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Additional file 1: Appendix 1. Interview Guide (Patient). Appendix 2. Interview Guide (Family Caregiver). Appendix 3. Steps of thematic analysis and translation process.

Additional file 1: Appendix 1. Guide for Focus-GroupDiscussions with Healthcare Professionals

Supplemental digital content is available in the text., Background The Caregiver Reaction Assessment (CRA) is considered one of the well-developed instruments for measuring the multidimensional burden of family caregivers. To date, there is no available validated instrument to assist healthcare professionals in measuring the caregiver’s burden in Indonesia. Objective To translate the CRA from English into Indonesian and to conduct psychometric testing of this CRA–Indonesian version (CRA-ID) with family caregivers of patients with cancer. Methods Cross-cultural translation and psychometric testing were conducted. Confirmatory factor analysis and exploratory factor analysis were performed to check, explore, and confirm the best model for the CRA-ID; internal consistency was also measured. Results A total of 451 respondents participated, of whom 40 were involved in the feasibility testing. Confirmatory factor analysis with the original factors of the CRA revealed that the fit was not satisfactory, and adaptation was needed. Through exploratory factor analysis, the best model fit was developed, and confirmatory factor analysis was performed again. Five factors from the original instrument were confirmed with an explained variance of 54.89%. Almost all items in the CRA-ID appeared to have a similar structure as the original version. Cronbach's α's ranged between .64 and .81. Conclusions The CRA-ID appeared to be feasible, valid, and reliable for measuring the burden of family caregivers of patients with cancer in Indonesia. Implications for Practice Nurses can use the CRA-ID to measure family caregivers’ burden. Its availability in the Indonesian language enhances the opportunity to conduct international comparisons of family caregiver burden using the same instrument.

Cancer patients experience cancer-related fatigue (CRF) that are subjective and persistent. CRF can have a negative impact on psychosocial, spiritual, and self-perceived burden. To understand more deeply about CRF, we need to answer one fundamental question: how are the causal mechanisms (cause-effect) of the factors related to CRF. The studies related so far are still limited to correlation analysis between factors and have not focused on the mechanism of a causal relationship. The purpose of this study is to model the causal relationship between CRF and psychosocial, spiritual, and self-perceived burden, using a causal method called the Stable Specification Search for Cross-Sectional Data With Latent Variables (S3C-Latent). The results of this study are in the form of causal modeling between factors where self-burden has a causal relationship with CRF, spiritual need factors (religion) also have a causal relationship with CRF. Meanwhile, the social support factor (friends) with spiritual needs (religion) does not represent a causal relationship, but there is a strong association relationship. Meanwhile, the social support factor (friends) with CRF did not have a causal relationship or an association relationship between the two variables., Pasien kanker mengalami cancer-related fatigue (CRF) yang bersifat subyektif dan menetap. CRF dapat memberikan dampak negatif terhadap keadaan psikososial, spiritual, dan perasaan beban diri. Untuk memahami tentang CRF, kita perlu menjawab satu pertanyaan mendasar: bagaimana mekanisme kausal (sebab-akibat) dari faktor-faktor yang berhubungan dengan CRF. Studi-studi terkait sejauh ini masih sebatas prediksi atau analisis korelasi antara faktor, dan belum berfokus pada mekanisme hubungan kausal. Tujuan penelitian ini adalah untuk memodelkan hubungan kausal antara CRF dengan faktor psikososial, spiritual, dan perasaan beban diri, menggunakan algoritma kausal yang bernama Stable Specification Search for Cross-Sectional Data With Latent Variables (S3C-Latent). Pada penelitian ini kami menemukan bahwa beban diri menyebabkan CRF dengan reliability score 0.67, faktor kebutuhan spiritual (religi) menyebabkan CRF dengan reliability score 0.73, faktor dukungan sosial (teman) berasosiasi kuat dengan kebutuhan spiritual (religi) dengan reliability score 0.9. Lebih jauh lagi kami tidak menemukan hubungan kausal maupun asosiasi antara faktor dukungan sosial (teman) dan CRF.