Background: Individuals with advanced cancer face the challenge of living meaningfully while also preparing for end of life. The ability to sustain this duality, called "double awareness," may reflect optimal psychological adaptation, but no psychometric scale exists to measure this construct.
Objectives: The purpose of this study was to develop a novel scale to measure double awareness in patients living with advanced cancer.
Methods: Guided by best practices for scale development, this study addresses the first three of nine steps in instrument development, including domain clarification and item generation, establishment of content validity of the items, and pre-testing of the items with patients.
Results: Instrument development resulted in a 41-item measure with two dimensions titled "life engagement" and "death contemplation." Items retained in the measure displayed face validity and were found to be both acceptable by patients and relevant to their lived experience.
Significance of results: The results of this scale development study will allow for full validation of the measure and future use in clinical and research settings. This novel measure of double awareness will have clinical utility and relevance in a variety of settings where patients with advanced cancer are treated.
Keywords: Advanced cancer; Death contemplation; Double awareness; End of life; Life engagement; Living with cancer; Meaning; Oncology; Palliative care; Scale development.