Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-26T17:03:00.123Z Has data issue: false hasContentIssue false
  • English
  • Français

Dignity in cancer patients with a life expectancy of a few weeks. Implementation of the factor structure of the Patient Dignity Inventory and dignity assessment for a patient-centered clinical intervention: A cross-sectional study

Published online by Cambridge University Press:  07 February 2018

Andrea Bovero Open the ORCID record for Andrea Bovero [Opens in a new window] ,
Nader Alessandro Sedghi ,
Rossana Botto ,
Chiara Tosi ,
Valentina Ieraci  and
Riccardo Torta
Andrea Bovero*
Affiliation:
Psycho-Oncology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
Nader Alessandro Sedghi
Affiliation:
Psycho-Oncology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
Rossana Botto
Affiliation:
Psycho-Oncology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
Chiara Tosi
Affiliation:
Psycho-Oncology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
Valentina Ieraci
Affiliation:
Psycho-Oncology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
Riccardo Torta
Affiliation:
Psycho-Oncology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
*
Author for Correspondence: Andrea Bovero, Psycho-Oncology Unit, A.O.U. “Città della Salute e della Scienza,” Corso Bramante n. 88, 10126, Torino, Italy. E-mail: abovero@cittadellasalute.to.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Hospice is a favored setting for dignity care. Studies on dignity dimension in end-of-life patients are growing. The Patient Dignity Inventory (PDI) is a tool that can lead to interesting information on dignity-related aspects of suffering. The study aimed to investigate dignity among end-of-life cancer patients, by examining the Italian version of the PDI factor structure and assessing the relationship between dignity and other patients’ psychosocial and spiritual variables to improve a patient-centered clinical practice.

Method

This is a cross-sectional study. Data were collected using a battery of self-administered validated rating scales. The sample included 127 hospice patients with a life expectancy of a few weeks and a Karnofsky Performance Status ≤40. Factor structure and concurrent validity of PDI and correlations between dignity and anxious and depressive symptomatology, quality of life, demoralization, personal coping styles, spiritual well-being, and spiritual daily experience were analyzed.

Result

Factor analysis highlighted a five-factor solution, accounting for 60% of the overall variance. The factors were labeled Psychological Distress, Social Support, Physical Symptoms and Dependency, Existential Distress, and Loss of Purpose/Meaning. Dignity assessment evidenced that self-blame coping style, emotional and physical well-being, and depression were the loss of dignity significant predictors (R2 = 0.605; p < 0.01).

Significance of results

The results point out the intercultural validity of the PDI and empower an accurate detection of dignity-related distress sources in the daily clinical practice. Personality traits seem to have an active role in the loss of dignity, whereas spirituality is confirmed to be positively involved in dignity enhancement.

Keywords

Dignityhospicesend-of-life patientscancerpalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 6 , December 2018 , pp. 648 - 655
Copyright
Copyright © Cambridge University Press 2018 

