Hopelessness at the end of life: The utility of the hopelessness scale with terminally ill cancer patients

Jennifer Greene Abbey · Barry D. Rosenfeld · Hayley Pessin · WILLIAM S. BREITBART

76 citations0/0 files storedBritish Journal of Health Psychology

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Optimism, Hope, and Well-being Psychometric Methodologies and Testing Cancer survivorship and care

Abstract

OBJECTIVES: We sought to investigate the utility of the Beck Hopelessness Scale (HS) in a sample of terminally ill cancer patients by examining the scale properties. Moreover, we sought to identify and remove potentially problematic items in order to ascertain a "purer" index of hopelessness for this population. DESIGN: A cross-sectional study of 200 hospice inpatients with a life expectancy of less than 6 months. The HS, as well as several other distress measures, were administered to patients at bedside by trained clinicians. METHODS: An item analysis of the HS was conducted, looking specifically at item endorsement and item-total correlations. Three abbreviated versions (3-item 7-item, 13-item) were developed based on certain denoted item-total correlation cut-offs. Reliability and validity of the original 20-item HS was then compared to that of the newly developed abbreviated version. RESULTS: All scales were found to be reliable and valid measures of hopelessness. The three abbreviated versions were more highly correlated with the distress measures than the original version, and the 7-item and 13-item subscales outperformed the original HS in the prediction of suicidal ideation and desire for hastened death. CONCLUSION: The data suggest that the HS may be improved, when applied to a terminally ill sample, by the elimination of problematic items. The development of a shorter, purer measure of hopelessness for this population is crucial given the need to reduce the burden placed on those who participate in end-of-life studies, and the important role of hopelessness in the prediction of suicide and desire for hastened death.

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1960A RATING SCALE FOR DEPRESSION 1985Optimism, coping, and health: Assessment and implications of generalized outcome expectancies.1974The measurement of pessimism: The Hopelessness Scale.1992Abbreviated instrument to measure hope: development and psychometric evaluation 1993Hopelessness, Depression, Suicidal Ideation, and Clinical Diagnosis of Depression 2001Further Validity and Reliability Evidence for Beck Hopelessness Scale Scores in a Nonclinical Sample 1996Personal hopefulness: A conceptual review of the relevance of the perceived future to psychiatry

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