Hostname: page-component-76fb5796d-r6qrq Total loading time: 0 Render date: 2024-04-27T00:10:53.415Z Has data issue: false hasContentIssue false
  • English
  • Français

The Italian validation of the Death and Dying Distress Scale

Published online by Cambridge University Press:  07 December 2022

Andrea Bovero Open the ORCID record for Andrea Bovero [Opens in a new window] ,
Luigi Zerbinati Open the ORCID record for Luigi Zerbinati [Opens in a new window] ,
Luigi Grassi Open the ORCID record for Luigi Grassi [Opens in a new window] ,
Kenneth Mah ,
Gary Rodin ,
Sarah Hales ,
Carmine Malfitano ,
Elisa TIberto ,
Paolo Leombruni  and
Marco Miniotti Open the ORCID record for Marco Miniotti [Opens in a new window]
...Show all authors
Andrea Bovero
Affiliation:
Clinical Psychology Unit, Department of Neuroscience, University of Turin, “Città della Salute e della Scienza” Hospital, Turin, Italy
Luigi Zerbinati*
Affiliation:
Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
Luigi Grassi
Affiliation:
Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
Kenneth Mah
Affiliation:
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
Gary Rodin
Affiliation:
Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Sarah Hales
Affiliation:
Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Carmine Malfitano
Affiliation:
Faculty of Medicine, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Elisa TIberto
Affiliation:
Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
Paolo Leombruni
Affiliation:
“Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
Marco Miniotti
Affiliation:
“Rita Levi Montalcini” Department of Neuroscience, University of Turin, Turin, Italy
Rosangela Caruso
Affiliation:
Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behavior, University S. Anna Hospital and Health Trust, Ferrara, Italy
*
Author for correspondence: Luigi Zerbinati, Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara 44121, Italy. Email: luigi.zerbinati@unife.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Death anxiety (DA), a condition characterized by fear, angst, or panic related to the awareness of one’s own death, is commonly observed in advanced cancer patients. The aim of this study was to examine the psychometric properties of the Italian version of the Death and Dying Distress Scale (DADDS-IT) in a sample of patients with advanced cancer.

Methods

The sample included 200 Italian advanced cancer patients meeting eligibility criteria to access palliative care. Patients’ levels of DA were assessed by using the DADDS-IT, while the levels of depression, anxiety, demoralization, spiritual well-being, and symptom burden were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being Scale, and the Edmonton Symptom Assessment System, respectively; Karnofsky Performance Status was used to measure functional impairment. Confirmatory factor analyses (CFA) of previous structures and exploratory factor analyses (EFA) were conducted.

Results

CFA revealed that none of the previous structures adequately fitted data from our sample. EFA revealed a 4-factor model comprising Finitude (α = 0.91), Regret (α = 0.86), Dying (α = 0.88), and Relational Burden (α = 0.73), accounting for the 77.1% of the variance. Dying subscore was higher in hospice patients than in those recruited in medical wards.

Significance of results

The present study provides further evidence that DA is a condition that deserves attention and that DADDS-IT shows good psychometric properties to support its use in research and clinical settings.

Keywords

Death anxietyDeath distressPalliative careEnd-of-life careTerminal care
Type
Original Article
Information
Palliative & Supportive Care , Volume 21 , Issue 2 , April 2023 , pp. 283 - 291
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

