Die Erfassung der Paarkommunikation bei Patienten mit einer fortgeschrittenen Krebserkrankung: Validierung einer deutschen Version der Couple Communication Scale (CCS)

Zusammenfassung

Hintergrund Bisher liegen nur wenig valide Messinstrumente zur Erhebung der Paarkommunikation bei Krebspatienten für den deutschen Sprachraum vor. Die Couple Communication Scale (CCS) stellt ein etabliertes Instrument zur Erfassung der Paarkommunikation dar. Es liegen jedoch noch keine Untersuchungen zu den psychometrischen Eigenschaften der deutschen CCS-Version vor und die bislang angenommene 1-Faktorenlösung wurde bisher nicht an einer Stichprobe von Patienten mit einer fortgeschrittenen Tumorerkrankung überprüft.

Methode Die CCS wurde im Rahmen der Studie „Managing Cancer and Living Meaningfully“ (CALM) an N=136 Tumorpatienten (≥18 Jahre, UICC-Stadium III/ IV) validiert. Es wurden die psychometrischen Kennwerte der Skala berechnet (Faktorreliabilität, Itemreliabilitäten, durchschnittlich extrahierte Varianz [DEV]) sowie eine konfirmatorische Faktorenanalyse (Maximum-Likelihood-Schätzung) durchgeführt. Die Analyse der Kriteriumsvalidität erfolgte mittels valider Messinstrumente bezüglich Angst (GAD-7), Depressivität (BDI-II) und selbstberichteter Bindungsunsicherheit (ECR-M16).

Ergebnisse Die 1-Faktorenlösung zeigte in der konfirmatorischen Faktorenanalyse einen grenzwertigen, aber noch akzeptablen Modellfit und erklärt 49% der Varianz der Items (DEV). Die CCS weist eine sehr gute Reliabilität auf (Cronbachs α=0,91) und steht im negativen Zusammenhang mit der selbstberichteten Bindungsunsicherheit (ECR-M16: Ängstlichkeit: r=− 0,55, p<0,01; Vermeidung: r=− 0,42, p<0,01) sowie Angstsymptomatik (GAD-7: r=− 0,20, p<0,05) und Depressivität (BDI-II: r=− 0,27, p<0,01).

Schlussfolgerung Die CCS stellt ein reliables und valides Erhebungsinstrument zur Erfassung der Paarkommunikation bei Patienten mit einer fortgeschrittenen Krebserkrankung dar.

Abstract

Background There are only a few valid instruments measuring couples’ communication in patients with cancer for German speaking countries. The Couple Communication Scale (CCS) represents an established instrument to assess couples’ communication. However, there is no evidence regarding the psychometric properties of the German version of the CCS until now and the assumed one factor structure of the CCS was not verified for patients with advanced cancer yet.

Method The CCS was validated as a part of the study “Managing cancer and living meaningfully” (CALM) on N=136 patients with advanced cancer (≥18 years, UICC-state III/IV). The psychometric properties of the scale were calculated (factor reliability, item reliability, average variance extracted [DEV]) and a confirmatory factor analysis was conducted (Maximum Likelihood Estimation). The concurrent validity was tested against symptoms of anxiety (GAD-7), depression (BDI-II) and attachment insecurity (ECR-M16).

Results In the confirmatory factor analysis, the one factor structure showed a low, but acceptable model fit and explained on average 49% of every item’s variance (DEV). The CCS has an excellent internal consistency (Cronbachs α=0,91) and was negatively associated with attachment insecurity (ECR-M16: anxiety: r=− 0,55, p<0,01; avoidance: r=− 0,42, p<0,01) as well as with anxiety (GAD-7: r=− 0,20, p<0,05) and depression (BDI-II: r=− 0,27, p<0,01).

Conclusion The CCS is a reliable and valid instrument measuring couples’ communication in patients with advanced cancer.