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

Albers, G, de Vet, HC, Pasman, HR, et al. (2013) Personal dignity in the terminally ill from the perspective of caregivers: A survey among trained volunteers and physicians. Journal of Palliative Medicine 16, 1108–1114.Google Scholar
Cella, DF, Tulsky, DS, Gray, G, et al. (1993) The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. Journal of Clinical Oncology 11, 570–579.Google Scholar
Chochinov, HM (2007) Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. British Medical Journal 335, 184–187.Google Scholar
Chochinov, HM, Hack, T, McClement, S, et al. (2002) Dignity in the terminally ill: A developing empirical model. Social Science & Medicine 54, 433–443.Google Scholar
Chochinov, HM, 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, 2008, 36, 559–571.Google Scholar
Chochinov, HM, Krstjanson, LJ, Hack, TF, et al. (2006) Personality, neuroticism, and coping towards the end of life. Journal of Pain and Symptom Management 32, 332–341.Google Scholar
Chochinov, HM, McClement, SE, Hack, TF, et al. (2012). The Patient Dignity Inventory: Applications in the oncology setting. Journal of Palliative Medicine 15, 998–1005.Google Scholar
Costantini, M, Musso, M, Viterbori, P, et al. (1999) Detecting psychological distress in cancer patients: Validity of the Italian version of the Hospital Anxiety and Depression Scale. Supportive Care in Cancer 7(3), 121–127.Google Scholar
Costantini, A, Picardi, A, Brunetti, S, et al. (2013) Italian version of Demoralization Scale: A validation study. Rivista di Psichiatria 48(3), 234–239.Google Scholar
Di Lorenzo, R, Cabri, G, Carretti, E, et al. (2017) A preliminary study of Patient Dignity inventory validation among patients hospitalized in an acute psychiatric ward. Neuropsychiatric Disease and Treatment 13, 177–190.Google Scholar
Ferri, P, Muzzalupo, J, and Di Lorenzo, R (2015) Patients’ perception of dignity in an Italian general hospital: a cross-sectional analysis. BMC Health Services Research 15, 1–8.Google Scholar
Folstein, M, Folstein, S, and McHugh, P (1975) “Mini-mental-state”: A practical method of grading the cognitive state of patients for the clinicians. Journal of Psychiatric Research 12, 189–198.Google Scholar
Grassi, L, Costantini, A, Caruso, R, et al. (2017) Dignity and psychosocial-related variables in advanced and non advanced cancer patients by using the Patient Dignity Inventory-Italian Version. Journal of Pain and Symptom Management 53, 279–287.Google Scholar
Guo, Q and Jacelon, CS (2014) An integrative review of dignity in end-of-life care. Palliative Medicine 28, 931–940.Google Scholar
Karnofsky, DA and Burchenal, JH (1949) The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of chemotherapeutic agents, pp. 191–205. MacLeod, CM (ed.). New York: Columbia University Press.Google Scholar
Peterman, AH, Fitchett, G, Brady, MJ, 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), 49–58.Google Scholar
Ripamonti, CI, Buonaccorso, L, Maruelli, A, et al. (2012) Patient dignity inventory (PDI) questionnaire: The validation study in Italian patients with solid and hematological cancers on active oncological treatments. Tumori 98, 491–500.Google Scholar
Rodríguez-Prat, A, Monforte-Royo, C, Porta-Sales, J, et al. (2016) Patient perspectives of dignity, autonomy and control at the end of life: Systematic review and meta-ethnography. PLoS One 11, e0151435.Google Scholar
Rullàn, M, Carvajal, A, Nùnez-Còrdoba, JM, et al. (2015) Spanish version of the patient dignity inventory: Translation and validation in patients with advanced cancer. Journal of Pain and Symptom Management 50, 874–881.Google Scholar
Sautier, L, Vehling, S, Mehnert, A (2014) Assessment of patient dignity in cancer care: preliminary psychometrics of the German version of the patient dignity inventory (PDI-G). Journal of Pain and Symptom Management 47, 181–188.Google Scholar
Scott, J and Huskisson, EC (1979). Graphic representation of pain. Pain 2, 175–184.Google Scholar
Sica, C, Novara, C, Dorz, S, et al. (1997). Coping orientations to problems experienced: Italian translation and adaptation. Bollettino di Psicologia Applicata 23, 25–34.Google Scholar
Street, AF and Kissane, DW (2001) Constructions of dignity in end-of-life care. Journal of Palliative Care 17, 93–101.Google Scholar
Underwood, LG (2006). Ordinary spiritual experience: Qualitative research, interpretive guidelines, and population distribution for the Daily Spiritual Experience Scale. Archive for the Psychology of Religion 28(1), 181–218.Google Scholar
Vehling, S and Mehnert, A (2014) Symptom burden, loss of dignity, and demoralization in patients with cancer: A mediation model. Psycho-Oncology 23, 283–290.Google Scholar