MEASURING MEANING AND PEACE WITH THE FACIT-SP: DISTINCTION WITHOUT A DIFFERENCE?
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1 MEASURING MEANING AND PEACE WITH THE FACIT-SP: DISTINCTION WITHOUT A DIFFERENCE? Eboni Hedgspeth, B.A. Charlie Reeve, Ph.D. Amy Peterman, Ph.D. University of North Carolina at Charlotte
2 ACKNOWLEDGEMENTS David Cella, Ph.D. (PI): Feinberg School of Medicine at Northwestern University Joel Tsevat, M.D. (PI) and Sian Cotton, Ph.D.: University of Cincinnati and Cincinnati VAMC Richard McQuellon, Ph.D. (PI): Wake Forest University Baptist Medical Center
3 FACIT-SP Functional Assessment of Chronic Illness Therapy Spiritual Well-Being Scale 12-item scale derived from contributions of patients and experts Spiritual well-being Sense of meaning, harmony, peacefulness, strength, comfort from one s faith Peterman et al., 2002
4 FACIT-SP ITEMS Meaning/Peace I feel peaceful. I have a reason for living. My life has been productive. I have trouble feeling peace of mind.* I feel a sense of purpose in my life. Faith I find comfort in my faith or spiritual beliefs. I find strength in my faith or spiritual beliefs. My illness has strengthened my faith or spiritual beliefs. I know that whatever happens with my illness, things will be okay. I am able to reach deep down into myself for comfort. I feel a sense of harmony within myself. My life lacks meaning and purpose.* Note. * indicates negatively worded item. Items arranged according to the original 2-factor model.
5 2-FACTORS VS. 3-FACTORS Peterman et al. (2002) 2 Factors: Meaning/Peace and Faith Canada et al. (2008) 3 Factors: Meaning, Peace, and Faith Peace positively related to mental health Meaning positively related to physical and mental health Faith negatively related to mental health Murphy et al. (2010) 3 Factors: Meaning, Peace, and Faith Different models across racial/ethnic groups Peace more strongly related to mental health than Meaning
6 THE PRESENT STUDY 2 objectives 1.Compare 2- and 3-factor models Replicate Canada et al. (2008) and Murphy et al. (2010) 2.Evaluate utility of the two models across various physical and mental health outcomes
7 SAMPLES Sample N Description Cancer and/or HIV diagnoses Cancer diagnoses; receiving chemotherapy HIV/AIDS diagnoses Cancer diagnoses; undergoing bone marrow transplantation Note. Total = 2810.
8 OBJECTIVE 1: METHOD Confirmatory factor analyses 4 models tested per sample 2-factors no cross-load 2-factors cross-load 3-factors no cross-load 3-factors cross load
9 OBJECTIVE 1: RESULTS SAMPLE 1 RMSEA 90% CI Model df χ 2 χ 2 /df TLI CFI NFI RMSEA Lo Hi 2 factors, no factors, 3 factors, no 3 factors, Note. Cross-loading refers to item 12 which was allowed to load on both the Faith and Peace factors.
10 OBJECTIVE 1: RESULTS SAMPLE RMSEA 90% CI Model df χ 2 χ 2 /df TLI CFI NFI RMSEA Lo Hi 2 factors, no factors, 3 factors, no 3 factors, Note. Cross-loading refers to item 12 which was allowed to load on both the Faith and Peace factors.
11 OBJECTIVE 1: RESULTS SAMPLE 3 RMSEA 90% CI Model df χ 2 χ 2 /df TLI CFI NFI RMSEA Lo Hi 2 factors, no factors, 3 factors, no 3 factors, Note. Cross-loading refers to item 12 which was allowed to load on both the Faith and Peace factors.
12 OBJECTIVE 1: RESULTS SAMPLE 4 RMSEA 90% CI Model df χ 2 χ 2 /df TLI CFI NFI RMSEA Lo Hi 2 factors, no factors, 3 factors, no 3 factors, Note. Cross-loading refers to item 12 which was allowed to load on both the Faith and Peace factors.
