10 research outputs found
Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population
Purpose: The Demoralization scale (DS-I) is a validated and frequently used instrument
to assess existential distress in patients with cancer and other severe medical illness.
The purpose of this study was to provide normative values derived from a representative
German general population sample and to analyze the correlational structure of the DS-I.
Methods: A representative sample of the adult German general population completed
the DS-I (24 Items), the Emotion Thermometers (ET) measuring distress, anxiety,
depression, anger, need for help, and the Functional Assessment of Chronic Illness
Therapy Fatigue Scale (FACIT-fatigue).
Results: The sample consists of N = 2,407 adults (mean age = 49.8; range = 18â94
years), 55.7% women). The percentages of participants above the DS-I cutoff (30) was
13.5%. The mean scores of the DS-I dimensions were as follows: (1) loss of meaning
and purpose: M = 2.78 SD = 4.49; (2) disheartenment: M = 3.19 SD = 4.03; (3)
dysphoria M = 4.51 SD = 3.20; (4) sense of failure: M = 6.24 SD = 3.40; and for
the DS-I total score: M = 16.72 SD = 12.74. Women reported significantly higher levels
of demoralization than men, with effect sizes between d = 0.09 (Loss of Meaning) and
d = 0.21 (Dysphoria). Age was not associated with demoralization in our sample. DS-I
reliability was excellent (a = 0.94) and DS-I subscales were interrelated (r between 0.31
and 0.87) and significantly correlated with ET, especially depression, anxiety, and need
for help and fatigue (r between 0.14 and 0.69).
Conclusions: In order to use the DS-I as a screening tool in clinical practice and research
the normative values are essential for comparing the symptom burden of groups of
patients within the health care system to the general population. Age and sex differences
between groups of patients can be accounted for using the presented normative scores
of the DS-I
Testing the Treatment Integrity of the Managing Cancer and Living Meaningfully Psychotherapeutic Intervention for Patients With Advanced Cancer
Introduction: The Managing Cancer and Living Meaningfully (CALM) therapy for
patients with advanced cancer was tested against a supportive psycho-oncological
counseling intervention (SPI) in a randomized controlled trial (RCT). We investigated
whether CALM was delivered as intended (therapistsâ adherence); whether CALM
therapists with less experience in psycho-oncological care show higher adherence
scores; and whether potential overlapping treatment elements between CALM and SPI
can be identified (treatment differentiation).
Methods: Two trained and blinded raters assessed on 19 items four subscales of
the Treatment Integrity Scale covering treatment domains of CALM (SC: Symptom
Management and Communication with Health Care Providers; CSR: Changes in Self
and Relationship with Others; SMP: Spiritual Well-being and Sense of Meaning and
Purpose; FHM: Preparing for the Future, Sustaining Hope and Facing Mortality).
A random sample of 150 audio recordings (75 CALM, 75 SPI) were rated on a threepoint
Likert scale with 1 = âadherent to some extent,â 2 = âadherent to a sufficient
extent,â 3 = âvery adherent.â
Results: All 19 treatment elements were applied, but in various frequencies. CALM
therapists most frequently explored symptoms and/or relationship to health care
providers (SC_1: n_applied = 62; 83%) and allowed expression of sadness and anxiety
about the progression of disease (FHM_2: n_applied = 62; 83%). The exploration of CALM
treatment element SC_1 was most frequently implemented in a satisfactory or excellent
manner (n_sufficient or very adherent = 34; 45%), whereas the treatment element SMP_4:
Therapist promotes acknowledgment that some life goals may no longer be achievable
(n_sufficient or very adherent = 0; 0%) was not implemented in a satisfactory manner.
In terms of treatment differentiation, no treatment elements could be identified which
were applied significantly more often by CALM therapists than by SPI therapists.
