Patient Dignity Inventory (PDI) Questionnaire: The Validation Study in Italian Patients with Solid and Hematological Cancers on Active Oncological Treatments
Restricted accessResearch articleFirst published online July, 2012
Patient Dignity Inventory (PDI) Questionnaire: The Validation Study in Italian Patients with Solid and Hematological Cancers on Active Oncological Treatments
In Oncology, little is known about dignity-related distress and the issues that influence the sense of dignity for patients. We validated the Patient Dignity Inventory (PDI) questionnaire in Italian patients on oncological active treatments.
Methods
After the translation procedures, the PDI was administered to 266 patients along with other questionnaires to assess the psychometric properties of the Italian version of PDI. Factor structure was tested by both explorative and confirmatory factor analyses. Concurrent validity was tested through convergent and divergent validity with validated questionnaires inquiring about physical and psychological symptoms, and religiosity. The test/retest reliability was assessed through the concordance coefficient of Linn (two-week interval, 80 patients).
Results
The explorative analysis suggested one factor only loading highly on all the 25 items (>.45) and explaining the 48% variance; confirmative analysis and Cronbach alpha (0.96) confirmed the adequacy of the one-factor model. In the 2-week test-retest study, a concordance coefficient of 0.73 (95% CI, 0.64–0.83) was found. High correlations of problems with dignity were found with both physical and psychological symptoms (0.52 and 0.64 rho coefficient, respectively), and a moderate inverse correlation with spiritual well being (-.40). The dignity construct, as measured by PDI, proved to be orthogonal to that of religiosity (-.02).
Conclusions
The Italian version of PDI is a valid and reliable tool to evaluate the dignity related-distress in out-patients with solid and hematological cancers, on active oncological treatments, in non advanced stages of the disease.
ChochinovH.M.: Dying, dignity, and new horizon in palliative end-of-life care.CA Cancer J Clin, 56: 84–103, 2006.
3.
ChochinovH.M.: Dignity-conserving care-a new model for palliative care.JAMA, 287: 2253–2260, 2002.
4.
EmanuelE.J., EmanuelL.L.: The promise a good death.Lancet, 351(suppl. 2): S1121–S1129, 1998.
5.
ChochinovH.M., WilsonK.G., EnnsM., LanderS.: Depression, hopelessness, and suicidal ideation in the terminally ill.Psychosomatics, 39: 366–370, 1998.
6.
GrantE., MurrayS.A., KendallM., BoydK., TilleyS., RyanD.: Spiritual issues and needs: perspectives from patients with advanced cancer and nonmalignant disease. A qualitative study.Palliat Support Care, 2: 371–378, 2004.
7.
LinH.R., Bauer-WuS.M.: Psycho-spiritual well-being in patients with advanced cancer: an integrative review of the literature.J Adv Nurs, 44: 69–80, 2003.
8.
McClainC.S., RosenfeldB., BreitbartW.: Effect of spiritual well-being on end-of-life in terminally-ill cancer patients.Lancet, 361: 1603–1607, 2003.
9.
NelsonC.J., RosenfeldB., BreitbartW., GaliettaM.: Spirituality, religion and depression in the terminally ill.Psychosomatics, 43: 213–220, 2002.
10.
SurboneA., BaiderL., WeitzmanT.S., BramesM.J., RittenbergC.N., JohnsonJ.: On behalf of the MASCC Psychosocial Study Group www.massc. Psychosocial care for patients and their families is integral to supportive care in cancer.MASCC position statement Support Care Cancer, 18: 255–263, 2010.
11.
ChochinovH.M.: Dying and the eye of the beholder.J Clin Oncol, 22: 1336–1340, 2004.
12.
SteinhauserK.E., ChristakisN.A., ClippE.C., MecNeillyM., McLntyreL., TlskyJ.A.: Factors considered important at the end of life by patients, family, physicians, and other care providers.JAMA, 284: 2476–2482, 2000.
13.
TurnerK., ChyleR., AggarwalG., PhillipJ., SkeelsA., LickissJ.N.: Dignity in the dying: a preliminary study of patients in the last three days of life.J Palliat Care, 12: 7–13, 1996.
14.
ChochinovH.M., HackT., HassardT., KristjansonsL.J., McClementS.: Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life.J Clinc Oncol, 23: 5520–5525, 2005.
15.
HallS., EdmondsP., HardingR., ChochinovH.M., HigginsonI.J.: Assessing the feasibility, acceptability and potential effectiveness of dignity therpay for people with advance cancer referred to a hospital-based palliative care team: Study protocol.BMC Palliative Care, 8: 1–8, 2009.
16.
ChochinovH.M., KristjansonL.J., BreitbartW., McClementS., HackT.F., HassardT., HarlosM.: Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomized controlled trial.Lancet Oncol, 12: 753–762, 2011.
17.
ChochinovH.M., HackT., HassardT., KristjansonL.J., McClementS., HarlosM.: Dignity in the terminally ill: a cross-sectional cohort study.Lancet, 360: 2026–2030, 2002.
18.
ChochinovH.M., HackT., McClementS., KristjansonL., HarlosM.: Dignity in the terminally ill: an empirical model.Soc Sci Med, 54: 433–443, 2002.
19.
