Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-21T14:35:18.490Z Has data issue: false hasContentIssue false
  • English
  • Français

The Short Demoralization Scale (SDS): A new tool to appraise demoralization in palliative care patients

Published online by Cambridge University Press:  09 January 2017

Laura Galiana ,
David Rudilla ,
Amparo Oliver  and
Pilar Barreto
Laura Galiana*
Affiliation:
Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
David Rudilla
Affiliation:
Home Care Unit of the Hospital General Universitario de Valencia, Valencia, Spain
Amparo Oliver
Affiliation:
Department of Methodology for the Behavioral Sciences, University of Valencia, Valencia, Spain
Pilar Barreto
Affiliation:
Department of Assessment, Treatments, and Personality, University of Valencia, Valencia, Spain
*
Address correspondence and reprint requests to: Laura Galiana, Department of Methodology for the Behavioral Sciences, University of Valencia, Avenida Blasco Ibañez 21, 46010 Valencia, Spain. E-mail: Laura.Galiana@uv.es.
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The Demoralization Scale (DS) is the most widely used measure for assessing demoralization. Following the recent clamor for brief assessment tools, and taking into account that demoralization has proved to be a symptom that needs to be controlled and treated in the palliative care setting, a shorter scale is needed. The aim of the present research is to introduce and evaluate the Short Demoralization Scale (SDS).

Method:

We employed a cross-sectional design that included a survey of 226 Spanish palliative care patients from the Hospital General Universitario de Valencia. We employed the SDS, the DS, and the Hospital Anxiety and Depression Scale (HADS).

Results:

The confirmatory factor analysis supported the one-factor structure of the SDS (χ2(5) = 12.915; p = 0.024; CFI = 0.999; RMSEA = 0.084; CI95% = [0.028, 0.141]). The reliability was found to be appropriate, with a value of Cronbach's alpha (α) equal to 0.920. A cutoff criterion of 10 was established, which favored the interpretability of the instrument.

Significance of results:

The SDS corrects previous limitations, has a simple scoring system, is cost-effective, and is widely and fully available. In addition, our findings demonstrate that the SDS can be employed effectively in the clinical context.

