Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-24T12:07:29.689Z Has data issue: false hasContentIssue false

A new measure of home care patients' dignity at the end of life: The Palliative Patients' Dignity Scale (PPDS)

Published online by Cambridge University Press:  11 June 2015

David Rudilla*
Affiliation:
Home Care Unit of the Hospital General Universitario de Valencia, Valencia, Spain
Amparo Oliver
Affiliation:
Faculty of Psychology, University of Valencia, Valencia, Spain
Laura Galiana
Affiliation:
Faculty of Psychology, University of Valencia, Valencia, Spain
Pilar Barreto
Affiliation:
Faculty of Psychology, University of Valencia, Valencia, Spain
*
Address correspondence and reprint requests to: David Rudilla, Home Care Unit of the Hospital General Universitario de Valencia, Avda Tres Cruces, 2–46014 – Valencia, Spain. E-mail: [email protected]

Abstract

Objective:

This study aimed to develop a new and brief instrument to be employed in dignity measurement, one based on the perceptions of patients, relatives, and professionals about dignity.

Method:

Surveys of patients receiving palliative care, family caregivers, and palliative care professionals were first carried out (sample 1). In the second step, palliative care patients were surveyed with a pilot questionnaire (sample 2). Finally, a survey design was used to assess patients admitted into a home care unit (sample 3). Sample 1 included 78 subjects, including patients, family caregivers, and professionals. Some 20 additional palliative patients participated in sample 2. Finally, 70 more patients admitted to a home care unit participated were surveyed (sample 3). Together with the Palliative Patients' Dignity Scale (PPDS), our survey included other measures of dignity, anxiety, depression, resilient coping, quality of life, spirituality, and social support.

Results:

After analyzing data from steps 1 and 2, an eight-item questionnaire was presented for validation. The new scale showed appropriate factorial validity (χ2(19) = 21.43, p = 0.31, CFI = 0.99, GFI = 0.92, SRMR = 0.07, and RMSEA = 0.04), reliability (internal consistency estimations of 0.75 and higher), criterial validity (significant correlations with the hypothesized related variables), and a cutoff criteria of 50 on the overall scale.

Significance of Results:

