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

Palliat Support Care. 2017 Oct;15(5):516-523. doi: 10.1017/S1478951516000973. Epub 2017 Jan 9.


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; CI 95% = [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: Demoralization; End of life; Palliative care; Psychometric testing; Symptom assessment.

MeSH terms

  • Chi-Square Distribution
  • Cross-Sectional Studies
  • Hope*
  • Humans
  • Palliative Care / psychology*
  • Palliative Care / statistics & numerical data
  • Psychometrics / instrumentation*
  • Psychometrics / methods
  • Psychometrics / standards*
  • Quality of Life / psychology
  • Reproducibility of Results
  • Spain
  • Stress, Psychological / complications
  • Stress, Psychological / etiology
  • Surveys and Questionnaires
  • Terminally Ill / psychology*
  • Terminally Ill / statistics & numerical data