Psychometric evaluation of the Chinese version of Templer’s death anxiety scale using item response theory

Abstract

Objective

Recently, the importance of assessing death anxiety (DA) has gained increasing recognition. The Chinese version of Templer's Death Anxiety Scale (C-T-DAS) is one of the most commonly used tools to evaluate death anxiety in cancer patients. This study is the first to examine the C-T-DAS in cancer patients using both non-parametric and parametric item response theory (IRT) methods.

Methods

This study included cancer patients from the "Be Resilient to Cancer" project in Guangdong, China, who completed the C-T-DAS after recruitment. The data collected were then randomly divided into Dataset 1 and Dataset 2 at a 1:1 ratio. Unidimensionality, monotonicity and local independence was estimated by non-parameter IRT of Mokken scale analysis (MSA) in Dataset 1. Parameter Item Response Theory (IRT) was performed in Dataset 2. Differential Item Functioning (DIF) analysis was used to compare the gender differences in all samples.

Results

A total of 462 patients participated in the study. Through MSA, three items were removed, and two factors, "Fear of Death" and "Acceptance of Death," were retained. IRT analysis showed strong discrimination, moderate difficulty, and low guessing probabilities for the items. Additionally, DIF analysis revealed non-uniform gender differences in one item from the "Fear of Death" dimension.

Conclusion

The revised C-T-DAS exhibits robust validity and reliability for evaluating death anxiety in Chinese cancer patients.