Background: There has been an increasing interest in the measurement of patients’ efforts to find meaning during the experience of a life-threatening illness. While the 48-item Life Attitude Profile – Revised (LAP-R) measure has been utilized to assess meaning in certain cancer populations, its length has been cited as burdensome for patients with advanced disease. Thus, a brief, valid, and comprehensive measure of meaning is needed for advanced cancer patients. This study evaluates the psychometric properties of the LAP-R and aims to construct a shortened version of the measure while preserving its psychometric properties.
Method: This is a secondary analysis of data from a large, randomized trial of individual Meaning-Centered Psychotherapy. Patients with stage IV solid tumor cancer and elevated distress (N=321) were recruited from a cancer center in New York. Patients completed the LAP-R and other psychological measures of depression/anxiety, hopelessness, and quality of life at baseline. Classical Test Theory assessed the internal consistency, validity, and test-retest reliability (screening-baseline). Exploratory factor analysis was used to examine the dimensionality of the LAP-R and exploratory graph analysis (EGA) identified relevant items and factors.
Results: Internal consistency (Cronbach’s alpha = 0.89–0.95) and test-retest reliability (ICC = 0.66–0.85) of each of the six LAP-R subscales were strong. Convergent validity was supported by correlations in the expected directions through choice/responsibleness with overall quality of life (ρ = .546, MQOL) and coherence with spiritual wellbeing (ρ = .636, SWB). Principal components analysis identified two factors, explaining 64.7% of the variance in the measure. EGA yielded a briefer 26-item measure with four domains: (1) Purpose and Coherence, (2) Choice/Responsibleness, (3) Death Acceptance, and (4) Existential Vacuum and Goal Seeking.
Conclusion: Analyses demonstrate that this briefer 26-item LAP-R measure displays sound psychometric properties and may be valuable to assess meaning in patients with advanced illness.