An, E, Lo, C, Hales, S, et al. (2018) Demoralization and death anxiety in advanced cancer. Psycho-Oncology 27(11), 2566–2572. doi:10.1002/pon.4843CrossRefGoogle ScholarPubMed
Bartlett, MS (1954) A note on the multiplying factors for various χ2 approximations. Journal of the Royal Statistical Society: Series B (Methodological) 16(2), 296–298. doi:10.1111/j.2517-6161.1954.tb00174.xGoogle Scholar
Battaglia, Y, Zerbinati, L, Piazza, G, et al. (2020) The use of demoralization scale in Italian kidney transplant recipients. Journal of Clinical Medicine 9(7), doi:10.3390/jcm9072119CrossRefGoogle ScholarPubMed
Belvederi Murri, M, Caruso, R, Ounalli, H, et al. (2020a) The relationship between demoralization and depressive symptoms among patients from the general hospital: Network and exploratory graph analysis. Journal of Affective Disorders 276, 137–146. doi:10.1016/j.jad.2020.06.074CrossRefGoogle ScholarPubMed
Belvederi Murri, M, Zerbinati, L, Ounalli, H, et al. (2020b) Assessing demoralization in medically ill patients: Factor structure of the Italian version of the demoralization scale and development of short versions with the item response theory framework. Journal of Psychosomatic Research 128, . doi:10.1016/j.jpsychores.2019.109889CrossRefGoogle ScholarPubMed
Bovero, A, Leombruni, P, Miniotti, M, et al. (2016) Spirituality, quality of life, psychological adjustment in terminal cancer patients in hospice. European Journal of Cancer Care 25(6), 961–969. doi:10.1111/ecc.12360CrossRefGoogle ScholarPubMed
Bovero, A, Opezzo, M, Botto, R, et al. (2021) Hope in end-of-life cancer patients: A cross-sectional analysis. Palliative and Supportive Care 19(5), 563–569. doi:10.1017/S1478951520001388CrossRefGoogle ScholarPubMed
Bovero, A, Sedghi, NA, Opezzo, M, et al. (2018) Dignity-related existential distress in end-of-life cancer patients: Prevalence, underlying factors, and associated coping strategies. Psycho-Oncology 27(11), 2631–2637. doi:10.1002/pon.4884CrossRefGoogle ScholarPubMed
Bovero, A, Tosi, C, Botto, R, et al. (2019) The spirituality in end-of-life cancer patients, in relation to anxiety, depression, coping strategies and the daily spiritual experiences: A cross-sectional study. Journal of Religion and Health 58(6), 2144–2160. doi:10.1007/s10943-019-00849-zCrossRefGoogle ScholarPubMed
Brady, MJ, Peterman, AH, Fitchett, G, et al. (1999) A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology 8(5), 417–428. doi:10.1002/(sici)1099-1611(199909/10)8:5<417::aid-pon398>3.0.co;2-43.0.CO;2-4>CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld, B, Pessin, H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 33(7), 749–754. doi:10.1200/JCO.2014.57.2198CrossRefGoogle ScholarPubMed
Bruera, E, Kuehn, N, Miller, MJ, et al. (1991) The Edmonton Symptom Assessment System (ESAS): A simple method for the assessment of palliative care patients. Journal of Palliative Care 7(2), 6–9. doi:10.1177/082585979100700202CrossRefGoogle ScholarPubMed
Canada, AL, Murphy, PE, Fitchett, G, et al. (2008) A 3-factor model for the FACIT-Sp. Psycho-Oncology 17(9), 908–916. doi:10.1002/pon.1307CrossRefGoogle ScholarPubMed
Caruso, R, Sabato, S, Nanni, MG, et al. (2020) Application of Managing Cancer and Living Meaningfully (CALM) in advanced cancer patients: An Italian pilot study. Psychotherapy and Psychosomatics 89(6), 402–404. doi:10.1159/000505875CrossRefGoogle ScholarPubMed
Chochinov, HM, Kristjanson, LJ, Breitbart, W, et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology 12(8), 753–762. doi:10.1016/S1470-2045(11)70153-XCrossRefGoogle Scholar
Cordova, MJ, Riba, MB and Spiegel, D (2017) Post-traumatic stress disorder and cancer. The Lancet Psychiatry 4(4), 330–338. doi:10.1016/S2215-0366(17)30014-7CrossRefGoogle ScholarPubMed
Cortina, JM (1993) What is coefficient alpha? An examination of theory and applications. Journal of Applied Psychology 78(1), 98–104. doi:10.1037/0021-9010.78.1.98CrossRefGoogle Scholar