Schlüsselwörter

Validierungsstudie - Paarkommunikation - konfirmatorische Faktorenanalyse - fortgeschrittene Krebserkrankung

Key words

validity - couple communication - confirmatory factor analysis - advanced cancer

• Literatur

• 1 Badr H, Acitelli LK, Taylor CLC. Does talking about their relationship affect couples' marital and psychological adjustment to lung cancer?. J Cancer Surviv 2008; 2: 53-64
• 2 Giese-Davis J, Hermanson K, Koopman C. et al. Quality of couples' relationship and adjustment to metastatic breast cancer. J Fam Psychol 2000; 14: 251-266
• 3 Milbury K, Badr H. Sexual problems, communication patterns, and depressive symptoms in couples coping with metastatic breast cancer. Psychooncology 2013; 22: 814-822
• 4 Drabe N, Jenewein J, Weidt S. et al. When cancer cannot be cured: A qualitative study on relationship changes in couples facing advanced melanoma. Palliat Support Care 2016; 14: 652-663
• 5 Higginson IJ, Costantini M. Communication in end-of-life cancer care: A comparison of team assessments in three European countries. J Clin Oncol 2002; 20: 3674-3682
• 6 Zhang AY, Siminoff LA. Silence and cancer: Why do families and patients fail to communicate?. Health Commun 2003; 15: 415-429
• 7 Badr H, Taylor CLC. Sexual dysfunction and spousal communication in couples coping with prostate cancer. Psychooncology 2009; 18: 735-746
• 8 Manne S, Ostroff J, Norton TR. et al. Cancerrelated relationship communication in couples coping with early stage breast cancer. Psychooncology 2006; 15: 234-247
• 9 Northouse LL, Mood DW, Montie JE. et al. Living with prostate cancer: Patients' and spouses' psychosocial status and quality of life. J Clin Oncol 2007; 25: 4171-4177
• 10 Kornblith AB, Regan MM, Kim Y. et al. Cancer-related communication between female patients and male partners scale: A pilot study. Psychooncology 2006; 15: 780-794
• 11 Shin DW, Shin J, Kim SY. et al. Family Avoidance of Communication about Cancer: A Dyadic Examination. Cancer Res Treat 2016; 48: 384-392
• 12 Mowll J, Lobb EA, Lane L. et al. A preliminary study to develop an intervention to facilitate communication between couples in advanced cancer. Palliat Support Care 2015; 13: 1381-1390
• 13 Manne S, Badr H. Intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Psychooncology 2010; 19: 941-954
• 14 Manne S, Badr H, Zaider T. et al. Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. J Cancer Surviv 2010; 4: 74-85
• 15 Olson D, Olson-Sigg A, Larson P. The Couple Checkup: Find your relationship strengths. Nashville, TN: Thomas Nelson; 2008
• 16 Fournier DG, Olson DH, Druckman JM. Assessing marital and premarital relationships: The Prepare-Enrich inventories. In: Filsinger EE. ed. Marriage and family assessment. Newbury: Sage; 1983: 229-250
• 17 Hunter MJ, Davis PJ, Tunstall JR. The influence of attachment and emotional support in end-stage cancer. Psychooncology 2006; 15: 431-444
• 18 Scheffold K, Philipp R, Engelmann D. et al. Efficacy of a brief manualized intervention Managing Cancer and Living Meaningfully (CALM) adapted to German cancer care settings: study protocol for a randomized controlled trial. BMC Cancer 2015; 15: 592
• 19 Katzman R, Brown T, Fuld P. et al. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry 1983; 140: 734-739
• 20 Wade DT, Vergis E. The Short Orientation-Memory-Concentration Test: a study of its reliability and validity. Clin Rehab 1999; 13: 164-170
• 21 Péus D, Newcomb N, Hofer S. Appraisal of the Karnofsky Performance Status and proposal of a simple algorithmic system for its evaluation. BMC Med Inform Decis Mak 2013; 13: 72
• 22 Olson DH, Larson PJ. PREPARE/ENRICH: Customized Version. Minneapolis: Life Innovations; 2008
• 23 Fowers BJ, Olson DH. Enrich marital inventory: A discriminant validity and cross-validation assessment. J Marital Fam Ther 1989; 15: 65-79
