Validity and reliability of the Brazilian version of the Patient Dignity Inventory (PDI – Br)

Donato, Suzana Cristina Teixeira; Chiba, Toshio; Carvalho, Ricardo Tavares de; Salvetti, Marina de Góes

doi:10.1590/1518-8345.4015.3371

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Revista Latino-Americana de Enfermagem

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Original Article • Rev. Latino-Am. Enfermagem 29 • 2021 • https://doi.org/10.1590/1518-8345.4015.3371 copy

Validity and reliability of the Brazilian version of the Patient Dignity Inventory (PDI – Br)^* * Paper extracted from master’s thesis “Patient dignity inventory psychometric validation (PDI-Br)”, presented to Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

to perform the psychometric validation of the Brazilian version of the Patient Dignity Inventory (PDI – Br) in patients with advanced diseases in palliative care.

Method:

a methodological study to verify the psychometric properties of the Patient Dignity Inventory (PDI – Br) instrument, through validity and reliability tests.

Results:

the exploratory factor analysis showed a factorial solution with three factors, responsible for 40.9% of the explained variance, with adequate internal consistency for the Presence of Symptoms (α=0.859), Dependence (α=0.871), and Existential Suffering (α=0.759) domains. The test-retest was performed and indicated moderate to strong correlations. Convergent validity demonstrated a positive correlation between the Presence of Symptoms and the sadness (r=0.443) and anxiety (r=0.464) variables. Weak negative correlations were observed between the PDI – Br domains and functionality, spiritual well-being and quality of life.

Conclusion:

composed of three domains and 25 items, the PDI – Br instrument presented satisfactory psychometric properties for its use in our environment, through the evidence of validity and reliability.

Descriptors:
Neoplasms; Palliative Care; Validation Study; Psychometrics; Translating; Surveys and Questionnaires

Qualitative variables (n = 135)
	n (%)		n (%)
Gender		Marital status
Male	74 (54.8)	Has a partner	71 (52.6)
Female	61 (45.2)	No partner	64 (47.4)
Religion		Work
Catholic	76 (56.3)	Retired	92 (68.2)
Evangelical	43 (31.9)	Illness benefit	18 (13.3)
Others	6 (4.4)	Unemployed	13 (9.6)
No religion	3 (2.2)	Pensioner	11 (8.2)
No information	7 (5.2)	No information	1 (0.7)
Diagnosis
Neoplasms	92 (68.2)
Respiratory system diseases	16 (11.8)
Cardiovascular system diseases	9 (6.7)
Neurological diseases	6 (4.4)
Chronic renal failure	3 (2.2)
Others^* * Skin (1.5%), hematological (1.5%), liver (1.5%), and rheumatic (0.7%) diseases, and congenital malformation (1.5%);	9 (6.7)
Quantitative variables (n = 135)		Mean (SP)	Median
Functionality (Karnofsky)		66.4 (16.6)	60
Age (years old)		65.0 (16.9)	66
Schooling (years)		5.96 (4.7)	5
Income (MW)^† † MW = Minimum wage in Brazil, in 2018 = R$ 954.00		1.53 (1.2)	1
Time of diagnosis (months)		75.4 (82.7)	39.5

Items	Domains
	PA1	PA2	PA3
PDI 8	0.782	0.043	-0.104
PDI 7	0.773	0.048	0.009
PDI 6	0.653	0.051	0.031
PDI 5	0.478	0.221	0.118
PDI 24	0.472	-0.069	0.374
PDI 4	0.395	0.214	0.069
PDI 3	0.388	0.326	-0.113
PDI 19	0.362	0.031	0.311
PDI 9	0.356	-0.017	0.273
PDI 11	0.284	0.231	0.200
PDI 16	0.277	0.167	0.177
PDI 2	-0.028	0.922	-0.008
PDI 1	-0.003	0.874	-0.017
PDI 10	0.112	0.636	0.118
PDI 20	0.175	0.539	0.175
PDI 18	0.213	0.512	-0.008
PDI 25	-0.136	0.119	0.788
PDI 14	0.283	-0.173	0.610
PDI 23	0.123	-0.022	0.588
PDI 21	-0.087	0.122	0.554
PDI 12	-0.026	0.153	0.537
PDI 22	-0.119	0.032	0.372
PDI 13	0.086	-0.160	0.336
PDI 15	0.245	-0.069	0.307
PDI 17	0.168	0.012	0.260

Domain/α^* * Cronbach's α	Items	Correlation with the other items	α value of the domain if the item is excluded
A1 (α=0.859)	3	0.442	0.854
	4	0.538	0.848
	5	0.633	0.840
	6	0.651	0.839
	7	0.705	0.834
	8	0.631	0.840
	9	0.449	0.854
	11	0.496	0.851
	16	0.439	0.855
	19	0.477	0.852
	24	0.572	0.845

A2 (α=0.871)	1	0.754	0.829
	2	0.789	0.820
	10	0.708	0.841
	18	0.572	0.874
	20	0.666	0.851

