Death-Related Anxiety in Patients With Advanced Cancer: Validation of the German Version of the Death and Dying Distress Scale

J Pain Symptom Manage. 2016 Oct;52(4):582-587. doi: 10.1016/j.jpainsymman.2016.07.002. Epub 2016 Aug 9.


Context: Distress and anxiety about issues related to death and dying is commonly experienced in patients with advanced disease and a limited life expectancy.

Objectives: To evaluate the psychometric properties of the German version of the Death and Dying Distress Scale (DADDS-G) in advanced cancer patients.

Methods: We recruited advanced patients with mixed tumor entities (Union for International Cancer Control [UICC] Stage III/IV) treated in two German University Medical Centers during their outpatient treatment. After testing a preliminary version of the state-of-the-art translated original Death and Dying Distress Scale, we analyzed the psychometric properties of the shortened nine-item adapted DADDS-G using validated instruments measuring distress, anxiety, depression, fear of progression, and quality of life.

Results: We obtained complete questionnaires from 77 of 93 patients with advanced cancer (response rate: 83%). Participants were mostly married or cohabiting (75%), well-educated, and both sexes were almost equally represented (52% men; mean age 58 years, SD = 12). The total mean DADDS-G score was 13.3 (SD = 8.5). Patients reported to be most distressed by the feeling of being a burden to others. The exploratory factor analysis led to one factor that accounted for more than 59% of the variance. The DADDS-G's internal consistency was excellent with Cronbach alpha = 0.91. The confirmatory factor analysis demonstrated a very good model fit. Death-related anxiety was significantly associated with distress, depression, anxiety, fear of progression, and lower quality of life (P < 0.001).

Conclusion: Results provide further evidence that the DADDS-G is a valid and reliable instrument of high clinical relevance for use in patients with advanced cancer.

Keywords: Death anxiety; advanced cancer; assessment; distress; palliative care.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Validation Study

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety / diagnosis*
  • Anxiety / etiology*
  • Attitude to Death*
  • Depression / diagnosis
  • Depression / etiology
  • Factor Analysis, Statistical
  • Fear
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasms* / diagnosis
  • Neoplasms* / psychology
  • Palliative Care
  • Pilot Projects
  • Psychometrics
  • Quality of Life
  • Self Report*
  • Translating