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

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Title: Validation of the Double Awareness Scale: A Novel Measure of Psychological Adaptation to Advanced Cancer.
Authors: Miljanovski, Melissa (AUTHOR), Mah, Kenneth (AUTHOR), Li, Athena (AUTHOR), Rydall, Anne (AUTHOR), McConnell, Mairead H. (AUTHOR), Shapiro, Gilla K. (AUTHOR), Hannon, Breffni (AUTHOR), Zimmermann, Camilla (AUTHOR), Rodin, Gary (AUTHOR)
Source: Psycho-Oncology. Apr2026, Vol. 35 Issue 4, p1-13. 13p.
Subjects: Psychological adaptation, Cancer patients, Palliative treatment, Psychometrics, Quality of life, Stress management, Test reliability
Abstract: Background: 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." Aims: This study aimed to evaluate the psychometric properties of the novel Double Awareness Scale (DAS). Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]
Copyright of Psycho-Oncology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Validation of the Double Awareness Scale: A Novel Measure of Psychological Adaptation to Advanced Cancer.
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  Data: <searchLink fieldCode="AR" term="%22Miljanovski%2C+Melissa%22">Miljanovski, Melissa</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Mah%2C+Kenneth%22">Mah, Kenneth</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Li%2C+Athena%22">Li, Athena</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rydall%2C+Anne%22">Rydall, Anne</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22McConnell%2C+Mairead+H%2E%22">McConnell, Mairead H.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Shapiro%2C+Gilla+K%2E%22">Shapiro, Gilla K.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Hannon%2C+Breffni%22">Hannon, Breffni</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Zimmermann%2C+Camilla%22">Zimmermann, Camilla</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Rodin%2C+Gary%22">Rodin, Gary</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Psycho-Oncology%22">Psycho-Oncology</searchLink>. Apr2026, Vol. 35 Issue 4, p1-13. 13p.
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  Data: <searchLink fieldCode="DE" term="%22Psychological+adaptation%22">Psychological adaptation</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer+patients%22">Cancer patients</searchLink><br /><searchLink fieldCode="DE" term="%22Palliative+treatment%22">Palliative treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Psychometrics%22">Psychometrics</searchLink><br /><searchLink fieldCode="DE" term="%22Quality+of+life%22">Quality of life</searchLink><br /><searchLink fieldCode="DE" term="%22Stress+management%22">Stress management</searchLink><br /><searchLink fieldCode="DE" term="%22Test+reliability%22">Test reliability</searchLink>
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  Data: Background: 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." Aims: This study aimed to evaluate the psychometric properties of the novel Double Awareness Scale (DAS). Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Psycho-Oncology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – SubjectFull: Test reliability
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              Text: Apr2026
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