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Mesters, Ilse; van den Borne, H; McCormick, L; Pruyn, J; de Boer, M; Imbos, T. Openness to discuss cancer in the nuclear family: Scale, development, and validation. Psychosomatic Medicine. Vol 59(3) May-Jun 1997, 269-279.
AN: Peer Reviewed Journal: 1997-04682-009.

Openness to Discuss Cancer in the Nuclear Family: Scale, Development, and Validation
[Original Article]
Mesters, I. PhD; van denBorne, H. PhD; McCormick, L. DrPH; Pruyn, J. PhD; de Boer, M. MD; Imbos, T. PhD
From the Faculty of Health Sciences, Department of Health Education (I.M., H.vdB.), and Department of Methodology & Statistics(T.I.), University of Limburg, The Netherlands; University of Texas Health Science Center, Center for Health Promotion Research & Development (L.McC.), School of Public Health, Houston Texas;Institute for Health and Environmental Issues (IGO) (J.P.), The Netherlands; and Department of Head and Neck Surgery (M. dB.), University Hospital Dr. Daniel den Hoed Cancer Clinic, The Netherlands.
Address reprint requests to: Ilse Mesters, PhD, University of Limburg, Department of Health Education, PO Box 616, 6200 MD Maastricht, The Netherlands.
Received for publication March 8, 1995;revision received April 24, 1996.
Objective: To describe the development and validation of a scale for assessing openness to discuss cancer in the family. Method: Two studies were conducted. Study 1 was a cross-sectional study designed to test the factor structure of the scale. Four hundred ninety-eight patients with either breast cancer or Hodgkin's disease were interviewed. In Study 2,a longitudinal study, 133 patients with cancer in the head and neck were tested at four points in time: just before treatment, 6 weeks, 13 weeks, and 52 weeks after treatment. Study 2 aimed to confirm the factor structure established in Study 1, to test for construct validity in a new population, to test the psychometric properties of the Openness Scale, and to test the scale's sensitivity tochange. Results: In Study 1, a one-factor solution was revealed, resulting in a scale of eight items. In Study 2, the factor structure found in Study 1 was confirmed. In line with theoretical expectations, subjects who perceived their communication about cancer as more open showed more positive rehabilitation outcomes especially at 13 weeks after treatment (less uncertainty, fewer negative feelings,more control, higher self-esteem, fewer psychological and physical complaints). Furthermore, more open communication related with more support by family members and more discussion with the partner. The scale was found to be stable over time. Conclusions: The scale's construction and subsequent analysis show that open discussion of problems (related to cancer) in the family can be measured reliablywith an eight-item instrument. Additional validation of the scale is indicated.

Key words: cancer, communication, openness, measurement instrument, validity, family.
Talking about one's cancer and openly expressing one's concerns and feelings within the nuclear family (the husband-wife pair and one or more children) can be a way that enables patients and theirfamilies to cope with the disease [1,2].
There are several threats to open discussion of cancer in the family. The assumption that one should be optimistic around the cancer patient and the belief that the patient should avoid thinking about negative aspects of the situation may lead family members to avoid discussing the patient's problems, thereby reducing the openness of communication [3]. Besides,family members often have contradictory or negative feelings about the cancer. Although they want to be compassionate and understanding, they are often afraid of cancer and are inclined to avoid discussing topics related to cancer [3,4]. This contradiction may present itself in a tense relationship with the patient, which does not stimulate open communication [4]. Also, patients themselves are...
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