Measuring death-related anxiety in advanced cancer: preliminary psychometrics of the Death and Dying Distress Scale

J Pediatr Hematol Oncol. 2011 Oct;33 Suppl 2:S140-5. doi: 10.1097/MPH.0b013e318230e1fd.


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.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Adult
  • Affective Symptoms / diagnosis
  • Affective Symptoms / psychology
  • Aged
  • Anxiety / diagnosis*
  • Anxiety / psychology
  • Attitude to Death*
  • Depression / diagnosis
  • Depression / psychology
  • Female
  • Humans
  • Male
  • Mental Status Schedule / standards*
  • Middle Aged
  • Neoplasms / psychology*
  • Palliative Care / methods
  • Pilot Projects
  • Psychometrics / methods*
  • Psychometrics / standards*
  • Reproducibility of Results