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

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.