Measuring attachment security in patients with advanced cancer: psychometric properties of a modified and brief Experiences in Close Relationships scale

Abstract

Attachment security has been identified as an important buffer of distress in patients with cancer and other medical illnesses but current measures have not been adapted for this population who may be older, in long-term stable relationships, and suffering from considerable disease burden. This study reports on (1) the psychometric properties of a modified 36-item Experiences in Close Relationships scale (ECR), adapted for this population; and (2) the validity of a brief 16-item version of our modified scale. A modified ECR (ECR-M36) was constructed by rephrasing relevant items to refer more generally to people with whom one feels close, instead of specifically in relation to one's romantic partner(s). Patients with metastatic gastrointestinal (GI) and lung cancer completed the ECR-M36 and other scales tapping self-esteem, social support, and depressive symptoms on two occasions within a period of 4-6 months. Based on factor analyses of the ECR-M36, 16 items were selected to form a brief measure (ECR-M16). Factor analyses of both ECR forms revealed a higher-order factor structure in which four first-order factors (Worrying about Relationships, Frustration about Unavailability, Discomfort with Closeness, Turning Away from Others) loaded onto two second-order factors tapping Attachment Anxiety and Avoidance. Both ECR forms were reliable and valid. The ECR-M36 and ECR-M16 are good measures of attachment orientations for use with medically ill, older populations.