Leon Sautier

Assessment of Patients' Dignity in Cancer Care: Preliminary Psychometrics of the German Version of the Patient Dignity Inventory (PDI-G)

CONTEXT The Patient Dignity Inventory (PDI) is a valid and reliable instrument designed to measure different sources of dignity-related distress in cancer patients receiving palliative care. OBJECTIVES We investigated item characteristics, factor structure, reliability, and concurrent validity of the German version of the PDI (PDI-G) among patients with cancer. METHODS PDI was translated into the German language following state-of-the-art criteria. In a sample of 112 inpatients with mixed tumor types, principal component analysis, reliability analysis (Cronbachs coefficient alpha), and correlation analysis were performed. Concurrent validity was evaluated by validated measures of distress, demoralization, anxiety, depression, hopelessness, quality of life, sense of meaning and purpose, and supportive care needs. RESULTS Cronbachs coefficient alpha for PDI-G was 0.96; factor analysis resulted in a four-factor solution, accounting for 71% of the overall variance, with factor loadings ranging from 0.49 to 0.86. Factor labels include Loss of Sense of Worth and Meaning, Anxiety and Uncertainty, Physical Symptom Distress and Body Image, and Loss of Autonomy, showing high internal consistencies ranging from Cronbachs α 0.80 to 0.95. Evidence for concurrent validity was established by significant associations between PDI-G scales and concurrent measures of distress. CONCLUSION Although we were unable to replicate the five-factor structure provided by Chochinov, this study gave strong support to an alternative four-factor solution of PDI-G, capturing all 25 items. We conclude that PDI-G is a psychometrically sound instrument assessing a broad range of dignity-related distress issues in patients with cancer.

Participation in patient support groups among cancer survivors: do psychosocial and medical factors have an impact?

A better understanding of the role of psychosocial resources and factors associated with participating in patient support groups appears to be important for the development and implementation of cancer survivorship care plans. We therefore investigated the frequency of participation in and satisfaction with patient support groups after completion of a rehabilitation programme and aimed to examine differences in demographic, medical and psychosocial characteristics between group participants and non-participants. We further aimed to identify predictors of participation in patient support groups. A total of 1281 eligible patients (75.5% participation rate) were recruited on average 11 months post diagnosis and assessed at the beginning (t1 ), at the end (t2 ) and 12 months after rehabilitation (t3 ). Study participants completed self-report measures assessing support-group participation and satisfaction, psychosocial distress (anxiety, fear of cancer recurrence, depression), social support, coping, quality of life, pain and treatment-related characteristics. Sixty-seven patients (7.6%) participated in a patient self-help group. Being unemployed, undergoing an increased number of overall treatments, and a higher active emotion-oriented coping style significantly predicted self-help group participation; the predictive power of the multivariate logistic regression model was rather weak (Nagelkerkes R(2) = 0.07). Our data provide evidence that self-help group participation in cancer patients may be largely related to other factors than medical or psychosocial distress.

Standardization of the Colombian version of the PHQ-4 in the general population

BackgroundThe PHQ-4 is a widely used open access screening instrument for depression and anxiety in different health care and community settings; however, empirical evidence of its psychometric quality in Colombia is lacking. The objectives of the current study were to generate normative data and to further investigate the construct validity and factorial structure of the PHQ-4 in the general population.MethodsA nationally representative face-to-face household survey was conducted in Colombia in 2012 (n = 1,500). The item characteristics of the PHQ-4 items, including the inter-item correlations and inter-subscale correlations, were investigated. To measure the scale’s reliability, the internal consistency (Cronbach’s α) was assessed. For factorial validity, the factor structure of the PHQ-4 was examined with confirmatory factor analysis (CFA).ResultsThe Cronbach’s alpha coefficient for the PHQ-4 was 0.84. The confirmatory factor analysis supported a two-factor model, which was structurally invariant between different age and gender groups. Normative data for the PHQ-4 were generated for both genders and different age levels. Women had significantly higher mean scores compared with men [1.4 (SD: 2.1) vs. 1.1 (SD: 1.9), respectively]. The results supported the discriminant validity of the PHQ-4.ConclusionsThe normative data provide a framework for the interpretation and comparisons of the PHQ-4 with other populations in Colombia. The evidence supports the reliability and validity of the two-factor PHQ-4 as a measure of anxiety and depression in the general Colombian population.

