Development and Psychometric Testing of the Buddhist Death Acceptance Scale

Death acceptance relates to a good death of people. Notably, each culture/religion has its own traditions, beliefs, and practices surrounding death, which has been handed down for centuries. Culture/religion creates not only the meaning of death, but also often influences how people die. To date, the measurement of death acceptance, especially from a religious perspective, has not been widely developed. This research was conducted to develop and psychometrically test the Buddhist Death Acceptance Scale for Cancer, reflecting Buddhists' beliefs towards karma, and three characteristics of existence. Using a multistage sampling method, Buddhists diagnosed with cancer from six hospitals in four regions of Thailand were recruited into the study from April 2018 to January 2019. Exploratory factor analysis was conducted in the first group of 300 participants. The final version of the questionnaire had 13 items in two components that explained 45.87% of the variation of the construct. These two dimensions were 1) acceptance of the natural process of death and 2) preparing for death. Confirmatory factor analysis was performed in with 230 participants. The results showed that the two-dimension construct of the scale fit with the empirical data. The Cronbach's alpha coefficient was 0.82. In conclusion, the Scale demonstrated acceptable psychometric properties to measure death acceptance in Buddhists who are diagnosed with cancer. Nurses and other healthcare professionals can use this scale as a tool for evaluating death acceptance and intervention effectiveness among Thai Buddhists with cancer. In addition, next steps include testing the Scale for use with Thai Buddhists at end-of-life with illnesses other than cancer and translating it into other languages to test for use with Buddhists worldwide.