The denial of cancer interview: development and first assessment of psychometric properties in lung cancer patients.

OBJECTIVE

Based on Weissman and Hackett's comprehensive definition of denial, a semi-structured interview was developed to measure denial in cancer patients. The denial in cancer interview (DCI) covers both the patients' recount of their illness experience and the expert's impression of the level of denial in the patient story. This paper describes the development and first psychometric analyses of the instrument.

METHOD

The development of the DCI was based on clinical observation, the expert opinion of eight specialised psychiatrist as well as three small pilot studies to assess feasibility. The DCI is composed of two parts: a semi-structured interview consisting of nine specific items to be answered by the patient and two items covering the interviewer's clinical impression of the patient's type and level of denial. Follow-up interviews were held at 8, 16 and 32 weeks after the baseline assessment (T2-4). To measure the inter-rater reliability, interviews were recorded and rated independently by one interviewer and one of the study's co-workers.

RESULTS

One hundred and ninety-five consecutive newly diagnosed lung cancer patients were interviewed. The internal consistency of the DCI (Cronbach's alpha) was 0.84 at first interview and 0.85, 0.82 and 0.83 at T2-4, respectively. The inter-rater agreement was good for the DCI overall and the patient's assessment scale, and satisfactory for the clinical impression items. Content validity was supported by clinical observation, in depth open interviewing and expert opinion.

CONCLUSION

The DCI proved to be a feasible and reliable instrument for measuring denial in lung cancer patients. Further testing in other oncology settings will provide insight in wider applicability.

PRACTICE IMPLICATIONS

The DCI can be used in future studies concerning denial in cancer patients. Insight in denial and its background will help us to adequately address denial in patients and communicate with them.