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Full citation and link to published version:Krause S, Rydall A, Hales S, Rodin G, Lo C.
Abstract
ContextThe experience of death anxiety in patients with advanced cancer has been understudied partly due to the lack of a tailored measure for this population. The Death and Dying Distress Scale (DADDS) was constructed to address this gap. Although an initial version of this instrument has shown promising psychometric properties, validation of the finalized version is needed.
ObjectivesThis study aims to validate the recent 15-item DADDS by examining its factor structure and construct validity.
MethodsSixty participants with advanced or metastatic cancer were recruited from the Princess Margaret Cancer Centre, Toronto, Canada, into a pilot trial of a psychological intervention. This paper analyzes the baseline measures on death anxiety, depressive symptoms (PHQ-9, SCID), generalized anxiety (GAD-7), and preparation for end of life (QUAL-EC). Exploratory factor analysis was conducted. Construct validity was assessed by correlations between measures.
ResultsFactor analysis revealed a dominant single factor explaining over 75% of the shared variation between items. Factor loadings were high, ranging from 0.57 to 0.86. Item communalities were evenly ranged from 0.33 to 0.75 and with the 15:1 variable to factor ratio, suggest the viability of parameter estimates despite the small sample size. Cronbach's alpha was 0.95. Death anxiety was associated with less preparation for end of life, r = -0.68, p < 0.0001, and more generalized anxiety, r = 0.63, p < 0.0001, and depressive symptom severity, r = 0.50, p < 0.0001. Individuals with major depression had greater death anxiety than the non-depressed, mean difference = 17, CI .95 = (1.5, 33), as did individuals with minor depression, mean difference = 25, CI .95 = (10, 41).
ConclusionThe DADDS is a valid measure of death anxiety in patients with advanced cancer. It may provide useful information in the assessment and treatment of distress in patients near the end of life.4