Analysis of the construct of dignity and content validity of the patient dignity inventory

Data were collected within the framework of an advance directives cohort study. This cohort study is aiming to get a better insight into how decisions are made at the end of life with regard to advance directives in the Netherlands. One half of the cohort (n = 2404) received an open-ended question concerning factors relevant to dignity. Content labels were assigned to issues mentioned in the responses to the open-ended question. The other half of the cohort (n = 2537) received a written questionnaire including the PDI. The relevance and comprehensiveness of the PDI items were assessed with the COSMIN checklist ('COnsensus-based Standards for the selection of health status Measurement INstruments').The majority of the PDI items were found to be relevant for the construct to be measured, the study population, and the purpose of the study but the items were not completely comprehensive. The responses to the open-ended question indicated that communication and care-related aspects were also important for dignity.This study demonstrated that the PDI items were relevant for people with an advance directive in the Netherlands. The comprehensiveness of the items can be improved by including items concerning communication and care.Dignity is a topic which often arises in discussions about care for dying patients. Since the concept of dignity is not clearly defined in palliative care, the term dignity is used in many different ways, and easily evokes confusion. Although, several authors have argued that dignity should be considered as a central principle in palliative care [1-3], and that conserving dignity can be considered as a goal of the care that is provided [4-7].Dignity can be defined as the quality of being worthy of esteem or respect. A distinction can be made between two types of dignity: basic dignity and personal dignity. Basic dignity is the inherent dignity of every human being, which nothing can take away, and personal dignity refers to a personal sense of wort