Dana-Farber Cancer Institute.
Cancer Prevention Research Center.
J Consult Clin Psychol. 2019 Mar;87(3):234-245. doi: 10.1037/ccp0000369. Epub 2018 Dec 27.
Cancer is one of the most physically and emotionally debilitating diseases. Despite evidence that psychosocial care can improve psychological and physiological functioning, as few as 4.4% of patients are willing to engage in psychosocial treatment. Few studies explored drivers of psychosocial care underutilization. Therefore, treatment engagement strategies are needed, by identifying patients' barriers to psychosocial treatment. This study evaluated readiness to utilize psychosocial care by developing transtheoretical model (TTM) measures of stage of change, decisional balance, and self-efficacy.
Online survey data was collected from a national sample of 475 adults ( = 47.89, = 14.77) with cancer diagnoses. A sequential process of measure development was used. Semistructured expert and research participant interviews were conducted for initial item development, followed by exploratory, confirmatory, and external validation analyses.
Principal components analyses (PCA) indicated two, 4-item factors (pros α = .874; cons α = .716) for decisional balance. Confirmatory factor analyses (CFA) supported a 2-factor correlated model, χ²(19) = 68.56, CFI = .962, RMSEA = .078. For self-efficacy, PCA indicated two, 3-item components (physical α = .892; social/emotional α = .708). CFA supported this structure χ²(8) = 23.72, CFI = .989, RMSEA = .067. Physical component items included fatigue, pain, and discomfort. Multivariate analyses indicated significant cross-stage differences for pros, cons, and self-efficacy.
Findings support the validity of the developed stage of change, 8-item decisional balance, and 6-item self-efficacy measures for psychosocial care. Clinicians could use these tools to address perceived cons of psychosocial care, including shame and self-efficacy (e.g., using psychosocial care despite pain). These scales may help treatment teams better address barriers to psychosocial care utilization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
癌症是对身体和精神伤害最大的疾病之一。尽管有证据表明心理社会关怀可以改善心理和生理功能，但只有不到 4.4%的患者愿意接受心理社会治疗。很少有研究探讨心理社会保健利用率低的驱动因素。因此，需要通过确定患者接受心理社会治疗的障碍来制定治疗参与策略。本研究通过开发跨理论模型（TTM）的变化阶段、决策平衡和自我效能度量来评估利用心理社会护理的准备情况。
从全国范围内患有癌症的 475 名成年人（n = 475，M = 47.89，SD = 14.77）中收集了在线调查数据。使用了一个顺序的度量开发过程。半结构化的专家和研究参与者访谈用于初始项目开发，随后进行了探索性、验证性和外部验证分析。
主成分分析（PCA）表明，决策平衡有两个 4 项因素（赞成α=.874；反对α=.716）。验证性因素分析（CFA）支持了一个两因素相关模型，χ²（19）= 68.56，CFI =.962，RMSEA =.078。对于自我效能，PCA 表明有两个 3 项成分（身体α=.892；社会/情感α=.708）。CFA 支持这一结构，χ²（8）= 23.72，CFI =.989，RMSEA =.067。身体成分项目包括疲劳、疼痛和不适。多变量分析表明，在赞成、反对和自我效能方面存在显著的跨阶段差异。
研究结果支持为心理社会护理开发的变化阶段、8 项决策平衡和 6 项自我效能度量的有效性。临床医生可以使用这些工具来解决心理社会保健的负面认知，包括羞耻感和自我效能（例如，尽管有疼痛但仍使用心理社会保健）。这些量表可能有助于治疗团队更好地解决心理社会保健利用率低的障碍。
