Development and validation of the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer) Michael S. Wolf a,b,c , Chih-Hung Chang b,c,d , Terry Davis e , Gregory Makoul a,b,c, * a Program in Communication and Medicine, Northwestern University Feinberg School of Medicine, 676 North St. Clair, Suite 200, Chicago, IL 60611, USA b Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA c Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA d Buehler Center on Aging, Northwestern University Feinberg School of Medicine, Chicago, IL, USA e Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center at Shreveport, Chicago, IL, USA Received 10 February 2004; received in revised form 31 August 2004; accepted 4 September 2004 Abstract We sought to develop a reliable and valid measure of patient self-efficacy within the context of productive communication and positive attitude for cancer patients. A set of 19 potential items for the Communication and Attitudinal Self-Efficacy scale for cancer (CASE-cancer) was pilot tested with 50 cancer patients. Based on the pilot test, item valence was made consistent (i.e., all items worded positively) and the response scale was simplified. The CASE-cancer was then administered to 127 persons receiving cancer treatment at general oncology clinics in Shreveport, Louisiana and Chicago, Illinois. Psychometric analyses revealed three 4-item factors: understanding and participating in care, maintaining a positive attitude, and seeking and obtaining information. The CASE-cancer proved to have high internal consistency and construct validity. Moreover, scale items performed similarly across literacy levels. The CASE-cancer is a psychometrically-sound tool that may provide new information on important mediating factors of cancer care. Our two-step approach to presenting response options may also provide a model for helping lower literate patients more accurately respond to survey items. # 2004 Elsevier Ireland Ltd. All rights reserved. Keywords: Cancer; Communication; Attitude; Self-efficacy; Literacy 1. Introduction Each year, over 1 million individuals in the United States are diagnosed with some form of cancer [1]. These patients contend with extensive physical and psychological ramifi- cations of both the disease and associated treatment regimens, which cause significant strains on their existing personal and social resources [2–7]. In spite of such limitations, cancer patients must continue to function in a variety of roles related to their care. For instance, patients routinely interact with medical providers and allied health professionals, and are expected to possess a basic under- standing of treatment regimens and options, actively participate in healthcare decisions, and simultaneously cope with the everyday psychosocial stressors associated with the disease and treatment side effects. Patients who do not fulfill these roles have been found to be at greater risk for anxiety and depression [8]. While it is far from clear that psychological coping styles affect cancer survival and recurrence [9], there is little question that the quality of communication and perseverance of positive attitude have ramifications for the management of cancer; both have been recognized as being personally meaningful to patients [10–12]. Moreover, a patient’s attitude toward cancer and related care may influence communication with physicians and other healthcare professionals, since providers may expect and encourage a fighting spirit or positive attitude [13]. Despite the obvious complexity and difficulty surrounding cancer care, pre- sumptions are often made about a patient’s ability to seek and obtain information, understand and participate in care, www.elsevier.com/locate/pateducou Patient Education and Counseling 57 (2005) 333–341 * Corresponding author. Tel.: +1 312 695 4959; fax: +1 312 695 0951. E-mail address: makoul@northwestern.edu (G. Makoul). 0738-3991/$ – see front matter # 2004 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2004.09.005