title: The development of an instrument to measure factors that influence self-perceived dignity.
abstract: BACKGROUND
  Preserving dignity can be considered as a goal of palliative care. To provide dignity-conserving care, it is relevant to identify the factors that influence a patient's self-perceived dignity. This study aims to develop an instrument to measure factors affecting self-perceived dignity that has good content validity and is appropriate for use in practice.
  
  
  METHODS
  Data were collected in the Advance Directives Cohort Study. In 2008, the cohort received a questionnaire with 31 items that might influence one's self-perceived dignity. For a subsample of people with poor health (n = 292), we analyzed which items could be removed because of the mean scores for presence of the item and its influence on dignity.
  
  
  RESULTS
  The 31 items fell into four domains: evaluation of self in relation to others, functional status, mental state, and care and situational aspects. Mean scores for presence and influence on dignity showed large differences and were not correlated. Six items were scarcely present and did not substantially affect self-perceived dignity. Because three of these were expected to influence dignity in other settings, only three items could be removed and two items could be combined into one. After calculating correlations between conceptually similar items, one extra item could be removed.
  
  
  CONCLUSIONS
  Reducing the instrument to 26 items and dichotomizing the answer option for presence increases its feasibility for use in practice. The instrument offers an important step to better understanding the phenomenon of self-perceived dignity by gaining information directly from patients.
authors.affiliation: Department of Public and Occupational Health, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands. mg.vlug@vumc.nl
authors.forename: Mariska G
authors.initials: MG
authors.lastname: Vlug
authors.forename: Henrica C W
authors.initials: HC
authors.lastname: de Vet
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Mette L
authors.initials: ML
authors.lastname: Rurup
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D012297:Right to Die; D012649:Self Concept; D011795:Surveys and Questionnaires; D019452:Terminally Ill