A3 (α=0.759)	12	0.508	0.726
	13	0.317	0.754
	14	0.613	0.705
	15	0.398	0.743
	17	0.313	0.762
	21	0.424	0.740
	22	0.289	0.758
	23	0.507	0.725
	25	0.619	0.709

Patient Dignity Inventory, PDI - Br (n=32)
	Items	r^* * Pearson's correlation coefficient;	p^† † Significance level, p<0.001
1.	Not being able to perform daily life activities (e.g.: taking a bath, getting dressed).	0.557	< 0.001
2.	Not being able to perform my body functions independently (e.g.: needing help to go to the toilet).	0.755^* * Pearson's correlation coefficient;	< 0.001
3.	Feeling stressing physical symptoms (e.g.: pain, shortness of breath, nausea).	0.508	0.003
4.	Feeling that, for the others, my appearance changed substantially.	0.602	< 0.001
5.	Feeling depressed.	0.784	< 0.001
6.	Feeling anxious.	0.643	< 0.001
7.	Feeling uncertainty about my disease and the treatment.	0.611	< 0.001
8.	Worrying about my future.	0.571	< 0.001
9.	Not being able to think clearly.	0.627	< 0.001
10.	Not being able to go on with my routine activities.	0.551	< 0.001
11.	Feeling that I am no longer who I was.	0.663	< 0.001
12.	Not feeling useful or valued.	0.330	0.065
13.	Not being able to fulfill important roles (e.g.: wife/husband, father/mother).	0.803	< 0.001
14.	Feeling that life makes no sense or has no purpose any longer.	0.703	< 0.001
15.	Feeling that I have not made any significant and lasting contribution in my life.	0.771	< 0.001
16.	Feeling that I have "unfinished businesses" (e.g.: incomplete or unsaid things).	0.718	< 0.001
17.	Worrying about my spiritual life not being significant.	0.823	< 0.001
18.	Feeling that I am a burden for the others.	0.709	< 0.001
19.	Feeling that I have no control over my own life.	0.692	< 0.001
20.	Feeling that my disease and care needs reduced my privacy.	0.598	< 0.001
21.	Not feeling supported by my group of friends and family.	-	-
22.	Not feeling support from the health professionals who care for me.	1	< 0.001
23.	Feeling that I cannot mentally "fight" against the challenges of the disease any longer.	0.633	< 0.001
14.	Not being able to accept things as they are.	0.694	< 0.001
15.	Not being treated with respect or understanding.	0.641	< 0.001

Scales (n = 135)	Domains (PDI - Br)
	PS^* * Presence of symptoms;		D^† † Dependence;		SS^‡ ‡ Spiritual suffering;
ESAS	r^§ § Pearson' correlation coefficient;	p^\|\| \|\| p<0.05	r^§ § Pearson' correlation coefficient;	p^\|\| \|\| p<0.05	r^§ § Pearson' correlation coefficient;	p^\|\| \|\| p<0.05
Pain	0.230	< 0.001	0.280	< 0.001	0.068	0.291
Tiredness	0.179	0.005	0.224	< 0.001	0.132	0.038
Nausea	0.154	0.021	0.109	0.102	0.142	0.033
Sadness	0.443	< 0.001	0.325	< 0.001	0.253	< 0.001
Anxiety	0.464	< 0.001	0.242	< 0.001	0.143	0.026
Sleepiness	0.142	0.029	0.087	0.181	0.136	0.036
Appetite	0.010	0.882	0.005	0.935	0.043	0.514
Well-being	0.131	0.044	0.015	0.820	0.066	0.311
Shortness of breath	0.119	0.067	0.140	0.031	0.176	0.007
Sleep	0.146	0.022	0.078	0.221	0.032	0.614
Total	0.372	< 0.001	0.262	< 0.001	0.223	< 0.001
HADS
Anxiety	0.430	< 0.001	0.269	< 0.001	0.240	< 0.001
Depression	0.336	< 0.001	0.235	< 0.001	0.263	< 0.001
Karnofsky (KPS)
	-0.257	< 0.001	-0.291	< 0.001	-0.238	< 0.001
FACIT -sp 12
Meaning and peace	-0.296	< 0.001	-0.127	0.036	-0.361	< 0.001
Faith	-0.143	0.022	0.018	0.775	-0.316	< 0.001
Total	-0.254	< 0.001	-0.068	0.256	-0.374	< 0.001
EORTC-QLQ-C30
General health	-0.202	0.001	-0.149	0.018	-0.206	0.001
General quality of life	-0.269	< 0.001	-0.180	0.004	-0.257	< 0.001

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Suzana Cristina Teixeira Donato E-mail: sudonato0612@gmail.com

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Validity and reliability of the Brazilian version of the Patient Dignity Inventory (PDI – Br)* * Paper extracted from master’s thesis “Patient dignity inventory psychometric validation (PDI-Br)”, presented to Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.

Objective:

Method:

Results:

Conclusion:

Validity and reliability of the Brazilian version of the Patient Dignity Inventory (PDI – Br)^* * Paper extracted from master’s thesis “Patient dignity inventory psychometric validation (PDI-Br)”, presented to Universidade de São Paulo, Escola de Enfermagem, São Paulo, SP, Brazil.