title: Preliminary evaluation of the reliability and validity of the Shame and Stigma Scale in head and neck cancer.
abstract: BACKGROUND
  Facial disfigurement from head and neck cancer can lead to the development of shame and a perception of stigma. We sought to develop the Shame and Stigma Scale (SSS) to measure this. Items were administered to 104 patients with squamous cell carcinoma of the oral cavity, together with measures of quality of life and adaptation. Exploratory factor analysis and item response theory (IRT) models assessed its psychometric properties.
  
  
  RESULTS
  A 20-item SSS had a Cronbach's alpha of 0.94 and 4 factors: shame with appearance, sense of stigma, regret, and speech/social concerns. These factors show satisfactory internal validity, convergent validity with the Functional Assessment of Cancer Therapy-General (FACT-G) and Functional Assessment of Cancer Therapy-Head and Neck (FACT-H&N), Demoralization Scale and Patient Health Questionnaire (PHQ) Depression, and divergent validity with the Social Desirability Scale. The items displayed desirable properties in factor-specific (IRT) models.
  
  
  CONCLUSIONS
  Further validation studies are worthwhile to confirm this factor structure, reliability, and validity, and generalizability to all head and neck cancers.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA. Kissaned@mskcc.org
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.forename: Snehal G
authors.initials: SG
authors.lastname: Patel
authors.forename: Raymond E
authors.initials: RE
authors.lastname: Baser
authors.forename: Rachel
authors.initials: R
authors.lastname: Bell
authors.forename: Maria
authors.initials: M
authors.lastname: Farberov
authors.forename: Jamie S
authors.initials: JS
authors.lastname: Ostroff
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
authors.forename: Bhuvanesh
authors.initials: B
authors.lastname: Singh
authors.forename: Dennis H
authors.initials: DH
authors.lastname: Kraus
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
mesh_terms: D000222:Adaptation, Physiological; D000223:Adaptation, Psychological; D000367:Age Factors; D001828:Body Image / Q000523:psychology; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000523:psychology / Q000601:surgery; D006801:Humans; D008297:Male; D009062:Mouth Neoplasms / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D037981:Neck Dissection / Q000379:methods / Q000523:psychology*; D011788:Quality of Life; D015203:Reproducibility of Results; D018570:Risk Assessment; D012649:Self Concept; D012737:Sex Factors; D012752:Shame; D018434:Sickness Impact Profile; D057545:Social Stigma; D011795:Surveys and Questionnaires