Gender invariance of dignity in non-terminal elderly patients with chronic diseases: a multicentric study

The Dignity construct, originally developed in end-of-life care, includes perceptions, cognitions and emotions related to the quality of being worthy of esteem or respect. The Patient Dignity Inventory is a self-report questionnaire developed to measure this construct. There is a lack of research on the construct in populations with chronic diseases, where Dignity may be expected to be impaired due to the associated changes in life. In addition, gender invariance of the construct has not been investigated yet. The current study investigated the single-dimension structure of the PDI in non-terminal elderly patients with different chronic diseases. A multicentric study at general hospitals included 421 elderly patients with chronic respiratory, renal or heart failure, stroke and oncological pathology in the initial phase of chemotherapeutic treatment. The dimensionality of the PDI was assessed by structural equation models and gender invariance by multigroup analysis. A single-dimension model optimized based on the Modification Indices showed excellent reliability and good fit. The inclusion of covariances between residuals of some items improved the model fit and suggested content overlap between some items which was interpreted considering the specific characteristics of chronic patients. The Dignity construct resulted invariant in relation to gender. Dignity in care appears to be an unitary construct also in chronic diseases. Future research should include also other types of chronicity and might assess further item fit through Item Response Theory analysis.