{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T06:15:52Z","timestamp":1778652952394,"version":"3.51.4"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychol."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>EFA supported a two-factor structure: \u201cBehavioral and Somatic Responses\u201d and \u201cCognitive and Emotional Distress.\u201d CFA confirmed the model\u2019s adequacy with acceptable fit (CFI\u202f=\u202f0.906, RMSEA\u202f=\u202f0.068). The PN-MTFS demonstrated excellent internal consistency (total Cronbach\u2019s alpha\u202f=\u202f0.980), 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyg.2026.1794189","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T05:55:53Z","timestamp":1778651753000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.3389","volume":"17","author":[{"given":"Xuexing","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Oncology, Anning First People's Hospital Affiliated to Kunming University of Science and Technology","place":["Anning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guozhong","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology","place":["Anning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology","place":["Anning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongjiang","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine, Anning First People's Hospital Affiliated to Kunming University of Science and Technology","place":["Anning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xingxing","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The Third People's Hospital of Honghe Prefecture, Honghe Prefecture Cancer Hospital","place":["Gejiu, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaomin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Oncology, Ziyang Central Hospital","place":["Ziyang, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nuo","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quanfang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Guangxi Medical University","place":["Nanning, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1497","DOI":"10.1016\/j.chest.2024.12.011","article-title":"Neighborhood-level socioeconomic disadvantage and adherence to guidelines for the evaluation of patients with incidentally detected pulmonary nodules","volume":"167","author":"Abrahams","year":"2025","journal-title":"Chest"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1007\/s11469-020-00270-8","article-title":"The fear of COVID-19 scale: development and initial validation","volume":"20","author":"Ahorsu","year":"2020","journal-title":"Int J Ment Health Addict."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"950","DOI":"10.1186\/s12885-016-2839-3","article-title":"Oral cancer incidence and survival rates in the Republic of Ireland, 1994-2009","volume":"16","author":"Ali","year":"2016","journal-title":"BMC Cancer"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1016\/S2468-1253(21)00014-5","article-title":"Prevalence of symptoms of anxiety and depression in patients with inflammatory bowel disease: a systematic review and meta-analysis","volume":"6","author":"Barberio","year":"2021","journal-title":"Lancet Gastroenterol. 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