The Content Validity of the Items Related to the Social and Spiritual Dimensions of the Utrecht Symptom Diary-4 Dimensional From a Patient's Perspective: A Qualitative Study

J Pain Symptom Manage. 2021 Feb;61(2):287-294.e2. doi: 10.1016/j.jpainsymman.2020.07.036. Epub 2020 Aug 7.


Context: In palliative care, caregivers often lack words and competences to discuss patients' needs in social and spiritual dimensions. The Utrecht Symptom Diary-4 Dimensional (USD-4D) is an instrument that can be used to monitor symptoms and needs in the physical, psychological, social, and spiritual dimensions and to optimize communication between patients and caregivers.

Objective: To assess the content validity of the USD-4D items related to the social and spiritual dimensions from a patient's perspective, measured in terms of comprehensibility, relevance, and comprehensiveness.

Methods: An explorative qualitative study was conducted using in-depth semistructured interviews and thematic analysis. Twelve participants (male N = 7, 53-87 years old) with an estimated life expectancy of less than one year were recruited in two home care services: a general hospital and a hospice.

Results: The instructions, items, and response options were comprehensible for almost all participants. The meaning that was provided to the items was expressed in themes: maintaining personal identity and autonomy, resilience, letting go, perceived balance in one's life, and death and afterlife. This corresponds with the intended meaning. The items were relevant at some points in time. Not all participants had needs for personal care during the interviews. Participants found the USD-4D comprehensive, no key concepts related to the social or spiritual dimensions appeared to be missing.

Conclusions: The USD-4D constitutes a content valid PROM from the patient's perspective. The items support patients in identifying needs in the social and spiritual dimensions and in the conversation to further explore these needs.

Keywords: Palliative care; communication; patient reported outcome measures; sociological factors; spirituality; validation study.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Hospice Care*
  • Hospices*
  • Humans
  • Male
  • Middle Aged
  • Palliative Care
  • Qualitative Research
  • Spirituality