13 OBJECTIVE 1: CONCLUSIONS 3-factor model in which Meaning and Peace are separate proves to be superior compared to 2-factor model Results consistent across all 4 samples Substantive distinction between these 2 concepts
14 OBJECTIVE 2: METHOD Factor correlations Correlated vectors Zero-order correlations between Meaning and Peace factors with health outcomes by sample Tests of incremental validity of Meaning and Peace factors
15 M OBJECTIVE 2: RESULTS FACTOR CORRELATIONS Sample 1 Sample 2 Sample 3 Sample 4 M P F M P F M P F M P F P F Note. M = Meaning. P = Peace. F = Faith
16 OBJECTIVE 2: RESULTS ZERO-ORDER CORRELATIONS, SAMPLE 1 Health Outcome Meaning Peace FACIT_Peace.61 Physical Well-Being.25*.32 Social/Family Well-Being.27*.22 Emotional Well-Being.42*.60 Functional Well-Being FACT-G Total.51*.59 Patient-rated ECOG Physician-rated ECOG Woodcock-Johnson III.11* -.03 Profile of Mood States: Tension -.29* -.51 Profile of Mood States: Depression -.40* -.55 Profile of Mood States: Anger -.31* -.47 Profile of Mood States: Vigor Profile of Mood States: Fatigue -.27* -.41 Profile of Mood States: Confusion -.43* -.51 Profile of Mood States: Total -.45* -.61 Correlation of Vectors.986
17 OBJECTIVE 2: RESULTS ZERO-ORDER CORRELATIONS, SAMPLE 2 Health Outcome Meaning Peace FACIT_Peace.45 Physical Well-Being -.28* -.32 Social/Family Well-Being Emotional Well-Being.40*.69 Functional Well-Being.39*.57 FACT-G Total.48*.63 FACIT Fatigue Cancer Behavior Inventory.42*.57 Life Orientation Test Total Positive Affect Negative Affect -.43* -.66 General Health Perceptions Satisfaction with Life Symptom Impact Inventory Total Correlation of Vectors.956
18 OBJECTIVE 2: RESULTS ZERO-ORDER CORRELATIONS, SAMPLE 3 Health Outcome Meaning Peace FACIT_Peace.73 Overall Function Life Satisfaction Health Worries Financial Worries Medication Worries.48*.36 HIV Mastery Disclosure Worries Sexual Function CES-D Total Life Orientation Test Total Correlation of Vectors.994
19 OBJECTIVE 2: RESULTS ZERO-ORDER CORRELATIONS, SAMPLE 4 Health Outcome Meaning Peace FACIT_Peace.58 Physical Well-Being.29*.41 Social/Family Well-Being Emotional Well-Being.42*.68 Functional Well-Being.40*.56 FACT-G Total.47*.63 Correlation of Vectors.52
20 OBJECTIVE 2: RESULTS TEST FOR INCREMENTAL VALIDITY, SAMPLE 1 Health Outcome Total R 2 for Meaning & Peace R 2 for Meaning (over Peace) R 2 for Peace (over Meaning) Patient-rated ECOG Physician-rated ECOG Woodcock-Johnson Physical Well-Being Social/Family Well-Being Emotional Well-Being Functional Well-Being FACT-G Total Profile of Mood States: Tension Profile of Mood States: Depression Profile of Mood States: Anger Profile of Mood States: Vigor Profile of Mood States: Fatigue Profile of Mood States: Confusion Profile of Mood States: Total Note. All values shown are the increment in R 2 attributable to Meaning (or Peace) after controlling for Peace (or Meaning).
21 OBJECTIVE 2: RESULTS TEST FOR INCREMENTAL VALIDITY, SAMPLE 2 Health Outcome Total R 2 for Meaning & Peace R 2 for Meaning (over Peace) R 2 for Peace (over Meaning) Cancer Behavior Inventory FATS (Fatigue) Physical Well-Being Social/Family Well-Being Emotional Well-Being Functional Well-Being FACT-G Total Life Orientation Total Positive Affect Negative Affect General Health Perceptions Satisfaction with Life Symptom Impact Inventory Total Note. All values shown are the increment in R 2 attributable to Meaning (or Peace) after controlling for Peace (or Meaning).
22 OBJECTIVE 2: RESULTS TEST FOR INCREMENTAL VALIDITY, SAMPLE 3 Health Outcome Total R 2 for Meaning & Peace R 2 for Meaning (over Peace) R 2 for Peace (over Meaning) Overall Function Life Satisfaction Health Worries Financial Worries Medication Worries HIV Mastery Disclosure Worries Sexual Function CES-D Total Life Orientation Test Total Note. All values shown are the increment in R 2 attributable to Meaning (or Peace) after controlling for Peace (or Meaning).
23 OBJECTIVE 2: RESULTS TEST FOR INCREMENTAL VALIDITY, SAMPLE 4 Health Outcome Total R 2 for Meaning & Peace R 2 for Meaning (over Peace) R 2 for Peace (over Meaning) Physical Well-Being Social/Family Well-Being Emotional Well-Being Functional Well-Being FACT-G Total Note. All values shown are the increment in R 2 attributable to Meaning (or Peace) after controlling for Peace (or Meaning).
24 OBJECTIVE 2: CONCLUSIONS Peace correlates more strongly than Meaning across a variety of health outcomes Meaning and Peace appear to be functionally identical Correlated vectors After controlling for Peace, Meaning contributes little additional explanatory power
25 GENERAL DISCUSSION Conceptually, Meaning and Peace are discernable as separate factors Functionally, they appear to be somewhat redundant The variance they share as well as the unique variance associated with Peace appears to carry the explanatory power Unique portion of Meaning does not seem to have much utility
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