Conclusion: Results verify the application of CALM treatment domains. However,
CALM therapistsâ adherence scores indicated manual deviations. Furthermore, raters
were not able to significantly distinguish CALM from SPI, implying that overlapping
treatment elements were delivered to patients
Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer
Objective: To test the psychometric properties, internal consistency, dimensional
structure, and convergent validity of the German version of the Demoralization Scale-
II (DS-II), and to examine the association between demoralization, sociodemographic,
disease- and treatment-related variables in patients with cancer.
Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center
and at oncological wards. Participants completed the 16-item DS-II, Patient Health
Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress
Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency
of the DS-II using Cronbachâs Alpha (a). We tested the dimensional structure of the
DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed
through correlation coefficients with established measures of psychological distress.
The associations between demoralization, sociodemographic, disease- and treatmentrelated
variables were examined with ANOVAs.
Results: Out of 942 eligible patients, 620 participated. The average DS-II total score
was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20,
and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency
ranged from high to excellent with a = 0.93 for the DS-II total scale, a = 0.90 for
the Meaning and Purpose subscale, and a = 0.87 for the Distress and Coping Ability
subscale. The one-factor and the two-factor model yielded similar model fits, with
CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated
significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress
(DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization
were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients
who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29,
SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60).
Conclusion: The DS-II has very good psychometric properties and can be
recommended as a reliable tool for assessing demoralization in patients with cancer.
The results support the implementation of a screening for demoralization in specific risk
groups due to significantly increased demoralization scores
Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population
Purpose: The Demoralization scale (DS-I) is a validated and frequently used instrument
to assess existential distress in patients with cancer and other severe medical illness.
The purpose of this study was to provide normative values derived from a representative
German general population sample and to analyze the correlational structure of the DS-I.
Methods: A representative sample of the adult German general population completed
the DS-I (24 Items), the Emotion Thermometers (ET) measuring distress, anxiety,
depression, anger, need for help, and the Functional Assessment of Chronic Illness
Therapy Fatigue Scale (FACIT-fatigue).
Results: The sample consists of N = 2,407 adults (mean age = 49.8; range = 18â94
years), 55.7% women). The percentages of participants above the DS-I cutoff (30) was
13.5%. The mean scores of the DS-I dimensions were as follows: (1) loss of meaning
and purpose: M = 2.78 SD = 4.49; (2) disheartenment: M = 3.19 SD = 4.03; (3)
dysphoria M = 4.51 SD = 3.20; (4) sense of failure: M = 6.24 SD = 3.40; and for
the DS-I total score: M = 16.72 SD = 12.74. Women reported significantly higher levels
of demoralization than men, with effect sizes between d = 0.09 (Loss of Meaning) and
d = 0.21 (Dysphoria). Age was not associated with demoralization in our sample. DS-I
reliability was excellent (a = 0.94) and DS-I subscales were interrelated (r between 0.31
and 0.87) and significantly correlated with ET, especially depression, anxiety, and need
for help and fatigue (r between 0.14 and 0.69).
Conclusions: In order to use the DS-I as a screening tool in clinical practice and research
the normative values are essential for comparing the symptom burden of groups of
patients within the health care system to the general population. Age and sex differences
between groups of patients can be accounted for using the presented normative scores
of the DS-I
Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population
Purpose: The Demoralization scale (DS-I) is a validated and frequently used instrument
to assess existential distress in patients with cancer and other severe medical illness.
The purpose of this study was to provide normative values derived from a representative
German general population sample and to analyze the correlational structure of the DS-I.
Methods: A representative sample of the adult German general population completed
the DS-I (24 Items), the Emotion Thermometers (ET) measuring distress, anxiety,
depression, anger, need for help, and the Functional Assessment of Chronic Illness
Therapy Fatigue Scale (FACIT-fatigue).
