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J Consult Clin Psychol. 2019 Mar;87(3):234-245. doi: 10.1037/ccp0000369. Epub 2018 Dec 27.

Measures of psychosocial care utilization in a national sample of cancer patients.

Author information

Dana-Farber Cancer Institute.
Cancer Prevention Research Center.
South County Hospital.
College of Nursing.



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 (Mage = 47.89, SD = 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).

[Indexed for MEDLINE]

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