The new PPDS has appropriate psychometric properties that, together with its briefness, encourages its applicability for dignity assessment at the end of life.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Arranz, P. & Cancio, H. (2000). Counselling: Habilidades de información y comunicación con el paciente oncológic. In Manual de psico-oncología. Gil, F. (ed.), pp. 3956. Madrid: NovaSidonia.Google Scholar
Barreto, P., Fombuena, M., Diego, R. et al. (2013). Bienestar emocional y espiritualidad al final de la vida. Medicina Paliativa, 22(1), 2532.CrossRefGoogle Scholar
Barreto, P., Saez, J.L. & Saavedra, G. (2010). Acercamiento al sufrimiento a través del counselling. Información psicológica, 100, 171176.Google Scholar
Bearden, W.O., Sharma, S. & Teel, J.E. (1982). Sample size effects on chi square and other statistics used in evaluating causal models. Journal of Marketing Research, 19, 425430.CrossRefGoogle Scholar
Benito, E., Oliver, A., Galiana, L., et al. (2014). Development and validation of a new tool for the assessment and spiritual care of palliative care patients. Journal of Pain and Symptom Management, 47(6), 10081018.Google Scholar
Bentler, P.M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238246.Google Scholar
Bjordal, K., de Graeff, A., Fayers, P.M., et al. (2000). A 12-country field study of the EORTC QLQ–C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ–H&N35) in head and neck patients. European Journal of Cancer, 36(14), 17961807.CrossRefGoogle Scholar
Bollen, K.A. (1989). Structural equations with latent variables. New York: John Wiley & Sons.CrossRefGoogle Scholar
Broadhead, W.E., Gehlbach, S.H., Degruy, F.V., et al. (1988). The Duke–UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Medical Care, 26(7), 709723.CrossRefGoogle ScholarPubMed
Chochinov, H.M. (2002). Dignity-conserving care: A new model for palliative care. Helping the patient feel valued. The Journal of the American Medical Association, 287(17), 22532260.CrossRefGoogle Scholar
Chochinov, H.M. (2006). Dying, dignity, and new horizons in palliative end-of-life care. CA: A Cancer Journal of Clinicians, 56(2), 84103.Google ScholarPubMed
Chochinov, H.M. (2012). Dignity therapy: Final words for final days. New York: Oxford University Press.CrossRefGoogle Scholar
Chochinov, H.M., Hack, T., Hassard, T., et al. (2002 a). Dignity in the terminally ill: A cross-sectional, cohort study. Lancet, 360(9350), 20262030.Google Scholar
Chochinov, H.M., Hack, T., McClement, S., et al. (2002 b). Dignity in the terminally ill: A developing empirical model. Social Science & Medicine, 54(3), 433443.Google Scholar
Chochinov, H.M., Hack, T., Hassard, T., et al. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23(24), 55205525.Google Scholar
Chochinov, H.M., Kristjanson, L.J., Hack, T.F., et al. M. (2006). Dignity in the terminally ill: Revisited. Journal of Palliative Medicine, 9, 666672.Google Scholar
Chochinov, H.M., Hassard, T., McClement, S., et al. (2008). The Patient Dignity Inventory: A novel way of measuring dignity-related distress in palliative care. Journal of Pain and Symptom Management, 36, 559571.CrossRefGoogle ScholarPubMed
Chochinov, H.M., Hassard, T., McClement, S., et al. (2009). The landscape of distress in the terminally ill. Journal of Pain and Symptom Management, 38(5), 641649.CrossRefGoogle ScholarPubMed
Cicchetti, D.V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6, 284290.CrossRefGoogle Scholar
Clark, L.A. & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7, 309319.Google Scholar
Doorenbos, A.Z., Wilson, S.A., Coenen, A., et al. (2006). Dignified dying: Phenomenon and actions among nurses in India. International Nursing Review, 53, 2833.Google Scholar
Edmondson, D., Park, C.L., Blank, T.O., et al. (2008). Deconstructing spiritual well-being: Existential well-being and HRQoL in cancer survivors. Psycho-Oncology, 17(2), 161169.Google Scholar
Guo, Q. & Jacelon, C.S. (2014). An integrative review of dignity in end-of-life care. Palliative Medicine, 28(7), 931940.Google Scholar
Hall, S., Longhurst, S. & Higginson, I. (2009). Living and dying with dignity: A qualitative study of the views of older people in nursing homes. Age and Ageing, 38, 411416.Google Scholar
Hu, L.T. & Bentler, P.M. (1995). Evaluating model fit in SEM: Concepts, issues, and applications. In Structural equation modeling: Concepts, issues, and applications. Hoyle, R.H. (ed.), pp. 7699. London: Sage.Google Scholar
Iacobucci, D. (2010). Structural equations modeling: Fit indices, sample size, and advanced topics. Journal of Consumer Psychology, 20, 9098.Google Scholar
Kline, R.B. (2011). Principles and practice of structural equation modeling, 3rd ed.New York: Guilford.Google Scholar
Lynn, J. (1997). Measuring quality of care at the end of life: A statement of principles. Journal of the American Geriatrics Society, 45(4), 526527.Google Scholar
Martínez-García, M., Rullán, M., Centeno, C., et al. (2013). Spanish version of the Patient Dignity Inventory (PDI): Translation process and preliminary psychometrics. Barcelona: I jornada científica. Parc de recerca biomédica de Barcelona.Google Scholar
NCCN (National Comprehensive Cancer Network) (2013). Clinical practice guidelines for oncology and palliative care. Available from http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.Google Scholar
Periyakoil, V.S., Kraemer, H.C. & Noda, A. (2009). Creation and the empirical validation of the dignity card-sort tool to assess factors influencing erosion of dignity at life's end. Journal of Palliative Medicine, 12, 11251130.Google Scholar
Periyakoil, V.S., Noda, A.M. & Kraemer, H.C. (2010). Assessment of factors influencing preservation of dignity at life's end: Creation and the crosscultural validation of the preservation of dignity card-sort tool. Journal of Palliative Medicine, 13(5), 495500.Google Scholar
Peterman, A.H., Fitchett, G., Brady, M.J., et al. (2002). Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale (FACIT–sp). Annals of Behavioral Medicine, 24(1), 4958.Google Scholar
Pleschberger, S. (2007). Dignity and the challenge of dying in nursing homes: The residents' view. Age and Ageing, 36(2), 197202.Google Scholar
Quintana, J.M., Padierna, A., Esteban, C., et al. (2003). Evaluation of the psychometric characteristics of the Spanish version of the Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 107(3), 216221.CrossRefGoogle ScholarPubMed
Rudilla, D., Barreto, P., Oliver, A., et al. (2015). Estudio comparativo entre counselling y la terapia de la dignidad en pacientes paliativos en la Unidad de Hospitalización a Domicilio. Medicina Paliativa. 22(2), forthcoming. doi: 10.1016/j.medipa.2014.09.005.Google Scholar
Sinclair, V.G. & Wallston, K.A. (2004). The development and psychometric evaluation of the Brief Resilient Coping Scale. Assessment, 11(1), 94101.Google Scholar
Singer, P.A., Martin, D.K. & Kelner, M. (1999). Quality end-of-life care: Patients' perspectives. The Journal of the American Medical Association, 281(2), 163168.Google Scholar
Stewart, A.L., Teno, J., Patrick, D.L., et al. (1999). The concept of quality of life of dying persons in the context of health care. Journal of Pain and Symptom Management, 17(2), 93108.Google Scholar
Tanaka, J.S. (1993). Multifaceted conceptions of fit in structural equation models. In Testing structural equation models. Bollen, K.A. & Long, J.S. (eds.), pp. 1039. Newbury Park, CA: Sage.Google Scholar
Tomás, J.M., Sancho, P., Melendez, J.C., et al. (2012). Resilience and coping as predictors of general well-being in the elderly: A structural equation modeling approach. Aging & Mental Health, 16(3), 317326.Google Scholar
Turner, K., Chye, R., Aggarwal, G., et al. (1996). Dignity in dying: A preliminary study of patients in the last three days of life. Journal of Palliative Care, 112(2), 713.Google Scholar
Van't Spijker, A., Trijsburg, R.W. & Duivenvoorden, H.J. (1997). Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosomatic Medicine, 59(3), 280293.Google Scholar
Vanistendael, S. (2007). Resilience and spirituality. In Resilience in palliative care: Achievement in adversity. Monroe, B. & Oliviere, D. (eds.), pp. 115135. New York: Oxford University Press.Google Scholar
Vladeck, B.C. & Westphal, E. (2012). Dignity-driven decision making: A compelling strategy for improving care for people with advanced illness. Health Affairs, 31(6), 12691276.Google Scholar
Vlug, M.G., de Vet, H.C.W., Pasman, H.R.W., et al. (2011). The development of an instrument to measure factors that influence self-perceived dignity. Journal of Palliative Medicine, 14, 578586.Google Scholar
Whittemore, R. & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546553.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361370.Google Scholar