Death Preparedness Scale for Advanced Cancer Patients: Instrument Development and Psychometric Properties

PurposeDeath preparedness plays a crucial role in improving the quality of death for advanced cancer patients. However, existing tools only assess certain aspects of death preparedness in advanced cancer patients, and there is limited evidence regarding their reliability and validity. To develop and validate a specific and comprehensive measurement tool for death preparedness in advanced cancer patients.MethodsThe scale was developed using an exploratory mixed-methods approach, which included both qualitative and quantitative stages. Grounded theory and existing literature were used to construct a death preparedness scale for advanced cancer patients. Content validity was assessed using the Delphi method. A convenience sampling approach was employed to recruit 753 advanced cancer patients from the oncology wards of six tertiary grade-A general hospitals in Hubei and Anhui provinces, China, for psychometric testing of the scale. Item selection was based on item analysis, exploratory factor analysis was conducted to extract factors, and confirmatory factor analysis was used to assess structural validity.ResultsThe final scale consists of 4 dimensions and 22 items. These four dimensions are named "Death awareness," "Emotional response," "Hospice program," and "Reflexive care." They explain 64.010% of the total variance. The confirmatory factor analysis (CFA) model showed that the 4-factor model fit the data well. The overall Cronbach's alpha coefficient for the scale was 0.991.ConclusionThe death preparedness scale for advanced cancer patients that we developed demonstrates good reliability and validity, and can be used to comprehensively assess the death preparedness level of advanced cancer patients. Additionally, with the subscale scoring system, healthcare professionals can provide targeted interventions in specific areas of death preparedness for patients, thereby improving both the quality of life and quality of death for advanced cancer patients.