ArticleFrontiers in psychology2026
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.
Article in Frontiers in psychology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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