The Construction Of Indigenous Dignity Model Of Advanced Cancer Patients And The Development And Application Of Dignity Scale

Objectives:The objectives of this thesis are three-fold: Firstly,through semi-structured interview and Grounded Theory Analysis,we explored the meaning of the dignity of advanced cancer patients,to develop a conceptual model for the Chinese population and provide theoretical support to hospice care;Secondly,we developed the Dignity Scale based on the constructed dignity model,to provide a convenient and effective tool for clinical assessment;Finally,we apply the Dignity Scale to the clinical patients,to explore the dignity status and influencing factors of the advanced cancer patients,laying a preliminary basis for the intervention of the future study.Methods:⑴Qualitative research: Using purpose sampling,we conducted semi-structured interviews with advanced cancer patients;At the same time,we code the interview data through Grounded Theory,and stop the interview when the data reach saturation.Eventually,we constructed a dignity theme table and a dignity model.⑵Scale Development: We developed the Dignity Scale based on the constructed theoretical models.We then formed the initial scale through experts’ judgment and legibility of subjects;We used the initial scale in 155 advanced cancer patients,then we made the item analysis and exploratory factor analysis,finally we got 16 items Dignity Scale;We then tested the reliability and validity of the Dignity Scale in 148 advanced cancer patients.⑶Investigations: We used a general demographic information questionnaire,Dignity Scale,Cross-cultural(Chinese)Personality Assessment Inventory,Meaning in Life Scale and Distress Thermometer in 160 advanced cancer patients and recycled 151 effective questionnaires.We then conducted descriptive statistics,correlation analysis,step-wise regression,and structural equation modeling.Results:⑴Based on the three-level coding of the interview date of 29 advanced cancer patients,we got the four influencing factors of dignity,namely physical dignity,social dignity,psychological dignity and spiritual dignity.And formed dignity connotation model.⑵We got a initial 90 items pool based on the constructed dignity model;We then got a 32 items test version through expert’ evaluation and subjects legibility evaluation;We reserved 16 items through item analysis and exploratory factor analysis.⑶Results show that fitting index of the four dimensional structure model obtained from confirmatory factor analysis is good;In Correlation analysis,factors are basically in a medium degree of correlation,factors and total score are above the average degree of correlation;The Dignity Scale were negatively correlated with the Western dignity scale.However,the Dignity Scale was positively correlated with Index of well-being;the Dignity Scale significantly more predict 6% of Index of Well-being than Western dignity scale.The Dignity Scale had adequate internal consistency reliability and split-half reliability.Scale’ internal consistency reliability and split-half reliability are above 0.7.The Dignity Scale has good reliability and validity.⑷There were mean differences on the Dignity Scale scores for gender(t=2.09,p=0.038),degree of pain(t=6.15,p<0.000),educational background(F=3.41,p=0.006),age groups(F=3.97,p=0.021)and economic pressure(F=8.37,p<0.000);however,there were no mean differences across residence,religious belief,different stages of disease,chemotherapy,cancer metastasis and duration of disease.⑸The Dignity Scale were negatively correlated with the need attention,self-abasement and confidence and degree of psychological distress.However,the Dignity Scale was positively correlated with the Meaning in Life Scale and the internal and external locus of control.⑹The main influencing factors of dignity for advanced cancer patients are economic pressure,gender,self-abasement and confidence,having meaning,degree of psychological distress,these factors can explain 42.1% dignity variation of the advanced cancer patients.Conclusions:⑴The themes associated with dignity have unique cultural meaning under the traditional Chinese culture,so we should pay attention to the indigenous cultural characteristics in the study of dignity theory and model.⑵The newly developed Dignity Scale has good reliability and validity,and can be seen as promising measures.⑶Interesting differences on the level of dignity across demographic dimensions were found.Economic pressure,gender,self-abasement and confidence,having meaning,degree of psychological distress can predict the dignity status of the advanced cancer patients.