Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care

Linda L. Emanuel, Sheldon Solomon, Harvey Max Chochinov, Marvin Omar Delgado Guay, George Handzo, Joshua Hauser, Sheri Kittelson, Sean O'Mahony, Tammie E. Quest, Michael W. Rabow, Tasha M. Schoppee, Diana J. Wilkie, Yingwei Yao, George Fitchett*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Death anxiety is powerful, potentially contributes to suffering, and yet has to date not been extensively studied in the context of palliative care. Availability of a validated Death Anxiety and Distress Scale (DADDS) opens the opportunity to better assess and redress death anxiety in serious illness. Objective: We explored death anxiety/distress for associations with physical and psychosocial factors. Design: Ancillary to a randomized clinical trial (RCT) of Dignity Therapy (DT), we enrolled a convenience sample of 167 older adults in the United States with cancer and receiving outpatient palliative care (mean age 65.9 [7.3] years, 62% female, 84% White, 62% stage 4 cancer). They completed the DADDS and several measures for the stepped-wedged RCT, including demographic factors, religious struggle, dignity-related distress, existential quality of life (QoL), and terminal illness awareness (TIA). Results: DADDS scores were generally unrelated to demographic factors (including religious affiliation, intrinsic religiousness, and frequency of prayer). DADDS scores were positively correlated with religious struggle (p < 0.001) and dignity-related distress (p < 0.001) and negatively correlated with existential QoL (p < 0.001). TIA was significantly nonlinearly associated with both the total DADDS (p = 0.007) and its Finitude subscale (p ≤ 0.001) scores. There was a statistically significant decrease in Finitude subscale scores for a subset of participants who completed a post-DT DADDS (p = 0.04). Conclusions: Findings, if replicable, suggest that further research on death anxiety and prognostic awareness in the context of palliative medicine is in order. Findings also raise questions about the optimal nature and timing of spiritual and psychosocial interventions, something that might entail evaluation or screening for death anxiety and prognostic awareness for maximizing the effectiveness of care.

Original languageEnglish (US)
Pages (from-to)235-243
Number of pages9
JournalJournal of palliative medicine
Issue number2
StatePublished - Feb 1 2023


  • Dignity Therapy
  • death anxiety
  • existential quality of life
  • prognostic awareness

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • General Nursing


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