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

Abstract

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 (R 2 = 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.

Dignity‐related existential distress in end‐of‐life cancer patients: Prevalence, underlying factors, and associated coping strategies

“…Regarding the PDI‐IT, we opted for the validation obtained from our previous study, because of its specificity for end‐of‐life patients, and for the presence of the ED subscale. It differs from previous Italian validations in the oncological setting because they present different factor structures and are referred to advanced and nonadvanced cancer patients and patients with active oncological treatments.…”

“…Every item describes a theme or a subtheme of the dignity model in the terminally ill . The version we administered, validated for end‐of‐life patients, includes the following 5 subscales: psychological distress, social support, physical symptoms and dependency, existential distress, and loss of meaning and purpose. The ED subscale consists of 8 items, some of which differ from the previous studies (Table ).…”

“…Existential distress was operationalized as the existential distress PDI‐IT subscale . To examine the prevalence of different degrees of DR‐ED severity, the sample was divided into 3 subsets.…”

“…The Patient Dignity Inventory (PDI) is a valid and reliable instrument based on the dignity model, structured to routinely detect dignity‐related distress and promote tailored interventions. In many of its validations, a subscale specifically referred to ED was proposed as a crucial representation of dignity dimensions …”

“…Loss of dignity and demoralization are 2 constructs which were shown to be strictly and positively correlated . Moreover, it was hypothesized that they are part of the same continuum representing existential distress …”