Costantini, A, Picardi, A, Brunetti, S, et al. (2013) La versione Italiana della demoralization scale: Uno studio di validazione [Italian version of demoralization scale: A validation study]. Rivista Di Psichiatria 48(3), 234–239.Google Scholar
Daneault, S, Lussier, V, Mongeau, S, et al. (2016) Ultimate journey of the terminally ill: Ways and pathways of hope. Canadian Family Physician Medecin de Famille Canadien 62(8), 648–656.Google ScholarPubMed
Engelmann, D, Scheffold, K, Friedrich, M, et al. (2016) Death-related anxiety in patients with advanced cancer: Validation of the German version of the Death and Dying Distress Scale. Journal of Pain and Symptom Management 52(4), 582–587. doi:10.1016/j.jpainsymman.2016.07.002CrossRefGoogle ScholarPubMed
Eun, Y, Hong, I-W, Bruera, E, et al. (2017) Qualitative study on the perceptions of terminally ill cancer patients and their family members regarding end-of-life experiences focusing on palliative sedation. Journal of Pain and Symptom Management 53(6), 1010–1016. doi:10.1016/j.jpainsymman.2016.12.353CrossRefGoogle ScholarPubMed
Grassi, L, Costantini, A, Caruso, R, et al. (2017a) Dignity and psychosocial-related variables in advanced and nonadvanced cancer patients by using the Patient Dignity Inventory – Italian version. Journal of Pain and Symptom Management 53(2), 279–287. doi:10.1016/j.jpainsymman.2016.09.009CrossRefGoogle ScholarPubMed
Grassi, L, Costantini, A, Kissane, D, et al. (2017b) The factor structure and use of the Demoralization Scale (DS-IT) in Italian cancer patients. Psycho-Oncology 26(11), 1965–1971. doi:10.1002/pon.4413CrossRefGoogle ScholarPubMed
Iverach, L, Menzies, RG and Menzies, RE (2014) Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review 34(7), 580–593. doi:10.1016/j.cpr.2014.09.002CrossRefGoogle ScholarPubMed
Kaasa, S, Loge, JH, Aapro, M, et al. (2018) Integration of oncology and palliative care: A Lancet Oncology Commission. The Lancet Oncology 19(11), e588–e653. doi:10.1016/S1470-2045(18)30415-7CrossRefGoogle ScholarPubMed
Kaiser, HF (1970) A second generation little jiffy. Psychometrika 35(4), 401–415. doi:10.1007/BF02291817CrossRefGoogle Scholar
Kissane, DW, Wein, S, Love, A, et al. (2004) The demoralization scale: A report of its development and preliminary validation. Journal of Palliative Care 20(4), 269–276.CrossRefGoogle Scholar
Krause, S, Rydall, A, Hales, S, et al. (2015) Initial validation of the Death and Dying Distress Scale for the assessment of death anxiety in patients with advanced cancer. Journal of Pain and Symptom Management 49(1), 126–134. doi:10.1016/j.jpainsymman.2014.04.012CrossRefGoogle ScholarPubMed
Krebber, AMH, Buffart, LM, Kleijn, G, et al. (2014) Prevalence of depression in cancer patients: A meta-analysis of diagnostic interviews and self-report instruments. Psycho-Oncology 23(2), 121–130. doi:10.1002/pon.3409CrossRefGoogle ScholarPubMed
Lau, RWL and Cheng, S-T (2011) Gratitude lessens death anxiety. European Journal of Ageing 8(3), . doi:10.1007/s10433-011-0195-3CrossRefGoogle ScholarPubMed
Lo, C, Hales, S, Zimmermann, C, et al. (2011) Measuring death-related anxiety in advanced cancer: Preliminary psychometrics of the Death and Dying Distress Scale. Journal of Pediatric Hematology/Oncology 33(Suppl 2), S140–S145.CrossRefGoogle ScholarPubMed
Mah, K, Shapiro, GK, Hales, S, et al. (2020) The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psycho-Oncology 29(5), 833–840. doi:10.1002/pon.5354CrossRefGoogle ScholarPubMed
Neel, C, Lo, C, Rydall, A, et al. (2015) Determinants of death anxiety in patients with advanced cancer. BMJ Supportive & Palliative Care 5(4), 373–380. doi:10.1136/bmjspcare-2012-000420CrossRefGoogle ScholarPubMed
Neimeyer, RA (ed) (1994) Death Anxiety Handbook: Research, Instrumentation, and Application. Philadelphia: Taylor & Francis.Google Scholar
Oechsle, K (2019) Palliative care in patients with hematological malignancies. Oncology Research and Treatment 42(1–2), 25–30. doi:10.1159/000495424CrossRefGoogle ScholarPubMed
