Observational Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Sep 19, 2025; 15(9): 107672
Published online Sep 19, 2025. doi: 10.5498/wjp.v15.i9.107672
Reliability and validity of the preparatory grief scale for use with hemodialysis patients
Yue-Juan Li, Xue Li, Mei-Juan Li, Yu-Lin Gao
Yue-Juan Li, Yu-Lin Gao, School of Nursing, Southern Medical University, Guangzhou 510515, Guangdong Province, China
Yue-Juan Li, Hemodialysis Center of Nansha, Guangzhou First People's Hospital, Guangzhou 511457, Guangdong Province, China
Xue Li, Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang 550499, Guizhou Province, China
Mei-Juan Li, Hemodialysis Center, Guangzhou First People's Hospital, Guangzhou 511457, Guangdong Province, China
Author contributions: Li YJ designed the research and wrote the first manuscript; Li YJ, Li X, Li MJ and Gao YL contributed to conceiving the research and analyzing data; Li YJ conducted the analysis and provided guidance for the research; all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Ethic Committee of Guangzhou First People's Hospital (Approval No. K-2021-191-01).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: There is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: All data and materials are available from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Lin Gao, Associate Professor, School of Nursing, Southern Medical University, No. 1023-1063 Shatai South Road, Baiyun District, Guangzhou 510515, Guangdong Province, China. gyl@smu.edu.cn
Received: May 14, 2025
Revised: June 17, 2025
Accepted: July 8, 2025
Published online: September 19, 2025
Processing time: 104 Days and 1.8 Hours
Abstract
BACKGROUND

During the gradual decline of physical and social functioning associated with end-stage renal disease, patients might experience a premonition of impending death, resulting in a series of pre-mourning grief responses called preparatory grief. The preparatory grief in advanced cancer patients (PGAC) scale is the most widely used preparatory grief scale for patients on hemodialysis in China.

AIM

To verify the reliability and validity of the PGAC scale in patients on hemodialysis.

METHODS

In total, 327 patients undergoing regular hemodialysis in the blood purification center of three grade-A tertiary hospitals in Guangdong and Guizhou provinces were selected by convenience sampling. The assessment was administered using the general information questionnaire and the Chinese version of PGAC. SPSS 25.0 and Amos 24.0 were used for item analysis, confirmatory factor analysis (CFA), convergent validity, and internal consistency reliability estimation.

RESULTS

In the modified Chinese version of PGAC, 7 dimensions covering 27 total items were retained. CFA revealed a good fit of the factor model (chi-square degree of freedom = 2.056, standardized root mean square residual = 0.0479, root mean square error of approximation = 0.0570, GFI = 0.872, AGFI = 0.841, IFI = 0.931, CFI = 0.930, TLI = 0.919). The factor loadings of the items ranged 0.503-0.884. The composite reliability ranged 0.664-0.914, and the average variance extracted ranged 0.366-0.747. Cronbach’s α of the scale was 0.945, and Cronbach’s α for various dimensions ranged 0.662-0.914.

CONCLUSION

The modified PGAC has good reliability and validity, and it can effectively measure preparatory grief in patients on hemodialysis.

Keywords: Preparatory grief; Hemodialysis; Scale; Reliability; Validity

Core Tip: Because of the high mortality rate of end-stage renal disease (ESRD), some patients might not achieve their expected survival times even if they receive hemodialysis. Similar to patients with advanced cancer, those with ESRD also exhibit preoperatory grief. The preparatory grief in advanced cancer patients (PGAC) scale is the most widely used preparatory grief scale for patients in China, and it can be used to measure a range of preparatory grief responses in patients with advanced cancer or terminally ill patients. However, the use of this scale to assess patients on hemodialysis has not been reported. Therefore, this study evaluated the reliability and validity of the PGAC scale in patients on hemodialysis the aim of providing a standardized measurement tool for assessing preparatory grief for this population.