Clinical validation of the nursing diagnosis "Excessive Death Anxiety (00399)" in older adults with cancer

Death anxiety is one of the most common psychological responses among older adults with cancer and may adversely affect quality of life and end-of-life care. Accurate clinical identification and validation of the defining characteristics (DCs) of death anxiety are essential for designing targeted nursing interventions. This study aimed to determine the clinical validation of the nursing diagnosis (ND) of "Excessive Death Anxiety (00399)" and the sensitivity, specificity, likelihood ratio, and predictive value in older adults with cancer in Iran.

This descriptive cross-sectional study was conducted among 322 older adults with cancer in teaching hospitals in Tehran, Iran. The data were collected through structured interviews using a researcher-made list that included five sections of demographic information, patients' opinions about death anxiety, the researcher's diagnosis, 20 DCs of the ND of Excessive Death Anxiety, and the Death Anxiety Questionnaire. Data were analyzed using descriptive statistics as well as sensitivity, specificity, likelihood ratio, predictive value, and receiver operating characteristic (ROC) analysis.

All the 20 DCs were validated, 10 DCs as major and 10 DCs as minor. The findings indicated that "Fear of premature death" had the highest sensitivity (90.68%), the highest negative predictive value (88.28%), and the lowest negative likelihood ratio (0.13%). The major DC of "Fear of loneliness and abandonment during the dying process" had the highest specificity (94.40%), the highest positive predictive value (93.66%), and the highest positive likelihood ratio (14.75%). ROC analysis revealed an area under the curve of 0.917, indicating that the combined defining characteristics had excellent discriminative ability in distinguishing patients with death anxiety from those without death anxiety.

The findings suggest that identifying the key characteristics of death anxiety can provide a solid foundation for delivering targeted nursing care and reducing the psychological consequences of death anxiety among older adults with cancer.