Initial Validation of the Death and Dying Distress Scale for the Assessment of Death Anxiety in Patients With Advanced Cancer

Abstract

How to cite TSpace itemsAlways cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the author manuscript from TSpace because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page.This article was made openly accessible by U of T Faculty. Please tell us how this access benefits you. Your story matters. 1 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

A concept map of death-related anxieties in patients with advanced cancer

“…Total scores may range from 0 to 75 and scores ≥45 refer to the presence of at least moderate death anxiety. By inquiring about the specific death-related concerns of most relevance to patients with advanced cancer, the DADDS is distinct from death anxiety scales developed for use in non-advanced cancer populations for whom mortality is not imminent 15. It focuses on the assessment of disturbing thoughts that require alleviation and does not assess reaction to symbolic reminders of death, nor death attitudes, for which the direction of desired clinical change is less clear (eg, belief in an afterlife and death acceptance).…”

Managing Cancer And Living Meaningfully (CALM): randomised feasibility trial in patients with advanced cancer

“…Death anxiety was measured using the 15-item Death and Dying Distress Scale 29. Spiritual well-being was measured with the 12-item Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale 30.…”

Inviting end-of-life talk in initial CALM therapy sessions: A conversation analytic study

“…The DADDS was developed for use in patients with advanced or metastatic cancer and assesses regret about lost time and opportunities, fears about the dying process, and concern about the impact of death on loved ones (5,23). Each item is rated using the following values and anchors: 0 = I was not distressed about this; 1 = I experienced very little distress; 2 = I experienced mild distress; 3 = I experienced moderate distress; 4 = I experienced great distress; 5 = I experienced extreme distress.…”

“…Participants were selected to provide representation of groups with low, moderate, and high self-reported death anxiety at baseline. The strata were defined by cut-off values of 20 and 50, corresponding to the first and third quartiles in a prior psychometric study (23).…”

“…Death anxiety is distressing to the family (20) and may hinder advance care planning and preparation for the end of life (22). A death anxiety scale tailored for use in patients with advanced cancer, the Death and Dying Distress Scale (DADDS) (23), has recently been validated and employed as an outcome in clinical trials (24). However, the interpretation and clinical utility of self-reported scores may not be evident without further linkage to the phenomenology of death anxiety as it emerges in clinical settings (25,26).…”