Results: The sample consists of N = 2,407 adults (mean age = 49.8; range = 18â94
years), 55.7% women). The percentages of participants above the DS-I cutoff (30) was
13.5%. The mean scores of the DS-I dimensions were as follows: (1) loss of meaning
and purpose: M = 2.78 SD = 4.49; (2) disheartenment: M = 3.19 SD = 4.03; (3)
dysphoria M = 4.51 SD = 3.20; (4) sense of failure: M = 6.24 SD = 3.40; and for
the DS-I total score: M = 16.72 SD = 12.74. Women reported significantly higher levels
of demoralization than men, with effect sizes between d = 0.09 (Loss of Meaning) and
d = 0.21 (Dysphoria). Age was not associated with demoralization in our sample. DS-I
reliability was excellent (a = 0.94) and DS-I subscales were interrelated (r between 0.31
and 0.87) and significantly correlated with ET, especially depression, anxiety, and need
for help and fatigue (r between 0.14 and 0.69).
Conclusions: In order to use the DS-I as a screening tool in clinical practice and research
the normative values are essential for comparing the symptom burden of groups of
patients within the health care system to the general population. Age and sex differences
between groups of patients can be accounted for using the presented normative scores
of the DS-I
Testing the Treatment Integrity of the Managing Cancer and Living Meaningfully Psychotherapeutic Intervention for Patients With Advanced Cancer
Introduction: The Managing Cancer and Living Meaningfully (CALM) therapy for
patients with advanced cancer was tested against a supportive psycho-oncological
counseling intervention (SPI) in a randomized controlled trial (RCT). We investigated
whether CALM was delivered as intended (therapistsâ adherence); whether CALM
therapists with less experience in psycho-oncological care show higher adherence
scores; and whether potential overlapping treatment elements between CALM and SPI
can be identified (treatment differentiation).
Methods: Two trained and blinded raters assessed on 19 items four subscales of
the Treatment Integrity Scale covering treatment domains of CALM (SC: Symptom
Management and Communication with Health Care Providers; CSR: Changes in Self
and Relationship with Others; SMP: Spiritual Well-being and Sense of Meaning and
Purpose; FHM: Preparing for the Future, Sustaining Hope and Facing Mortality).
A random sample of 150 audio recordings (75 CALM, 75 SPI) were rated on a threepoint
Likert scale with 1 = âadherent to some extent,â 2 = âadherent to a sufficient
extent,â 3 = âvery adherent.â
Results: All 19 treatment elements were applied, but in various frequencies. CALM
therapists most frequently explored symptoms and/or relationship to health care
providers (SC_1: n_applied = 62; 83%) and allowed expression of sadness and anxiety
about the progression of disease (FHM_2: n_applied = 62; 83%). The exploration of CALM
treatment element SC_1 was most frequently implemented in a satisfactory or excellent
manner (n_sufficient or very adherent = 34; 45%), whereas the treatment element SMP_4:
Therapist promotes acknowledgment that some life goals may no longer be achievable
(n_sufficient or very adherent = 0; 0%) was not implemented in a satisfactory manner.
In terms of treatment differentiation, no treatment elements could be identified which
were applied significantly more often by CALM therapists than by SPI therapists.
Conclusion: Results verify the application of CALM treatment domains. However,
CALM therapistsâ adherence scores indicated manual deviations. Furthermore, raters
were not able to significantly distinguish CALM from SPI, implying that overlapping
treatment elements were delivered to patients
Testing the Treatment Integrity of the Managing Cancer and Living Meaningfully Psychotherapeutic Intervention for Patients With Advanced Cancer
Introduction: The Managing Cancer and Living Meaningfully (CALM) therapy for
patients with advanced cancer was tested against a supportive psycho-oncological
counseling intervention (SPI) in a randomized controlled trial (RCT). We investigated
whether CALM was delivered as intended (therapistsâ adherence); whether CALM
therapists with less experience in psycho-oncological care show higher adherence
scores; and whether potential overlapping treatment elements between CALM and SPI
can be identified (treatment differentiation).
Methods: Two trained and blinded raters assessed on 19 items four subscales of
the Treatment Integrity Scale covering treatment domains of CALM (SC: Symptom
Management and Communication with Health Care Providers; CSR: Changes in Self
and Relationship with Others; SMP: Spiritual Well-being and Sense of Meaning and
Purpose; FHM: Preparing for the Future, Sustaining Hope and Facing Mortality).
