Psychometric Properties of the Patient Dignity Inventory in a Longitudinal Cohort of Acute Respiratory Failure Survivors.

Authors

Lydia E Federico, Craig Kwiatkowski, C Jessica Dine, Yingying Lu, Taara V Prasad, Erich Dress, Stefania Scott, Michael O Harhay, Rachel A Hadler, Rachel Kohn

Published in

Critical care medicine. Jul 21, 2026. Epub Jul 21, 2026.

Abstract

Although greater than 50% of acute respiratory failure (ARF) survivors develop postintensive care syndrome, dignity-centered interventions-shown to improve psychosocial and existential outcomes in other longitudinally impaired populations-remain largely unexplored in ARF survivorship. We aimed to validate the Patient Dignity Inventory (PDI) among ARF survivors by evaluating internal consistency and generalizability and establishing a minimal clinically important difference (MCID).
Prospective cohort study (June 2022 to April 2023) of mechanically ventilated (≥24 h) adults in four University of Pennsylvania hospitals' ICUs.
None.
Patients completed the PDI within 1 month of ICU discharge and at 3, 6, and 12 months. We assessed internal consistency using Cronbach's alpha (reliability of questions measuring the same construct; range 0-1) and exploratory factor analysis to identify dignity-related distress domains. We evaluated generalizability using multilevel mixed-effects modeling to estimate variance attributable to patients, questions, and timepoints, which informed phi coefficient calculation (score consistency; range 0-1). We calculated MCID by averaging anchor-based (EuroQol-5 Dimension MCID = 0.11 from baseline to 12 months) and distribution-based (average of se of the mean, 0.3 × sd, and 5% of baseline score range) estimates.Of 967 eligible patients, 103 patients (11%) enrolled at baseline, with 70% retention at 12 months. PDI demonstrated excellent internal consistency across timepoints (Cronbach's alpha = 0.94-0.96). Factor analysis identified 2-3 factors per timepoint, with physical, psychologic, and cognitive impairments predominating early, and existential and interpersonal concerns increasing longitudinally. Seventy-five percent of score variance was attributable to patient differences and 25% to timepoint, yielding phi = 0.93 (excellent consistency).
The PDI is a valid, reliable instrument for assessing dignity among ARF survivors longitudinally, demonstrating excellent internal consistency and generalizability, providing a foundation for designing and evaluating dignity-centered interventions addressing ARF survivors' evolving needs.

PMID:
42479496
Bibliographic data and abstract were imported from PubMed on 22 Jul 2026.

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