Keywords

DemoralizationSymptom assessmentPalliative carePsychometric testingEnd of life
Type
Original Articles
Information
Palliative & Supportive Care , Volume 15 , Issue 5 , October 2017 , pp. 516 - 523
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Akizuki, N., Yamawaki, S., Akechi, T., et al. (2005). Development of an Impact Thermometer for use in combination with the Distress Thermometer as a brief screening tool for adjustment disorders and/or major depression in cancer patients. Journal of Pain and Symptom Management, 29(1), 91–99. Available from http://www.jpsmjournal.com/article/S0885-3924(04)00450-6/pdf.CrossRefGoogle ScholarPubMed
Antunes, B., Harding, R., Higginson, I.J., et al. (2014). Implementing patient-reported outcome measures in palliative care clinical practice: A systematic review of facilitators and barriers. Palliative Medicine, 28(2), 158–175. Epub ahead of print Jun 25, 2013. Available from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0059371/.CrossRefGoogle ScholarPubMed
Bausewein, C., Daveson, B., Benalia, H., et al. (2011). Outcome measurement in palliative care: The essentials. London: The PRISMA Project. Available from http://www.eapcnet.eu/LinkClick.aspx?fileticket=-T62WTgTHtU%3D&tabid=1577.Google Scholar
Benito, E., Oliver, A., Galiana, L., et al. (2014). Development and validation of a new tool for the assessment and spiritual care of palliative care patients. Journal of Pain and Symptom Management, 47(6), 1008–10018. Epub ahead of print Oct 5 m 2013. Available from http://www.jpsmjournal.com/article/S0885-3924(13)00404-1/pdf.CrossRefGoogle ScholarPubMed
Bjordal, K., de Graeff, A., Fayers, P.M., et al. (2000). A 12-country field study of the EORTC QLQ–C30 (version 3.0) and the head and neck cancer specific module (EORTC QLQ–H&N35) in head and neck patients. European Journal of Cancer, 36(14), 1796–1807.CrossRefGoogle Scholar
Bossola, M., Murri, R., Onder, G., et al. (2010). Physicians' knowledge of health-related quality of life and perception of its importance in daily clinical practice. Health and Quality of Life Outcomes, 8, 43. Available from https:// www.ncbi.nlm.nih.gov/pmc/articles/PMC2868041/pdf/1477-7525-8-43.pdf.Google Scholar
Butcher, J.N., Graham, J.R., Williams, C.L., et al. (1990). Development and use of the MMPI–2 content scales. Minneapolis: University of Minnesota Press.Google Scholar
Chochinov, H.M., Wilson, K.G., Enns, M., et al. (1997). “Are you depressed?” Screening for depression in the terminally ill. The American Journal of Psychiatry, 154(5), 674–676. Available from http://ajp.psychiatryonline.org/doi/pdf/10.1176/ajp.154.5.674.Google ScholarPubMed
Cicchetti, D.V. (1994). Guidelines, criteria, and rules of thumb for evaluating normed and standardized assessment instruments in psychology. Psychological Assessment, 6(4), 284–290.CrossRefGoogle Scholar
Cohen, J. (1988). Statistical power analysis for the behavioral sciences, 2nd ed. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
Cohen, J. (1992). A power primer. Psychological Bulletin, 112(1), 155–159.CrossRefGoogle ScholarPubMed
Cormier, J. & Askew, R.L. (2011). Assessment of patient-reported outcomes in patients with melanoma. Surgical Oncology Clinics of North America, 20(1), 201–213. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995694/pdf/nihms-237934.pdf.CrossRefGoogle ScholarPubMed
Costantini, A., Picardi, A., Brunetti, S., et al. (2013). La versione italiana della Demoralization Scale: Uno studio di validazione [Italian version of the Demoralization Scale: A validation study] [in Italian]. Rivista di Psichiatria, 48(3), 234–239. Available from http://www.rivistadipsichiatria.it/articoli.php?archivio=yes&vol_id=1292&id=14291.Google ScholarPubMed
Dalal, D.K. & Carter, N.T. (2015). Negatively worded items negatively impact survey research. In More statistical and methodological myths and urban legends. Lance, C.E. & Vanderberg, R.J. (eds.), pp. 112–132. New York: Routledge.Google Scholar
Daveson, B.A., Simon, S.T., Benalia, H., et al. (2012). Are we heading in the same direction? European and African doctors' and nurses' views and experiences regarding outcome measurement in palliative care. Palliative Medicine, 26(3), 242–249. Epub ahead of print Jun 22, 2011.CrossRefGoogle ScholarPubMed
Dawson, J., Doll, H., Fitzpatrick, R., et al. (2010). Routine use of patient-reported outcome measures in healthcare settings. BMJ, 340, 464–467. Available from http://www.bmj.com/content/340/bmj.c186.long.CrossRefGoogle ScholarPubMed
De Jong, C.A.J., Kissane, D.W., Geessink, R.J., et al. (2008). Demoralization in opioid-dependent patients: A comparative study with cancer patients and community subjects. The Open Addiction Journal, 1, 7–9. Available from http://benthamopen.com/contents/pdf/TOADDJ/TOADDJ-1-7.pdf.CrossRefGoogle Scholar
Dohrenwend, B.P., Shrout, P.E., Egri, G., et al. (1980). Nonspecific psychological distress and other dimensions of psychopathology: Measures for use in the general population. Archives of General Psychiatry, 37(11), 1229–1236.CrossRefGoogle ScholarPubMed
Hadnagy, Z., Csikós, A. & Nagy, L. (2012). Introduction of the demoralization scale in Hungary: A study on demoralization and depression among hospice patients [in Hungarian]. Orvosi Hetilap, 153(19), 737–743.CrossRefGoogle Scholar
Harding, R., Simon, S.T., Benalia, H., et al. (2011). The PRISMA Symposium 1: Outcome tool use. Disharmony in European outcomes research for palliative and advanced disease care: Too many tools in practice. Journal of Pain and Symptom Management , 42(4), 493–500. Available from http://www.jpsmjournal.com/article/S0885-3924(11)00378-2/pdf.Google ScholarPubMed