• 24 Fournier DG. Validation of PREPARE: A premarital inventory. Unpublished doctoral dissertation St. Paul: University of Minnesota; 1979
• 25 Bracken BA, Barona A. State of the Art Procedures for Translating, Validating and Using Psychoeducational Tests in Cross-Cultural Assessment. Sch Psychol Int 1991; 12: 119-132
• 26 Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory II. San Antonio, TX: Psychological Corporation; 1996
• 27 Hautzinger M, Keller F, Kühner C. BDI-II. Beck-Depressions-Inventar Revision-Manual. Frankfurt: Harcourt Test Services; 2006
• 28 Kühner C, Bürger C, Keller F. et al. Reliability and validity of the Revised Beck Depression Inventory (BDI-II). Nervenarzt 2007; 78: 651-656
• 29 Löwe B, Decker O, Muller S. et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care 2008; 46: 266-274
• 30 Spitzer RL, Kroenke K, Williams JBW. et al. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch Intern Med 2006; 166: 1092-1097
• 31 Lo C, Walsh A, Mikulincer M. et al. Measuring attachment security in patients with advanced cancer: Psychometric properties of a modified and brief Experiences in Close Relationships scale. Psychooncology 2009; 18: 490-499
• 32 Brennan KA, Clark CL, Shaver PR. Self-report measurement of adult attachment: An integrative overview. In: Simpson JA, Rholes WS. ed. Attachment theory and close relationships. New York, NY: Guilford; 1998: 46-76
• 33 Philipp R, Vehling S, Scheffold K. et al. Attachment insecurity in advanced cancer patients: psychometric properties of the German version of the Brief Experiences in Close Relationships Scale (ECR-M16-G). J Pain Symptom Manage 2017; 54: 555-562
• 34 Ferketich S. Focus on psychometrics. Aspects of item analysis. Res Nurs Health 1991; 14: 165-168
• 35 Bagozzi RP, Yi Y. On the evaluation of structural equation models. JAMS 1988; 16: 74-94
• 36 Fornell C, Larcker DF. Evaluating Structural Equation Models with Unobservable Variables and Measurement Error. J Mark Res 1981; 18: 39-50
• 37 Herke M, Hardt J. To impute or not to impute – and if so, how?. Psychother Psych Med 2013; 63: 101-102
• 38 Li Q, Loke AY. A systematic review of spousal couple-based intervention studies for couples coping with cancer: Direction for the development of interventions. Psychooncology 2014; 23: 731-739
• 39 Manne S, Sherman M, Ross S. et al. Couples' support-related communication, psychological distress, and relationship satisfaction among women with early stage breast cancer. J Consult Clin Psychol 2004; 72: 660-670
• 40 Manne S, Badr H. Intimacy and relationship processes in couples’ psychosocial adaptation to cancer. Cancer 2008; 112 11 Suppl 2541-2555
• 41 Donovan-Kicken E, Caughlin JP. Breast cancer patients’ topic avoidance and psychological distress: The mediating role of coping. J Health Psychol 2011; 16: 596-606
• 42 Porter LS, Keefe FJ, Baucom DH. et al. Partner-assisted emotional disclosure for patients with gastrointestinal cancer: Results from a randomized controlled trial. Cancer 2009; 115 18 Suppl 4326-4338
• 43 Arden-Close E, Moss-Morris R, Dennison L. et al. The Couples’ Illness Communication Scale (CICS): Development and evaluation of a brief measure assessing illness-related couple communication. Br J Health Psychol 2010; 15: 543-559
• 44 Regan TW, Lambert SD, Kelly B. et al. Cross-sectional relationships between dyadic coping and anxiety, depression, and relationship satisfaction for patients with prostate cancer and their spouses. Pat Educ Couns 2014; 96: 120-127
• 45 Hinz A, Stöbel-Richter Y, Brähler E. Der Partnerschaftsfragebogen (PFB). Diagnostica 2001; 47: 132-141
• 46 Dinkel A, Balck F. Psychometrische Analyse der deutschen Dyadic Adjustment Scale. Z Psychol 2006; 214: 1-9
• 47 Hilton BA. Family communication patterns in coping with early breast cancer. West J Nurs Res 1994; 16: 366-388