Abstract
PurposeTo evaluate psychometric characteristics of a questionnaire (the Northwestern Ego-integrity Scale (NEIS)) on ego-integrity (the experience of wholeness and meaning in life, even in spite of negative experiences) and despair (the experience of regret about the life one has led, and feelings of sadness, failure and hopelessness) among cancer patients.MethodsCancer patients (n = 164) completed patient reported outcome measures on ego-integrity and despair (NEIS), psychological distress, anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and quality of life (EORTC QLQ-C30 (cancer survivors, n = 57) or EORTC QLQ-C15-PAL (advanced cancer patients, n = 107)). Confirmatory Factor Analysis was used to assess construct validity. Cronbach’s alpha was used to assess internal consistency. Convergent validity was tested based on a priori defined hypotheses: a higher level of ego-integrity was expected to be related to a higher level of quality of life, and lower levels of distress, depression and anxiety; a higher level of despair was expected to be related to a lower level of quality of life, and higher levels of distress, depression and anxiety.ResultsThe majority of all items (94.5%) of the NEIS were completed by patients and single item missing rate was below 2%. The two subscales, labeled as Ego-integrity (5 items) and Despair (4 items) had acceptable internal consistency (Cronbach’s alpha .72 and .61, respectively). The Ego-integrity subscale was not significantly associated with quality of life, distress, anxiety, or depression. The Despair subscale correlated significantly (p <.001) with quality of life (r = -.29), distress (r = .44), anxiety (r = .47) and depression (r = .32).ConclusionThe NEIS has good psychometric characteristics to assess ego-integrity and despair among cancer patients.
Highlights
According to Erikson’s theory, ego-integrity and despair are key topics in the eighth developmental stage, when people enter the final stage of life and reflect on the meaning of life and how they lived it
The majority of all items (94.5%) of the Northwestern Ego-integrity Scale (NEIS) were completed by patients and single item missing rate was below 2%
Convergent validity of the questionnaire NEIS was tested based on a priori defined hypotheses: a higher level of ego-integrity was expected to be related to a higher level of quality of life, and lower levels of psychological distress, depression and anxiety; a higher level of despair was expected to be related to a lower level of quality of life, and higher levels of psychological distress, depression and anxiety [3]
Summary
According to Erikson’s theory, ego-integrity and despair are key topics in the eighth developmental stage, when people enter the final stage of life and reflect on the meaning of life and how they lived it. A person experiences ego-integrity, if he or she accepts his or her life cycle as something that had to be, feels connected to others, and experiences a sense of wholeness, meaning and coherence as he or she faces (the approach of) death. Information on ego-integrity and despair is scarce and a valid questionnaire to assess ego-integrity and despair among cancer patients is lacking. Such a questionnaire is important, because it is hypothesized that patients who do not achieve ego-integrity and have a high level of despair can experience more psychological problems and death anxiety, have fewer personal and interpersonal resources for facing cancer, and are more vulnerable to developing depressive symptoms [3,5]
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