Erfassung von Arbeitsengagement bei Patienten mit hämatologischen Malignomen: Die psychometrischen Eigenschaften der deutschen Version der Utrecht Work Engagement Scale 9 (UWES-9)

OBJECTIVE Our purpose was the psychometric evaluation of the German version of the Utrecht Work Engagement Scale-9 (UWES-9), a self-assessment tool measuring work-related resources consisting of 9 items. METHODS Based on a sample of 179 patients with hematological malignancies in in-patient and rehabilitative oncological settings, we tested the dimensional structure by confirmatory and explorative factor analysis. We further evaluated reliability, item characteristics, and construct validity of the UWES-9. RESULTS The confirmatory factor analysis showed acceptable fit for both a 1-dimensional factor structure and the original 3-factor model. Based on an explorative principal component analysis, we were able to replicate the 1-dimensional factor accounting for 67% of the total variance and showing very high internal consistency (α=0.94) and high factor loads (0.73-0.88). The construct validity was further supported by significant positive correlations between work engagement and meaning of work, corporate feeling, commitment to the workplace, and job satisfaction. CONCLUSION The German version of the UWES-9 shows good psychometric qualities in measuring dedication to work in patients with hematological malignancies in in-patient and rehabilitative oncological settings.

Standardization of the Beck Hopelessness Scale in the general population

Abstract Background: The Beck Hopelessness Scale (BHS) is a self-report instrument for the quantification of hopelessness in nonpsychiatric, as well as psychiatric patients. Hopelessness is a key psychological variable in suicide prediction. Until now the psychometric properties of the instrument have not been studied in a representative sample of the general population. Aims: The objectives of the study were to generate normative data and to further investigate the construct validity and factorial structure of the BHS. Methods: A nationally representative face-to-face household survey was conducted in Colombia in 2012 (N = 1500). Results: Cronbach’s alpha coefficient for the BHS was 0.81. Confirmatory factor analysis supported a three-factor model, achieving good fit indices (total sample: RMSEA = 0.043, CFI = 0.936, TLI = 0.921). Normative data for the BHS were generated for both genders and different age levels. Intercorrelations with hopelessness were highest for depression (r = 0.57), followed by anxiety (r = 0.52). Conclusions: The normative data provide a framework for the interpretation and comparisons of the BHS with other populations. Evidence supports reliability and validity of the three-factor BHS as a measure of hopelessness in the general population.

Psychische Belastungen von Kindern und Jugendlichen nach einer Leukämie oder Lymphomerkrankung

Psychological Symptom Burden in Children and Adolescents After Leukemia or Lymphoma Diseases. A cancer diagnosis represents a major challenge for children and young people at an early stage in life. Objective of the present study is the investigation of mental health and psychosocial burden in children and young adolescents two or more years after the treatment of leukemia (ALL, AML) or lymphoma disease (NHL) compared to peers not suffering from cancer as well as available standard values. 42 former patients and 23 healthy peers were included in the comparative analysis. In addition to socio-demographic and medical information the following validated questionnaires were used: the General Depression Scale (ADS), the Strength and Difficulties Questionnaire (SDQ) for the detection of behavioral difficulties and strengths, the KINDL-R questionnaire for assessing quality of life in children and adolescents, the Herth Hope Index (HHI), the Social Questionnaire (SFS 4-6) for assessing the educational integration and the General Self-Efficacy Scale (GSE) to measure self-efficacy. Children and young adolescent survivors of leukemia or lymphoma report significantly less depressive symptoms and significantly higher quality of life compared to a healthy age-matched comparison sample and representative standard values. Beyond, former patients do not differ significantly in psychological and psychosocial aspects compared to a healthy age-matched comparison sample and available standard values.