Validation of the Double Awareness Scale: A Novel Measure of Psychological Adaptation to Advanced Cancer

Individuals with advanced cancer face the challenge of remaining engaged in life, while also contemplating death. However, there has been no validated measure of the adaptive capacity to balance these tasks, which has been termed "double awareness."

This study aimed to evaluate the psychometric properties of the novel Double Awareness Scale (DAS).

Patients with advanced cancer attending an outpatient palliative care clinic (N = 197) completed the DAS and other self-report measures assessing quality of life near end of life, life completion, satisfaction with life, preparation for end of life, death anxiety, and depression. Factor structure, construct validity, and internal consistency of the DAS were evaluated, as were group differences across high, intermediate, and low levels of double awareness.

Factor analysis supported two factors, Life Engagement and Death Contemplation, with high internal consistency (α = 0.92 and 0.87, respectively). Life Engagement met the convergent validity criterion with quality of life near the end of life (r = 0.62) and life completion (r = 0.60), but not with life satisfaction (r = 0.46). Death Contemplation did not meet the convergent validity criterion with preparation for end of life (r = 0.23) but demonstrated discriminant validity with death anxiety (r = -0.03). Those with high levels of double awareness (high Life Engagement and high Death Contemplation) exhibited the best quality of life and lowest distress.

Preliminary evidence supports the validity of the DAS. Further research is needed to demonstrate its validity in diverse settings, its utility in clinical care, and its responsiveness to therapeutic interventions in the context of advanced disease.