Validation of the Death and Dying Distress Scale in patients with advanced cancer

Abstract

Background Distress about dying and death is an important clinical and research outcome in advanced cancer. A 15‐item Death and Dying Distress Scale (DADDS) measure has undergone preliminary validation, but full validation in a large sample has not previously been reported. We investigated its psychometric characteristics and responsiveness to a therapeutic intervention. Methods This is a secondary analysis of baseline data obtained from a randomized controlled trial of psychotherapeutic intervention for patients with advanced cancer. Participants (n = 386) completed the DADDS, and measures of depression, anxiety, demoralization, quality of life (including preparation for end of life), spirituality, attachment security, and symptom burden. Results A confirmatory factor analysis revealed factors related to “Finitude” and to “Dying.” Both factors showed good internal consistency (Cronbach α = 0.861–0.949). DADDS scores were significantly higher in females, those with lower income and not working. Construct validity was demonstrated by a positive correlation between DADDS and demoralization (r = 0.569–0.679), and a negative correlation with preparation for the end of life (r = −0.475 to −0.678). At 6 months, intervention participants with moderate DADDS scores at baseline reported significantly lower DADDS scores on both factors compared to usual care. Conclusions The DADDS is a valid and brief two‐factor measure that assesses distress related to the shortness of time and to the process of dying. The total and factor scores have utility in the clinical and research assessment of death‐related distress in patients with advanced cancer.

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

“…EFA using SP resulted in three factors which accounted 72.437% of variance in DADDS. Factor 1, accounting 32.124% variance in DADDS-C, consisted of items 1–7 about the shortness of time; Factor 2, accounting 29.534% of the variance in DADDS-C, consisted of items 10–15 that were about distress about dying and death; Factor 3, accounting 10.778% variance in DADDS-C, consisted of items 8 and 9, which were about the sense of being a burden to others, which was different from two factors reported by Shapiro ( 29 ) and one factor reported by Engelmann ( 21 ). High factor loadings ( Table 2 ), ranged from 0.615 to 0.865.…”

“…The present study demonstrated the validity of the DADDS-C assessing death anxiety in Chinese patients with advanced cancer. The analyses identified three factors on the DADDS-C, two of which correspond to the two factors of Finitude and Dying identified in a recent validation study of the DADDS ( 29 ). A third factor of worry about their loved ones was also identified in the present study.…”

“…The DADDS is a 15 item self-report scale of distress about death and dying, which has been validated in both English and in German ( 21 , 29 ). Items are rated on a 6-point Likert scale (0 = I did not experience this thought or concern; 1 = I experienced very little distress; 2 = I experience mild distress; 3 = I experienced moderate distress; 4 = I experienced great distress; 5 = I experienced extreme distress).…”

“…The advantages for this scale were as below: (1) it was designed specifically for cancer patients and practical for further interventional researches among this population; (2) all items focused on death and dying distress and no specific scenarios, which was beneficial for generalizing utilization among patients with limited life. Recent research demonstrated that the DADDS has two subfactors, which are Finitude, referring to distress about the perceived shortness of time, and Dying, which refers to distress about the process of dying and death ( 29 ).…”

“…The present cross-sectional study is a preliminary examination of the validity of the Death and Dying Distress Scale-Chinese version (DADDS-C) in patients with advanced cancer. It was conducted in preparation for a randomized controlled trial (RCT) of Managing Cancer and Living Meaningfully (CALM) therapy in Chinese patients with advanced cancer “(ID: ChisCRT1900023129).” We hypothesized that DADDS-C would be a valid measurement for death anxiety with two factors as the former researchers suggested (item 1–10 for factor 1-Finitude, item 11–15 for factor 2-Dying) ( 29 ), could be used for death anxiety assessment, and death anxiety would be positively associated with anxiety, depression, lower quality of life and negatively associated with spiritual well-being. This cross-sectional study was designed to: (1) test the structure and validation of DADDS-C locally with factor analyses; (2) addressing psychometric priority about this measurement; (3) explore the prevalence and independent risk factors of death anxiety among Chinese patients with advanced cancer through multiple regression analysis.…”