Spanish Version of the Patient Dignity Inventory: Translation and Validation in Patients With Advanced Cancer.
BACKGROUND
The Patient Dignity Inventory (PDI) is an instrument to measure sources of distress related to dignity at the end of life.


OBJECTIVE
To obtain a Spanish version of the PDI and measure psychometric aspects in patients with advanced cancer.


METHODS
A back-translation method was used to obtain the Spanish version. Inpatients and outpatients with advanced cancer were included. Patients completed the Spanish versions of the PDI (PDI-s), Edmonton Symptom Assessment System (ESAS), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp-12) instruments. The psychometric properties evaluated were internal consistency; concurrent validity between PDI-s/ESAS, PDI-s/HADS, and PDI-s/FACIT-Sp-12; discriminant validity, test-retest reliability, and factor analysis. The usefulness of the instrument also was tested.


RESULTS
A Spanish version of the PDI was obtained. One hundred twenty-four patients completed the study. Cronbach's alpha coefficient for the PDI-s was 0.89. The PDI-s significantly correlated with the ESAS (rs = 0.669; P < 0.001), HADS (rs = 0.788; P < 0.001), and FACIT-Sp-12 (rs = -0.442; P = 0.008). The instrument distinguished outpatients from inpatients and between patients with differing Karnofsky Performance Status scores (rs = -0.328; P < 0.001). The test-retest method indicated excellent reproducibility (intraclass correlation coefficient = 0.931). Factor analysis showed three factors accounting for 79.4% of the variance. Factors were labeled psychological and existential distress, physical symptoms and dependency, and social support. Patients had no difficulties in understanding or completing the questionnaire (mean time to complete: 7.2 minutes).


CONCLUSIONS
The Spanish version of the PDI showed adequate psychometric properties when tested with advanced cancer patients. This research provides a three-factor alternative in Spanish to the PDI.
Department of Gastroenterology, Complejo Hospitalario de Navarra, Pamplona, Spain; ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain.
María
M
Rullán
Faculty of Nursing, University of Navarra, Pamplona, Spain. Electronic address: acarvajal@unav.es.
Ana
A
Carvajal
Department of Preventive Medicine and Public Health, Medical School, University of Navarra, Pamplona, Spain; Research Support Service, University of Navarra Clinic, Pamplona, Spain; Public Health and Epidemiology Area, University of Navarra, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain; Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
Jorge M
JM
Núñez-Córdoba
Palliative Medicine Unit, University of Navarra Hospital, Pamplona, Spain.
Marina
M
Martínez
ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
José Miguel
JM
Carrasco
ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
Irene
I
García
ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Faculty of Nursing, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain.
María
M
Arantzamendi
ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Aita Meni Hospital, Guipuzcoa, Spain.
Alazne
A
Belar
ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Palliative Medicine Group, Area of Oncology and Hematology, Navarra's Health Research Institute (IdiSNA), Pamplona, Spain; Palliative Medicine Unit, University of Navarra Hospital, Pamplona, Spain.
Carlos
C
Centeno
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000523:psychology*; D028723:Personhood; D011581:Psychological Tests; D011594:Psychometrics; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000175:diagnosis*; D014175:Translating; D014177:Translations
Advanced cancer patients; Patient Dignity Inventory; dignity therapy; psychometric properties; validation