Send to

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

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

Author information

Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany.
Hamburg Cancer Society, Hamburg, Germany.
Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany. Electronic address:



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


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


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.


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).


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.


Death anxiety; advanced cancer; assessment; distress; palliative care

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center