Infection remains a major barrier to effective cancer treatment due to therapy-related immunosuppression, including neutropenia from conventional and novel anticancer agents. Preventing opportunistic infections is an important component of oncology care, and antimicrobial prophylaxis can reduce infection rates. However, prophylactic antibiotic use must be balanced with antimicrobial stewardship to limit the emergence of antimicrobial resistance. Pharmacists play a key role in optimizing prophylaxis regimens, identifying drug-related problems, and contributing to stewardship efforts. Despite this, validated instruments to assess pharmacists’ specific knowledge and practice around antimicrobial prophylaxis in cancer patients have been limited. The present study aimed to develop and validate a questionnaire to measure hospital pharmacists’ knowledge and practice in this domain, with the goal of identifying gaps and informing targeted educational interventions.
This cross-sectional study used a two-phase design: Phase I for questionnaire development and Phase II for psychometric evaluation. The timeline for the project included questionnaire development from February to March 2025, data collection from 1 April to 30 June 2025, and data analysis in July 2025. The study was conducted in Malaysia and targeted Fully Registered Pharmacists (FRP) working in hospital settings. Provisionally Registered Pharmacists (PRP) and FRP working outside hospitals were excluded.
The main outcome was the creation and validation of a questionnaire assessing pharmacists’ knowledge and practice regarding antimicrobial prophylaxis in oncology. The instrument development combined a structured literature review and multi-round expert review, followed by pilot testing and large-scale distribution via an online survey platform.
An extensive literature search across databases such as OvidMedline, PubMed, and Scopus informed item generation. The knowledge domain was constructed to cover infections in cancer patients, antimicrobial stewardship (AMS), antimicrobial resistance (AMR), pharmacists’ roles in cancer care, infection prevention in oncology, and patient safety/error prevention in prophylactic antimicrobial use. The practice domain focused on common prophylaxis recommendations for cancer patients, management of drug–drug interactions (DDIs), and monitoring and follow-up of prophylactic antimicrobial therapy.
An initial pool of 53 items was created. Content validity was assessed using face validity, pilot testing, and two rounds of the Delphi technique with a five-member expert panel composed of two academic pharmacists, one oncology pharmacist, one oncologist-microbiologist, and one antimicrobial pharmacist. Items were rated on a relevance scale from 1 (least relevant) to 4 (most relevant). Items were retained if they met an item-level content validity index (I-CVI) threshold of at least 0.87. Following expert feedback and pilot testing, the instrument was refined prior to psychometric testing.
Psychometric evaluation included Item Response Theory (IRT) analysis for knowledge items, Exploratory Factor Analysis (EFA) for construct validity across domains, and internal consistency assessment using Cronbach’s alpha. The knowledge items were evaluated with IRT parameters: discrimination, difficulty, and guessing. Acceptable thresholds reported by the study were discrimination ≥0.25, difficulty values within −3 to 3, and guessing parameter ≤0.4.
For practice items and the overall factor structure, EFA was used to examine item correlations with underlying factors; factor loadings >0.4 were considered acceptable. Domains with low reliability—defined in the study as Cronbach’s alpha below 0.6—were reviewed and removed if necessary. The final instrument’s internal consistency was measured by overall Cronbach’s alpha.
After expert review and pilot testing, the instrument was reduced from 53 to 43 items: 29 knowledge items and 14 practice items. IRT analysis applied to the knowledge domain identified acceptable discrimination, difficulty, and guessing parameters for retained items; eight knowledge items were removed following IRT results. EFA demonstrated strong correlations between items and their respective factors, with acceptable factor loadings greater than 0.4 for retained items. One practice-domain factor exhibited a reliability value below 0.6 and was removed from the practice section. The final questionnaire achieved an overall Cronbach’s alpha of 0.83, indicating good internal consistency across items.
The study presents a systematically developed and psychometrically evaluated questionnaire tailored to assess hospital pharmacists’ knowledge and practice regarding antimicrobial prophylaxis in cancer patients. The combination of expert-driven item refinement, IRT for item-level performance, and EFA for domain structure provided multiple layers of validation. The removal of poorly performing items based on IRT and the excision of a low-reliability practice domain reflect iterative refinement to improve construct validity and reliability. The final instrument can be used to identify knowledge and practice gaps among hospital pharmacists and to inform targeted educational or stewardship interventions in oncology settings.
Limitations reported in the source included the study setting being limited to Malaysia and the population restricted to Fully Registered Pharmacists in hospitals; generalizability to other countries or practice settings was not established in the source. The source also indicates the minimal anonymized dataset supporting the findings is publicly accessible via a DOI.
The developed questionnaire demonstrated acceptable psychometric properties, with IRT-supported knowledge items, EFA-confirmed factor structure, and good internal consistency (Cronbach’s alpha = 0.83). The validated 43-item tool offers a reliable measure to evaluate pharmacists’ knowledge and practice on antimicrobial prophylaxis in cancer care and can support future research and targeted educational activities to strengthen pharmacist contributions to infection prevention and antimicrobial stewardship in oncology.
The authors reported that the minimal anonymized dataset underlying the study is publicly available under the title “Questionnaire development- Antimicrobial prophylaxis among cancer patients” at a DOI provided in the article. The publication notes that the authors received no specific funding and declared no competing interests.