Multicenter Study of the Psychometric Properties of the New Demoralization Scale (DS-II) in Spanish-Speaking Advanced Cancer Patients

Abstract

Context. Demoralization is a state of existential distress in patients with advanced illness, typically with coping difficulties, feelings of loss of sense, and purpose in life and despair, among other things. The New Demoralization Scale (DS-II) is an evaluation tool for this syndrome, which has recently been reformulated on a shorter scale.Objectives. The objective of this study was to obtain a Spanish version of the DS-II and to assess its psychometric properties in advanced cancer patients in Spain and a number of Latin American countries.Methods. Following a translationeback translation process, a validation study and a confirmatory analysis using structural equation models with their corresponding latent constructs were undertaken. Patients completed the DS-II in Spanish (DS-II (es)), the Hospital Anxiety and Depression Scale, and the Edmonton Symptom Assessment Systemerevised. Reliability was studied according to internal consistency; construct validity and concurrent validity with the Hospital Anxiety and Depression Scale and the Edmonton Symptom Assessment Systemerevised; discriminant validity using the Karnofsky Performance Status scale; and feasibility, with response ratio and required time. Cutoff points were established, and sensitivity and specificity were studied.Results. The DS-II (es) was obtained. One hundred fifty patients completed the validation study. The confirmatory analysis showed coherence, and all items correlated positively with their subscales and with the overall scale. Cronbach's alpha for the DS-II (es) was 0.88, for the sense and purpose subscale 0.83, and for the coping ability 0.79. Demoralization correlated significantly with emotional distress (rho ¼ 0.73, P < 0.001). The tool distinguished between patients with diverse functional levels (rho ¼ À0.319, P ¼ 0.001). Cutoff points at 10 and 20 out of 32 were established. The scale showed high sensitivity (81.97%) and specificity (80.90%). The prevalence of demoralization was 33% in our sample.Conclusion. The Spanish version of the new Kissane DS-II demoralization scale has shown to be valid, reliable, and feasible with adequate psychometric properties.

Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer

“…All of the items contributed substantially to the total score and to the subscales, and the Cronbach's alpha coefficients for the total scale and for the subscales were almost excellent. The coefficients were slightly higher than in the study testing the DS-II in a sample of patients receiving palliative care (Robinson et al, 2016b), and they were also higher than the coefficients obtained in a sample of Spanish patients with advanced cancer (Belar et al, 2019). The higher reliability coefficients may be explained (at least partly) by the fact that our study did not only include patients with advanced stages of cancer, some of whom suffer from cognitive impairment, so coherent item responses may have been somewhat more likely in our sample.…”

“…The DS-II demonstrated high internal consistency (α = 0.89 for the total scale; α = 0.84 for the Meaning and Purpose subscale, and α = 0.82 for the Distress and Coping Ability subscale) ( Robinson et al, 2016b ). Subsequently, a Spanish version of the DS-II was tested in a sample of 150 patients with advanced cancer stages in Spain and a number of Latin American countries ( Belar et al, 2019 ). The Spanish DS-II version also showed a high internal consistency with α = 0.88 (total DS-II scale), α = 0.83 ( Meaning and Purpose) , and α = 0.79 ( Distress and Coping Ability ) ( Belar et al, 2019 ).…”

Evaluation of the Psychometric and Structural Properties of the Spanish Version of the Hospital Anxiety and Depression Scale in Latina Cancer Patients

“…Specifically, concern has been raised about the ability of the HADS depression subscale to identify depression in ill populations as the HADS items may capture an increase in anhedonia with physical disease burden and not true depressive symptoms. 40 Psychometric analyses show strong, positive correlations of the Spanish-and English-language HADS total and subscale scores with other measures commonly used to assess for depression and anxiety in patients with chronic illness, 11,41 affirming the utility of the HADS as a screening tool to assess for distress that may be followed up with more detailed assessment. In addition, the present study only included women.…”

Wish to die and hasten death in palliative care: a cross-sectional study factor analysis

“…Data related to symptom burden (Edmonton Symptom Assessment System-Revised, ESAS-r), 14 depressive and anxious symptoms (Hospital Anxiety and Depression Scale, HADS), 15 perceived loss of dignity (Patient Dignity Inventory, PDI) 16 and demoralisation (Spanish version of the Demoralisation Scale, DS-II (es), with two subscales: (1) meaning and purpose in life and (2) distress and coping strategies) were collected. 17 The latter refers to the patient's ability to cope with the illness trajectory. These variables have been considered triggering factors for WTD in previous studies.…”