Hearn, J. & Higginson, I.J. (1997). Outcome measures in palliative care for advanced cancer patients: A review. Journal of Public Health Medicine, 19(2), 193–199. Available from http://jpubhealth.oxfordjournals.org/content/19/2/193.long.CrossRefGoogle ScholarPubMed
Higginson, I.J. & Carr, A.J. (2001). Measuring quality of life: Using quality of life measures in the clinical setting. BMJ, 322(7297), 1297–1300. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1120388/pdf/1297.pdf.CrossRefGoogle ScholarPubMed
Hu, L. & Bentler, P.M. (1999). Cut-off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.CrossRefGoogle Scholar
Hung, H.C., Chen, H.W., Chang, Y.F., et al. (2010). Evaluation of the reliability and validity of the Mandarin version of Demoralization Scale for cancer patients. Journal of Internal Medicine of Taiwan, 21(6), 427–435.Google Scholar
Julião, M., Nunes, B., Sobral, M.A., et al. (2015). Is it useful to ask “Está deprimido?” (“Are you depressed?”) to terminally ill Portuguese patients? Results from outpatient research. Palliative & Supportive Care, 14(2), 138–141. Epub ahead of print May 20.CrossRefGoogle ScholarPubMed
Julião, M., Nunes, B. & Barbosa, A. (2016). Prevalence and factors associated with demoralization syndrome in patients with advanced disease: Results from a cross-sectional Portuguese study. Palliative & Supportive Care, 14(5), 468–473. Epub ahead of print Jan 6.CrossRefGoogle ScholarPubMed
Kissane, D.W., Wein, S., Love, A., et al. (2004). The Demoralization Scale: A report of its development and preliminary validation. Journal of Palliative Care, 20(4), 269–276.CrossRefGoogle Scholar
Mehnert, A., Vehling, S., Hocker, A., et al. (2011). Demoralization and depression in patients with advanced cancer: Validation of the German version of the Demoralization Scale. Journal of Pain and Symptom Management, 42(5), 768–776. Epub ahead of print May 18. Available from http://www.jpsmjournal.com/article/S0885-3924(11)00156-4/pdf.CrossRefGoogle ScholarPubMed
Mokkink, L.B., Terwee, C.B., Patrick, D.L., et al. (2010). The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An International Delphi study. Quality of Life Research, 19, 539–549. Available from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2852520/pdf/11136_2010_Article_9606.pdf.CrossRefGoogle ScholarPubMed
Morita, T., Tsunoda, J., Inoue, S., et al. (2001). Improved accuracy of physicians' survival prediction for terminally ill cancer patients using the Palliative Prognostic Index. Palliative Medicine, 15(5), 419–424.CrossRefGoogle ScholarPubMed
Mularski, R.A., Rosenfeld, K., Coons, S., et al. (2007). Measuring outcomes in randomized prospective trials in palliative. Journal of Pain and Symptom Management, 34(Suppl. 1), S7–S19. Epub ahead of print May 25. http://www.jpsmjournal.com/article/S0885-3924(07)00264-3/pdf.CrossRefGoogle ScholarPubMed
Mullane, M., Dooley, B., Tiernan, E., et al. (2009). Validation of the demoralization scale in an Irish advanced cancer sample. Palliative & Supportive Care, 7(3), 323–330.CrossRefGoogle Scholar
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23(10), 433–441.CrossRefGoogle Scholar
Robinson, S., Kissane, D.W., Brooker, J., et al. (2016 a). Refinement and revalidation of the Demoralization Scale: The DS–II. External validity. Cancer, 122(14), 2260–2267. Epub ahead of print May 12.CrossRefGoogle ScholarPubMed
Robinson, S., Kissane, D.W., Brooker, J., et al. (2016 b). Refinement and revalidation of the Demoralization Scale: The DS–II, Internal validity. Cancer, 122(14), 2251–2259. Epub ahead of print May 12.CrossRefGoogle ScholarPubMed
Rose, M. & Bezjak, A. (2009). Logistics of collecting patient-reported outcomes (PROs) in clinical practice: An overview and practical examples. Quality of Life Research, 18(1), 125–136. Epub ahead of print Jan 20.CrossRefGoogle ScholarPubMed
Rudilla, D., Galiana, L., Oliver, A., et al. (2015). Comparing counseling and dignity therapies in home care patients: A pilot study. Palliative & Supportive Care, 14(4), 321–329. Epub ahead of print Oct 14.CrossRefGoogle ScholarPubMed
Rudilla, D., Oliver, A., Galiana, L., et al. (2016 a). A new measure of home care patients' dignity at the end of life: The Palliative Patients' Dignity Scale (PPDS). Palliative & Supportive Care, 14(2), 99–108. Epub ahead of print Jun 11, 2015.CrossRefGoogle ScholarPubMed
Rudilla, D., Galiana, L., Oliver, A., et al. (2016 b). Demoralization Scale in Spanish-speaking palliative care patients. Journal of Pain and Symptom Management, 51(4), 769–775. Epub ahead of print Dec 22, 2015.CrossRefGoogle ScholarPubMed
Sloan, J.A., Halyard, M.Y., Frost, M.H., et al. (2007). The Mayo Clinic manuscript series relative to the discussion, dissemination, and operationalization of the Food and Drug Administration guidance on patient-reported outcomes. Value in Health, 10(Suppl. 2), S59–S63. http://www.valueinhealthjournal.com/article/S1098-3015(10)60629-8/pdf.CrossRefGoogle Scholar
Terwee, C.B., Bot, S.D.M., de Boer, M.R., et al. (2007). Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology, 60(1), 34–42. Epub ahead of print Aug 24, 2006.CrossRefGoogle ScholarPubMed
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.CrossRefGoogle ScholarPubMed
Zimmermann, C. & Rodin, G. (2004). The denial of death thesis: Sociological critique and implications for palliative care. Palliative Medicine, 18(2), 121–128.CrossRefGoogle ScholarPubMed