Development and validation of the Adult Oncology Fall Risk Assessment Scale

Abstract Background Cancer is a significant public health issue. Cancer treatments can alter cognitive function, balance, muscle strength, as well as sensory and organ functions—all of which may increase the risk of falls among oncology patients. This study aims to develop and validate a fall risk assessment scale specifically designed for adult cancer patients, aiming to enhance nurses' ability to identify fall risks in this population and ultimately reduce fall-related incidents Methods A multi-method and multi-phase design was adopted. Phase one comprised developmental tasks to generate scale items, based on a meta-analysis of fall-related factors in adult cancer patients, case-control studies, and semi-structured interviews, The scale was developed through two rounds of Delphi expert consultation. We conveniently sampled 310 adult cancer patients admitted to cancer-specialized hospitals and oncology departments of general hospitals in Yunnan Province from October to November 2024 were recruited for questionnaire surveys and assessed structural validity, internal reliability, split-half reliability, Data collection included a general information questionnaire, the newly developed Adult Oncology Fall Risk Assessment Scale(AOFRS), and the Morse Fall Scale (MFS). Patients were followed up for three months to monitor fall incidents, allowing for psychometric validation of the scale and determination of risk thresholds. Results The AOFRS comprises five dimensions (physical function factors, disease-related factors, treatment-related factors, symptom factors, and cognitive factors) with a total of 19 items. The overall Cronbach’s α coefficient was 0.87, and the split-half reliability was 0.82. The scale showed a positive correlation with MFS scores (r=0.51, P<0.01). The area under the ROC curve (AUC) for predicting fall risk in adult cancer patients was 0.827, with a cutoff value of 9.5 points, a sensitivity of 0.647, and a specificity of 0.833. The risk stratification of the scale was as follows: <9 points indicated low fall risk; 9~14 points indicated moderate fall risk; and≥14 points indicated high fall risk. Among adult cancer patients, 70% of those classified as high-risk by this scale experienced falls, compared to 36.84% of those classified as high-risk by the MFS, with a statistically significant difference (χ²=3.845, P=0.05). Conclusions The AOFRS demonstrated good reliability and validity in this study. It exhibited superior predictive performance for fall of adult cancer patients compared to MFS, enabling healthcare providers to accurately evaluate fall risk in adult cancer patients and serving as a valuable reference for implementing targeted preventive interventions.