Validation of Death and Dying Distress Scale-Chinese Version and Prevalence of Death Anxiety Among Patients With Advanced Cancer

Abstract

Purpose: Death anxiety is commonly experienced by individuals with advanced cancer who have a limited life expectancy. The Death and Dying Distress Scale (DADDS) is a validated measure that was created to capture this experience; but no Chinese version is available to date. We conducted a cross-sectional study to explore the psychometric properties of a Chinese version DADDS (DADDS-C) and address prevalence of death anxiety among patients with advanced cancer.Methods: Patients with advanced cancer were recruited from Peking University Cancer Hospital. Measures administered included: DADDS-C, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder-7(GAD-7), Quality of Life at End of Life in Cancer (QUAL-EC), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-sp). McDonald's Omega, Cronbach's alpha, Exploratory Factor Analysis and Confirmatory Factor Analysis were used to test DADDS-C's reliability and validity. Logistic regression analysis was used to identify risk factors for death anxiety.Results: Of 300 patients approached, 256 (85%) provided informed consent and completed the questionnaires. Of these participants, 43 (16.8%) had moderate death anxiety based on scores of ≥45 on the DADDS-C. Three factors (feeling shortness of time, dying and death distress, being a burden to others) explained 71.643% of shared variation with factor loadings ranging from 0.629 to 0.822. Cronbach's alpha was 0.939; Omega total was 0.959. DADDS-C had acceptable convergent and discriminant validity. Logistic regression analysis indicated that two factors (better relationship with healthcare providers and preparation for end of life) protected patients from death anxiety.Conclusion: DADDS-C is a valid tool for measuring death anxiety in Chinese patients with advanced cancer. The presence of at least moderate death anxiety in a substantial minority of these patients calls for screening for this symptom and for more routine psychological interventions to alleviate and prevent such distress in this population.

A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness

“…While it may be difficult to accurately predict the timing of death, having the ability to identify the signs and symptoms of impending death in terminally-ill individuals may lead to an early anticipation of care needs and better planning to provide care that is tailored to the individual’s needs, and ultimately results in better EOL care, as well as a better bereavement adjustment experience for the families. Published studies also demonstrate that dying persons are protected from death anxiety when they were able to prepare for the EOL (Tang et al, 2021).…”

Feasibility of online managing cancer and living meaningfully (CALM) in Chinese patients with metastatic breast cancer: a pilot randomized control trial

“…As recommended by Neel et al, a cut-off point of 45 was used to define death anxiety 8 . The Chinese version of the DADDS has been validated for use with patients with advanced cancer 25 .…”

Editorial: Resilience in chronic disease, volume II

“…Resilience, defined as one's ability to “bounce back” from adversity, is an important attribute of patients challenged with chronic disease ( 1 , 2 ). The call for submissions on Resilience in Chronic Disease: Volume I received a great response with a total of over 7,100 participants with chronic pain ( 3 ), cancer ( 4 ), irritable bowel disease ( 5 , 6 ), cardiovascular disease ( 7 ), neurocognitive disorders ( Wang et al ), renal transplant ( 8 ), rheumatoid arthritis ( 9 ), as well as caregivers for children with chronic illness ( 7 ), patients with liver cancer ( 10 ), and maintenance hemodialysis ( 7 ). However, most manuscript are performed with a cross-sectional design and the distinct resilience trajectories throughout the course of chronic disease are not well-explored in the first collection ( 11 ).…”