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Assessing the Stages of the Grieving Process in Chronic Obstructive Pulmonary Disease (COPD): Validation of the Acceptance of Disease and Impairments Questionnaire (ADIQ)

International Journal of Behavioral Medicine volume 21, pages 561–570 (2014)Cite this article

Abstract

Background

Patients with chronic obstructive pulmonary disease (COPD) encounter many (gradual) losses due to their disease, which trigger a grieving process. This process is characterized by stages of denial, resistance, sorrow, and acceptance.

Purpose

This study examined whether these stages are conceptually distinct and whether the Acceptance of Disease and Impairments Questionnaire (ADIQ) can validly and reliably measure these stages in three samples of patients with COPD in the Netherlands.

Methods

Exploratory factor analysis (EFA) was performed on 145 outpatients with moderate to severe COPD. Confirmatory factor analyses were performed on 303 outpatients with mild to very severe COPD and 127 patients entering an inpatient pulmonary rehabilitation program. Furthermore, internal reliability, construct validity, sensitivity to change, and floor and ceiling effects were examined.

Results

EFA yielded a four-factor solution that explained 73.2 % of variance. Confirmatory factor analyses showed a good fit of the four-factor structure in all study samples. Cronbach’s alpha reliability coefficients were .79 or higher. Subscales showed to be sensitive to change.

Conclusions

Four distinct stages of grief are recognized in COPD. The ADIQ is a valid and reliable instrument to measure these stages: denial, resistance, sorrow, and acceptance. Measuring the stages of grieving is important for disease management: addressing patients with a specific therapeutic approach for the stage they are in could help to motivate patients to engage in self-management and change their lifestyle.

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Acknowledgments

We would like to thank Rogier Donders of the Department of Epidemiology, Biostatistics and HTA of the Radboud University Nijmegen Medical Centre for his expert statistical guidance, the multidisciplinary expert group of the Pulmonary Rehabilitation Unit Dekkerswald for their contribution to the development of the questionnaire, and all patients who have participated. The study was supported by grants of the Dutch Asthma Foundation, PICASSO for COPD, and the Department of Medical Psychology of the Radboud University Nijmegen Medical Centre.

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Authors and Affiliations

  1. Department of Medical Psychology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands

    Lonneke M. Boer, Leonie Daudey, Jeannette B. Peters, Judith B. Prins & Jan H. Vercoulen

  2. Department of Pulmonary Diseases, Radboud University Nijmegen Medical Centre, Postbus 66, 6560 AB, Groesbeek, the Netherlands

    Lonneke M. Boer, Leonie Daudey, Jeannette B. Peters, Johan Molema & Jan H. Vercoulen

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  1. Lonneke M. Boer
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  2. Leonie Daudey
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  3. Jeannette B. Peters
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  4. Johan Molema
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  6. Jan H. Vercoulen
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Correspondence to Lonneke M. Boer.

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Boer, L.M., Daudey, L., Peters, J.B. et al. Assessing the Stages of the Grieving Process in Chronic Obstructive Pulmonary Disease (COPD): Validation of the Acceptance of Disease and Impairments Questionnaire (ADIQ). Int.J. Behav. Med. 21, 561–570 (2014). https://doi.org/10.1007/s12529-013-9312-3

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  • DOI: https://doi.org/10.1007/s12529-013-9312-3

Keywords

  • Acceptance
  • Chronic obstructive pulmonary disease (COPD)
  • Grieving process
  • Questionnaire
  • Self-management
  • Validation