The Preliminary Revision Of The Patient Dignity Inventory And The Research On Dignity In Patients With Advanced Cancer

Objective:This research introduced and revised the Patient Dignity Inventory(PDI) to serve as a tool for testing cancer patients’ dignity condition. Then we applied this tool to investigate the dignity damage situation among patients with advanced cancer in our country, and explored its impact factors. We also conducted a qualitative research on connotation of dignity by hermeneutic methods.Method:In this study, 185 patients with advanced cancer were the research object, data was collected by questionnaire survey, psychological test and semi-structured interviews.(1)The PDI was introduced and preliminary revised, the first draft was determined on the basis of expert advice after two rounds of translation and back-translation. After preliminary experiment on 10 patients, the formal scale was formed. Then it was tested among 150 cases of patients with advanced cancer, and we analyzed its item discrimination,reliability and validity, and conducted the confirmatory factor analysis.(2)The self-made general data questionnaire, Hospital Anxiety Depression(HAD),Quality of Life Questionnaire-Core 30(QLQ-C30 Chinese version) and Patient Dignity Inventory( PDI Chinese version) were chosen to survey the related condition of dignity for cancer patients. We adopted descriptive statistics, correlation analysis and regression analysis to explore the influence factors of dignity for cancer patients.(3)The purpose sampling method was adopted, and the 25 advanced cancer patientsho met the inclusion criteria were the qualitative research object, to further analysis the dignity of the patients with advanced cancer.Results:(1) The preliminary revision of the patients with dignity scale has good item discrimination which is between 0.270 to 0.768(p < 0.01) except to item 22; The internal consistency reliability of the scale was 0.924, the internal consistency reliability of each factor were 0.754, 0.850, 0.561, 0.553 and 0.516; Confirmatory factor analysis results show that the fitting index of PDI model reached an acceptable standard; The correlation coefficient of PDI and HAD, EORTC QLQ C30 is between 0.280 to 0.661, except to nausea and vomiting, constipation, diarrhea.(2)The incidence of the loss of dignity in the patients with advanced cancer was63.3%. There were significant differences on gender(t= 4.471, p<0.05), sources of income(F=18.978, p<0.01), monthly income(F=3.079, p<3.079), economic pressure(F=5.501,p<0.01), different disease stages(t=3.57, p<0.01), whether metastasis(t=3.30, p<0.01),whether radiotherapy(t=2.84, p<0.01), and different ways of rehabilitation(t=4.08, p<0.01). There was no significant difference on age, place of residence, the degree of education, religious or none religious, different occupation, marital status, the main caregivers and the life style,cancer, the disease awareness, disease duration and whether surgery, chemotherapy.(3)Anxiety, depression are significant positive correlated with dignity; Each dimension of functional areas and the quality of life are significant negative correlation with the total score of dignity; In symptoms area and other single items, fatigued, pain sleeplessness, appetiteless, financial difficulty were significant positive correlated with dignity scores, but nausea and vomiting, dyspnea, constipation and diarrhea were not correlated with dignity. Variables entered into the stepwise regression equation of dignity were emotional function, role function, anxiety, whether metastasis, health condition,financial difficulty.(4)10 themes and 24 sub-themes were separated out about the connotation of the dignity of life in patients with advanced cancer. 4 new themes which were economic pressure, learn to let it go, for love, let nature take its course were separated out. The difference is death anxiety and enduring pain compared with the pre-understanding. Others were basically same with the pre-understanding.Conclusion:(1) After the preliminary revision, the scale received good reliability and validity which can be used in the context of Chinese.(2) This research find that the dignity of patients with advanced cancer is in serious condition, emotional function, role function, anxiety, whether metastasis, health condition,financial difficulty can predict their dignity condition.(3) The connotation of dignity has the unique theme under the background of mainland China. We should pay attention to the sensitivity of the differences of Chinese and foreign culture in clinical practice of protecting the dignity of patients.