New tool helps nurses spot anxiety in young cancer patients

Background: Pictorial instruments can facilitate the assessment of anxiety levels in children and support nurses in selecting appropriate interventions. Aim: This study aimed to analyse the validity and reliability of the Children’s Anxiety Questionnaire Brazilian version (CAQ-BR) in children and adolescents with cancer who are undergoing chemotherapy in a Brazilian context. Methods: A multicentre psychometric evaluation of the CAQ-BR was conducted in three hospitals in São Paulo, Brazil, between 2020 and 2022. We included children aged 4–12 years, who completed the CAQ-BR based on four facial expressions – Happy/Content, Calm/Relaxed, Tense/Nervous, and Worried/Afraid – and evaluated the emotions of fictional characters. The Visual Analog Scale (VAS) was used for comparison. Data were analysed using classical test theory, including Cronbach’s alpha for internal consistency, item discrimination indices, and Fleiss Kappa for agreement analysis. Results: The study included 48 children aged 4–12 years (average age = 8.2 ± 0.70), 69% of whom were male. The CAQ-BR discrimination indices for the items ‘Happy/Content’, ‘Calm/Relaxed’, ‘Tense/Nervous’, and ‘Worried/Afraid’ were 0.917, 0.833, 0.667 and 0.667, respectively. For the characters, the discrimination indices were 0.583, 0.750, 0.833 and 0.750, respectively. A significant age-related difference was observed for the item ‘Tense/Nervous’, with younger children reporting lower anxiety compared to older ones ( p = 0.003). Low internal consistency (α = 0.51–0.53) is attributable to the low number of items. Conclusion: The CAQ-BR provides preliminary evidence of validity, though reliability was not fully supported. The tool is useful in paediatric nursing as a quick, pictorial, method to assess children’s anxiety and enhance communication, but further research is needed for its application in younger children.