Assessment of Attachment in Palliative Care Patients: Psychometric Properties of the Spanish Version of the Experiences in Close Relationships – Modified and Brief (ECR-M16)

Background: Insecure attachment styles have been associated with greater emotional distress, suffering, and existential anguish in patients with cancer and other advanced illnesses. In palliative care, attachment acquires clinical relevance, as it influences coping with illness, help-seeking and support acceptance, family caregiving dynamics, and therapeutic relationship. Therefore, its assessment is essential for delivering comprehensive, person-centered care. Objective: To adapt and validate the Spanish version of the Experiences in Close Relationships–Modified (ECR-M16) in patients with advanced cancer at the end of life, examining its structural validity, reliability, and criterion validity. Method: A cross-sectional study was conducted with 135 patients receiving care in the palliative care unit of Hospital-Residència Sant Camil (CSAPG), Barcelona. The scale was translated using a forward–backward procedure. Structural validity was evaluated through confirmatory factor analysis; internal consistency was assessed using Cronbach’s alpha and McDonald’s omega; and test–retest reliability was estimated using the intraclass correlation coefficient in a subsample reassessed after one week. Criterion validity was examined through correlations with emotional distress, existential loneliness, resilience, and family functioning. Results: Confirmatory factor analysis supported the original two-factor structure (anxiety and avoidance), showing adequate fit (χ²/df = 1.67; CFI = .906; RMSEA = .073). Internal consistency was adequate for both anxiety (α and ω ≈ .75–.75) and avoidance (α and ω ≈ .74–.75), and temporal stability was satisfactory (ICC ≈ .73–.74). Both anxiety and avoidance were positively associated with emotional distress and loneliness; avoidance was negatively correlated with family functioning and resilience. Conclusion: The Spanish version of the ECR-M16 demonstrates adequate psychometric properties and represents a brief, valid, and reliable instrument for assessing attachment in palliative care settings.