBJECTIVES: To develop and validate a Chinese Physicians' Reactions to Uncertainty Scale for Endoscopy for assessing endoscopists' reactions to uncertainty in clinical practice. METHODS: Using a mixed-methods design, we translated the original Physicians' Reactions to Uncertainty scale and generated endoscopy-specific items through focus-group interviews. The draft scale was refined through Delphi consultation and then evaluated in an online survey of 360 digestive endoscopists from 204 hospitals in China. Item reduction was based on dispersion, critical ratio, and item-total correlation analyses. Construct validity was assessed using exploratory factor analysis and confirmatory factor analysis. Content validity was evaluated using item-level and scale-level content validity indices, and reliability was examined using Cronbach's alpha and split-half reliability. RESULTS: The final scale comprised 16 items across four dimensions: concerns about uncertainty and bad outcomes, disclosing uncertainty to patients, disclosing mistakes to physicians, and endoscopy-specific uncertainty responses and self-efficacy. In exploratory factor analysis, four factors explained 73.474% of the total variance. Confirmatory factor analysis supported an acceptable four-factor model fit (χ2/df = 2.778, RMSEA = 0.098, IFI = 0.908, TLI = 0.931). Cronbach's alpha was 0.818 for the overall scale and 0.801-0.932 for the subscales. Split-half reliability was 0.919. Item-level content validity indices ranged from 0.86 to 1.00, and the scale-level content validity index was 0.96. CONCLUSIONS: The Chinese Physicians' Reactions to Uncertainty Scale for Endoscopy is a reliable and valid instrument for assessing endoscopists' reactions to uncertainty in China.