Vos Martina S, Putter Hein, Leurs Amber, Rooijmans Harry G M, de Haes Hanneke C J M, van Houwelingen Hans C
Department of Psychiatry, Bronovo Hospital, Bronovolaan 5, 2597 AX The Hague, The Netherlands.
Patient Educ Couns. 2007 Jul;67(1-2):224-34. doi: 10.1016/j.pec.2007.03.019. Epub 2007 May 11.
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.
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.
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.
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.
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.
基于魏斯曼和哈克特对否认的全面定义，开发了一种半结构化访谈来测量癌症患者的否认情况。癌症否认访谈（DCI）既涵盖患者对其疾病经历的叙述，也包括专家对患者叙述中否认程度的印象。本文描述了该工具的开发过程及首次心理测量分析。
DCI的开发基于临床观察、八位专业精神科医生的专家意见以及三项小型试点研究以评估可行性。DCI由两部分组成：一个半结构化访谈，包括九个由患者回答的特定项目，以及两个涵盖访谈者对患者否认类型和程度的临床印象的项目。在基线评估（T2 - 4）后的第8、16和32周进行随访访谈。为测量评分者间信度，访谈进行了录音，并由一名访谈者和该研究的一名同事独立评分。
对195名连续新诊断的肺癌患者进行了访谈。DCI的内部一致性（克朗巴哈系数）在首次访谈时为0.84，在T2 - 4时分别为0.85、0.82和0.83。评分者间一致性在DCI整体和患者评估量表方面良好，在临床印象项目方面令人满意。内容效度得到临床观察、深入开放式访谈和专家意见的支持。
DCI被证明是一种测量肺癌患者否认情况的可行且可靠的工具。在其他肿瘤学环境中的进一步测试将有助于了解其更广泛的适用性。
DCI可用于未来关于癌症患者否认情况的研究。了解否认及其背景将有助于我们充分应对患者的否认并与他们进行沟通。
