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.
Highlights
Cancer is still one of the leading causes of death in China, with almost four million new cancer cases in 2015 and more than 2 million cancer deaths [1]
The three most frequent items reported as the cause of distress on Death and Dying Distress Scale (DADDS)-C in descending order were: being a burden to others (2.78 ± 1.945), the impact of my death on my loved ones (2.60 ± 1.934), dying and death happening with a lot of pain or suffering (2.27 ± 2.018)
Results of One-way ANOVA or non-parametric Kruskal-Wallis H test showed that the mean Death and Dying Distress ScaleChinese version (DADDS-C) score differed by age and educational level but not by cancer type and sex (Table 1)
Summary
Cancer is still one of the leading causes of death in China, with almost four million new cancer cases in 2015 and more than 2 million cancer deaths [1]. Terror management theory (TMT) suggested that death anxiety is a fundamental human fear that is amplified by mortality salience (awareness that one’s death is inevitable), different from general anxiety which is triggered by excessive worry about practical problems in daily life [12]. Based on this theory, self-esteem (experiencing sense of meaning and value) was the core protective factor for death anxiety and was suggested to be integrated into death anxiety management [13]
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