A random sample of 150 audio recordings (75 CALM, 75 SPI) were rated on a threepoint
Likert scale with 1 = âadherent to some extent,â 2 = âadherent to a sufficient
extent,â 3 = âvery adherent.â
Results: All 19 treatment elements were applied, but in various frequencies. CALM
therapists most frequently explored symptoms and/or relationship to health care
providers (SC_1: n_applied = 62; 83%) and allowed expression of sadness and anxiety
about the progression of disease (FHM_2: n_applied = 62; 83%). The exploration of CALM
treatment element SC_1 was most frequently implemented in a satisfactory or excellent
manner (n_sufficient or very adherent = 34; 45%), whereas the treatment element SMP_4:
Therapist promotes acknowledgment that some life goals may no longer be achievable
(n_sufficient or very adherent = 0; 0%) was not implemented in a satisfactory manner.
In terms of treatment differentiation, no treatment elements could be identified which
were applied significantly more often by CALM therapists than by SPI therapists.
Conclusion: Results verify the application of CALM treatment domains. However,
CALM therapistsâ adherence scores indicated manual deviations. Furthermore, raters
were not able to significantly distinguish CALM from SPI, implying that overlapping
treatment elements were delivered to patients
Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer
Objective: To test the psychometric properties, internal consistency, dimensional
structure, and convergent validity of the German version of the Demoralization Scale-
II (DS-II), and to examine the association between demoralization, sociodemographic,
disease- and treatment-related variables in patients with cancer.
Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center
and at oncological wards. Participants completed the 16-item DS-II, Patient Health
Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress
Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency
of the DS-II using Cronbachâs Alpha (a). We tested the dimensional structure of the
DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed
through correlation coefficients with established measures of psychological distress.
The associations between demoralization, sociodemographic, disease- and treatmentrelated
variables were examined with ANOVAs.
Results: Out of 942 eligible patients, 620 participated. The average DS-II total score
was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20,
and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency
ranged from high to excellent with a = 0.93 for the DS-II total scale, a = 0.90 for
the Meaning and Purpose subscale, and a = 0.87 for the Distress and Coping Ability
subscale. The one-factor and the two-factor model yielded similar model fits, with
CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated
significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress
(DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization
were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients
who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29,
SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60).
Conclusion: The DS-II has very good psychometric properties and can be
recommended as a reliable tool for assessing demoralization in patients with cancer.
The results support the implementation of a screening for demoralization in specific risk
groups due to significantly increased demoralization scores
Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer
Objective: To test the psychometric properties, internal consistency, dimensional
structure, and convergent validity of the German version of the Demoralization Scale-
II (DS-II), and to examine the association between demoralization, sociodemographic,
disease- and treatment-related variables in patients with cancer.
Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center
and at oncological wards. Participants completed the 16-item DS-II, Patient Health
Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress
Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency
of the DS-II using Cronbachâs Alpha (a). We tested the dimensional structure of the
DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed
through correlation coefficients with established measures of psychological distress.
The associations between demoralization, sociodemographic, disease- and treatmentrelated
variables were examined with ANOVAs.
Results: Out of 942 eligible patients, 620 participated. The average DS-II total score
was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20,
and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency
ranged from high to excellent with a = 0.93 for the DS-II total scale, a = 0.90 for
the Meaning and Purpose subscale, and a = 0.87 for the Distress and Coping Ability
subscale. The one-factor and the two-factor model yielded similar model fits, with
CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated
significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress
(DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization
were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients
who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29,
SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60).
Conclusion: The DS-II has very good psychometric properties and can be
recommended as a reliable tool for assessing demoralization in patients with cancer.
The results support the implementation of a screening for demoralization in specific risk
groups due to significantly increased demoralization scores