The measurement of meaning in illness.

A scale is presented that operationalizes the concept of meaning as it is constructed within the context of life-threatening illness. Development of the scale is based on a symbolic interactionist perspective. The reliability and validity of the scale are examined using a sample of 422 persons with a variety of types of cancer at specified points in the illness trajectory. The scale was found to have item-total correlations ranging from 0.50 to 0.73, all significant at P < 0.01, and a Cronbach's alpha of 0.81. A factor analysis indicated the total scale explained 57.3% of the variance. Evidence of the scale's validity was found in its ability to differentiate persons who were newly diagnosed as having non-metastatic cancer from those individuals experiencing the first recurrence of cancer and those with metastatic disease, as well as individuals experiencing a first remission from those experiencing a first recurrence or those with metastatic disease. In addition, using regression analysis meaning was found to be predicted by social support and specific coping strategies, and to be predictive of personal control, body image and psychological adjustment. A bi-directional relationship was demonstrated between the construction of meaning (primarily a cognitive phenomenon) and emotional response, which is congruent with the bi-directional relationship between cognition and emotion as proposed in the theory of Lazarus and Folkman.