Measuring Death-related Anxiety in Advanced Cancer: Preliminary Psychometrics of the Death and Dying Distress Scale
Abstract
The alleviation of distress associated with death and dying is a central goal of palliative care, despite the lack of routine measurement of this outcome. In this study, we introduce the Death and Dying Distress Scale (DADDS), a new, brief measure we have developed to assess death-related anxiety in advanced cancer and other palliative populations. We describe its preliminary psychometrics based on a sample of 33 patients with advanced or metastatic cancer. The DADDS broadly captures distress about the loss of time and opportunity, the process of death and dying, and its impact on others. The initial version of the scale has a one-factor structure and good internal reliability. Dying and death-related distress was positively associated with depression and negatively associated with spiritual, emotional, physical, and functional well-being, providing early evidence of construct validity. This distress was relatively common, with 45% of the sample scoring in the upper reaches of the scale, suggesting that the DADDS may be a relevant outcome for palliative intervention. We conclude by presenting a revised 15-item version of the scale for further study in advanced cancer and other palliative populations.
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Reducing psychological distress and death anxiety is a fundamental element of end-of-life care and treatment.
“Based on this evidence, reducing psychological distress and death anxiety is a fundamental element of end-of-life care and treatment (Lo, Hales, Jung, Chiu, Panday, Rydall, et al., 2014;Lo, Hales, Zimmermann, Gagliese, Rydall and Rodin, 2011;Sherman et al., 2010).”
From Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct (2014) · cites this paper as Lo, Hales, Zimmermann, Gagliese, Rydall and Rodin, 2011
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Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct
Iverach, L., Menzies, R. G., & Menzies, R. E. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.09.002 · Cited by 459 · see citing works
“These approaches address the psychological consequences associated with dying, including death anxiety, and have been associated with several psychosocial improvements, such as reduced depression and anxiety, enhanced quality of life, decreased pain, and improved coping skills (Lo et al., 2011; Lo et al., 2014; Sherma…”
BackgroundRodin, G., Lo, C., Rydall, A., Shnall, J., Malfitano, C., Chiu, A., Panday, T., Watt, S., An, E., Nissim, R., et al. (2018) · Journal of Clinical Oncology · doi:10.1200/jco.2017.77.1097 · Cited by 338 · see citing works
Self-citationLo, C., Hales, S., Jung, J., Chiu, A., Panday, T., Rydall, A., Nissim, R., Malfitano, C., Petricone-Westwood, D., Zimmermann, C., et al. (2014) · Palliative Medicine · doi:10.1177/0269216313507757 · Cited by 166 · see citing works
Self-citationFear of cancer recurrence and death anxiety
Sharpe, L., Curran, L., Butow, P., & Thewes, B. (2018) · Psycho-Oncology · doi:10.1002/pon.4783 · Cited by 149 · see citing works
Death anxiety interventions in patients with advanced cancer: a systematic review
Grossman, C. H., Brooker, J., Michael, N., & Kissane, D. (2018) · Palliative Medicine · doi:10.1177/0269216317722123 · Cited by 144 · see citing works
Determinants of death anxiety in patients with advanced cancer
Neel, C., Lo, C., Rydall, A., Hales, S., & Rodin, G. (2015) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2012-000420 · Cited by 114 · see citing works
Self-citationDemoralization and death anxiety in advanced cancer
An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018) · Psycho-Oncology · doi:10.1002/pon.4843 · Cited by 115 · see citing works
Self-citationKrause, S., Rydall, A., Hales, S., Rodin, G., & Lo, C. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.04.012 · Cited by 102 · see citing works
Self-citationFear of cancer recurrence and death anxiety: unaddressed concerns for adult neuro-oncology patients
Loughan, A. R., Lanoye, A., Aslanzadeh, F. J., Villanueva, A. A. L., Boutte, R., Husain, M., & Braun, S. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-019-09690-8 · Cited by 60 · see citing works
- Authors
- Lo, C., Hales, S., Zimmermann, C., Gagliese, L., Rydall, A., & Rodin, G.
- Affiliations
- University Health Network (CA)
- Venue
- Journal of Pediatric Hematology/Oncology
- Published
- 2011-10
- Volume
- 33
- Issue
- Supplement 2
- Pages
- S140-S145
- ISSN
- 1077-4114 (ISSN-L)
- OpenAlex
- W2313442361
- Cited by
- 124
- References
- 4
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 14 · 2023: 8 · 2022: 10 · 2021: 13 · 2020: 8 · 2019: 7 · 2018: 7 · 2017: 11 · 2016: 7 · 2015: 6 · 2014: 4 · 2013: 5 · 2012: 1
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Pediatric Hematology/Oncology (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline at James Cook University (James Cook University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- advanced cancer, palliative care, psychometric validation, depression, well-being, scale development, metastatic cancer
- MeSH terms
- Adult, Affective Symptoms, Aged, Anxiety, Attitude to Death, Depression, Female, Humans, Male, Mental Status Schedule, Middle Aged, Neoplasms, Palliative Care, Pilot Projects, Psychometrics, Reproducibility of Results
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