Rabitti, E, Cavuto, S, Iani, L, et al. (2020) The assessment of spiritual well-being in cancer patients with advanced disease: Which are its meaningful dimensions? BMC Palliative Care 19(1), . doi:10.1186/s12904-020-0534-2CrossRefGoogle ScholarPubMed
Ripamonti, C, Leporati, R, De Feo, G, et al. (2022) Italian version of the Edmonton Symptom Assessment System (ESAS)-Total Care (TC): Development and psychometric validation in patients undergoing cancer treatment or follow-up. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 30(3), 1923–1933. doi:10.1007/s00520-021-06594-yCrossRefGoogle ScholarPubMed
Rizzo, R, Piccinelli, M, Mazzi, M, et al. (2000) The Personal Health Questionnaire: A new screening instrument for detection of ICD-10 depressive disorders in primary care. Psychological Medicine 30(4), 831–840. doi:10.1017/S0033291799002512CrossRefGoogle ScholarPubMed
Rodin, G (2018) From evidence to implementation: The global challenge for psychosocial oncology. Psycho-Oncology 27(10), 2310–2316. doi:10.1002/pon.4837CrossRefGoogle ScholarPubMed
Rodin, G, Lo, C, Mikulincer, M, et al. (2009) Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients. Social Science & Medicine 68(3), 562–569. doi:10.1016/j.socscimed.2008.10.037CrossRefGoogle ScholarPubMed
Rodin, G, Lo, C, Rydall, A, et al. (2018) Managing Cancer and Living Meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 36(23), 2422–2432. doi:10.1200/JCO.2017.77.1097CrossRefGoogle Scholar
Rodin, G and Zimmermann, C (2008) Psychoanalytic reflections on mortality: A reconsideration. The Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 36(1), 181–196. doi:10.1521/jaap.2008.36.1.181CrossRefGoogle ScholarPubMed
Russac, RJ, Gatliff, C, Reece, M, et al. (2007) Death anxiety across the adult years: An examination of age and gender effects. Death Studies 31(6), 549–561. doi:10.1080/07481180701356936CrossRefGoogle ScholarPubMed
Saracino, RM, Weinberger, MI, Roth, AJ, et al. (2017) Assessing depression in a geriatric cancer population. Psycho-Oncology 26(10), 1484–1490. doi:10.1002/pon.4160CrossRefGoogle Scholar
Schag, CC, Heinrich, RL and Ganz, PA (1984) Karnofsky performance status revisited: Reliability, validity, and guidelines. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 2(3), 187–193. doi:10.1200/JCO.1984.2.3.187CrossRefGoogle ScholarPubMed
Scheffold, K, Philipp, R, Koranyi, S, et al. (2018) Insecure attachment predicts depression and death anxiety in advanced cancer patients. Palliative & Supportive Care 16(3), 308–316. doi:10.1017/S1478951517000281CrossRefGoogle ScholarPubMed
Shapiro, GK, Mah, K, Li, M, et al. (2021) Validation of the Death and Dying Distress Scale in patients with advanced cancer. Psycho-Oncology 30(5), 716–727. doi:10.1002/pon.5620CrossRefGoogle ScholarPubMed
Singer, S, Das-Munshi, J and Brähler, E (2010) Prevalence of mental health conditions in cancer patients in acute care – a meta-analysis. Annals of Oncology 21(5), 925–930. doi:10.1093/annonc/mdp515CrossRefGoogle ScholarPubMed
Smith, HR (2015) Depression in cancer patients: Pathogenesis, implications and treatment (Review). Oncology Letters 9(4), 1509–1514. doi:10.3892/ol.2015.2944CrossRefGoogle ScholarPubMed
Soleimani, MA, Bahrami, N, Allen, K-A, et al. (2020) Death anxiety in patients with cancer: A systematic review and meta-analysis. European Journal of Oncology Nursing: The Official Journal of European Oncology Nursing Society 48, . doi:10.1016/j.ejon.2020.101803CrossRefGoogle Scholar
Spitzer, RL, Kroenke, K and Williams, JB (1999) Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. Journal of the American Medical Association 282(18), 1737–1744. doi:10.1001/jama.282.18.1737CrossRefGoogle ScholarPubMed
Spitzer, RL, Kroenke, K, Williams, JBW, et al. (2006) A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine 166(10), 1092–1097. doi:10.1001/archinte.166.10.1092CrossRefGoogle ScholarPubMed
Sussman, JC and Liu, WM (2014) Perceptions of two therapeutic approaches for palliative care patients experiencing death anxiety. Palliative & Supportive Care 12(4), 251–260. doi:10.1017/S1478951513000199CrossRefGoogle ScholarPubMed