ChochinovH.M., HassardT., McClementS., HackT., KristjansonL.J., HarlosM., SinclairS., MurrayA.: The Patient Dignity Inventory: a novel way of measuring dignity-related distress in palliative care.J Pain Symp Manage, 36: 559–571, 2008.
20.
ZigmondA.S., SnaithR.P.: The Hospital Anxiety and Depression Scale.Acta Psychiatr Scand, 67: 361–370, 1983.
21.
CostantiniM., MussoM., ViterboriP., BonciF., Del MastroL., GarroneO., VenturiniM., MorassoG.: Detecting psychological distress in cancer patient: validity of the Italian version of the Hospital Anxiety and Depressione Scale.Support Care Cancer, 7: 121–127, 1999.
22.
BrueraE., KuehnN., MillerM.J., SelmserP., MacmillanK.: The Edmonton Symptom Assessment Scale (ESAS): a simple method for the assessment of palliative care patients.J Palliative Care, 7: 6–9, 1991.
23.
MoroC., BrunelliC., MiccinesiG., FallaiM., MorinoP., PiazzaM., LabiancaR., RipamontiC.: Edmonton Symptom Assessment Scale: Italian validation in two palliative care settings.Support Care Cancer, 14: 30–37, 2006.
24.
CellaD.F., TulskyD.S., GrayG., SarafianB., LinnE., BonomiA., SilbermanM., YellenS.B., WinicourP., BrannonJ.: The functional Assessment of Cancer Therapy (FACT) scale: development and validation of the general measure.J Clin Oncol, 11: 570–579, 1993.
25.
PetermanA., FitchettG., BradyM.J., HernandezL., CellaD.: Measuring spiritual well being in people with cancer: the Functional Assessment of Chronic Illness Therapy-Spiritual well-being scale (FACIT-Sp).Ann Behav Med, 24: 49–58, 2002.
26.
MazzottiE., MazzucaF., SebastianiC., ScoppolaA., MarchettiP.: Predictors of existential and religious well-being among cancer patients.Support Care Cancer, 19: 1931–1937, 2011.
27.
HollandJ.C., KashK.M., PassikS., GronertM.K., SisonA., LederbergM., RussakS.M., BaiderL., FoxB.: A brief spiritual beliefs inventory for use in quality of life research in life-threatening illness.Psychooncology, 7: 460–469, 1998.
28.
KashK.M.: The System of Belief Inventory-SBI: a scale to measure spiritual and religious beliefs: development and validation of the general measure.Psychosom Med, 57: 62–67, 1995.
29.
RipamontiC.I., BorreaniC., MaruelliA., ProserpioT., PessiM.A., MiccinesiG.: System of Belief Inventory (SBI-15R): a validation study in Italian cancer patients on oncological, rehabilitation, psychological and supportive care settings.Tumori, 96: 1016–1021, 2010.
30.
Control of pain in adults with cancer, a national clinical guideline, November 2008. Available at www.sign.ac.uk
31.
MarcoulidesG.A., HershbergerS.L.: Multivariate statistical methods.A first course.Mahawa, NJ: Lawrence Erlbaum Associates1997.
32.
SatorraA., BentlerP.M.: A scaled difference chi-square test statistic for moment structure analysis.Psychometrika, 66(4): 507–514, 2001.
BarbaranelliC., NataliE.: I test psicologici: teorie e modelli psicometrici.Roma, Carocci, 2005.
35.
BentlerP.M.: EQS structural equations program manual.Encino, CA: Multivariate Software1995.
36.
TuckerL.R., LewisC.: A reliability coefficient for maximum likelihood factor analysis.Psychometrika, 38, 1–10, 1973.
37.
SteigerJ.H.: Structural model evaluation and modification: an interval estimation approach.Multivariate Behavioral Res, 25: 173–180, 1990.
38.
KlineR.B.: Principles and Practice of Structural Equation Modeling. (2nd edn), Guilford Press, New York, 2005.
39.
BrowneM.W., CudeckR.: Alternative ways of assessing model fit. In: Testing Structural Equation Models, BollenK.A., & LongJS (Eds), pp 136–162, Sage, Newbury Park, CA, 1993.
40.
CohenJ.W.: Statistical Power Analysis For the Biomedical Sciences, 2nd edition, Lawrence Erlbaum Associates, Hillsdale, NJ, 1988.
41.
MorselliM., BandieriE., ZaninR., BuonaccorsoL., D'AmicoR., ForghieriF., PietramaggioriA., PotenzaL., BertiA., CacciapagliaG., MolitiernoA., GalliL., ArtioliF., RipamontiC., BrueraE., TorelliG., LuppiM.: Pain and emotional distress in leukemia patients at diagnosis.Leukemia Res, 34: e67–68, 2010.
42.
BandieriE., SichettiD., LuppiM., Di BiagioK., RipamontiC., TognoniG., BelfiglioM., RomeroM.: Is pain in haematological malignancies under-recognised? The results from Italian ECAD-O survey.Leukemia Res, 34: e334–e335, 2010.
43.
MiccinesiG., ProserpioT., PessiM.A., MaruelliA., BonacchiA., BorreaniC., and RipamontiC.: Is the spiritual life of cancer patients a resource to be taken into account by professional caregivers from the time of diagnosis?Tumori, 98: 186–189, 2012.
