Development and validation of the Pulmonary Nodule Malignant Transformation Fear Scale (PN-MTFS) to identify patients at high risk of cancer-related fear: a multicenter study.

OBJECTIVES

To develop and psychometrically validate the Pulmonary Nodule Malignancy Transformation Fear Scale (PN-MTFS), a disease-specific instrument for assessing fear related to the potential malignant transformation of pulmonary nodules, addressing a critical gap left by existing general anxiety or cancer-specific fear scales.

METHODS

A mixed-methods, two-phase study was conducted. In Phase I, qualitative interviews with 12 patients and expert consultation informed the development of the 18-item scale. In Phase II, a multicenter cross-sectional survey involving 579 patients was conducted for comprehensive psychometric validation, including Exploratory (EFA), Confirmatory Factor Analysis (CFA) and Multi-Group Confirmatory Factor Analysis (MGCFA). Multiple linear regression and subgroup analyses were performed to identify factors associated with fear.

RESULTS

EFA supported a two-factor structure: "Behavioral and Somatic Responses" and "Cognitive and Emotional Distress." CFA confirmed the model's adequacy with acceptable fit (CFI = 0.906, RMSEA = 0.068). The PN-MTFS demonstrated excellent internal consistency (total Cronbach's alpha = 0.980), good validity, and high acceptability. Multiple regression identified several independent predictors of higher fear, including female sex, Han ethnicity, higher educational attainment, a positive family history of malignancy, and specific nodule characteristics (multiple, larger size, part-solid/ground-glass type). Subgroup analyses revealed distinct fear-related determinants across different nodule types.

CONCLUSION

The PN-MTFS is a highly reliable, valid, and well-accepted instrument for the specific assessment of malignancy-related fear in patients with pulmonary nodules. Its robust two-factor structure and the identification of key influencing factors support its utility for early psychological screening and the development of targeted, personalized interventions.