# Validating the socio-spiritual items of the Utrecht Symptom Diary—4 Dimensional: Content and construct validity

## TL;DR

The study confirms that the socio-spiritual items of the USD-4D accurately measure what they are intended to in palliative care patients.

## Contribution

The study validates the socio-spiritual items of the USD-4D for use in clinical palliative care.

## Key findings

- At least 80% of participants found the items comprehensible and relevant.
- About half of the respondents identified missing items in the USD-4D.
- For every item, at least 75% of hypotheses were confirmed, except one.

## Abstract

The Utrecht Symptom Diary—4 Dimensional (USD-4D) is a multidimensional Patient-Reported Outcome Measure to monitor symptoms and needs and increase patients’ self-efficacy. Assessing the content and construct validity of the USD-4D ensures it accurately measures the intended construct and is contextually relevant.

This study aimed to assess the content and construct validity of the socio-spiritual items of the USD-4D in a population of Dutch patients in the palliative phase of their illness.

A multiple method study was performed consisting of a cross-sectional survey and an observational cohort study.

The study population consisted of (a) healthcare providers working with patients in the palliative phase and (b) a cohort of patients with a life limiting illness in all settings supplemented by a cohort of hospice patients.

At least 80% of participants positively assessed the items comprehensibility and relevance. About half of the respondents indicated that certain items are missing from the USD-4D. A qualitative analysis of missing topics revealed either topics for monitoring over time or topics underlying the constructs included. For every item, at least 75% of hypotheses were confirmed. One hypothesis for the item “I can let my loved ones go” was rejected.

This study confirmed the content and construct validity on the socio-spiritual items of the USD-4D. Hence, the USD-4D is a validated PROM suitable to be structurally used in clinical palliative care to signal, monitor and to go into dialogue about social and spiritual aspects of patients’ values, wishes, and needs.