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Randomized Controlled Trial
. 2023 Feb;26(2):235-243.
doi: 10.1089/jpm.2022.0052. Epub 2022 Sep 2.

Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care

Linda L Emanuel  1   2 , Sheldon Solomon  3 , Harvey Max Chochinov  4   5 , Marvin Omar Delgado Guay  6 , George Handzo  7 , Joshua Hauser  8   9 , Sheri Kittelson  10 , Sean O'Mahony  11 , Tammie E Quest  12   13 , Michael W Rabow  14 , Tasha M Schoppee  15   16 , Diana J Wilkie  16 , Yingwei Yao  16 , George Fitchett  17
Affiliations
Randomized Controlled Trial

Death Anxiety and Correlates in Cancer Patients Receiving Palliative Care

Linda L Emanuel et al. J Palliat Med. 2023 Feb.

Abstract

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.

Keywords: Dignity Therapy; death anxiety; existential quality of life; prognostic awareness.

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Conflict of interest statement

D.J.W. is Founder and Chairman of eNURSING LLC, a company with no interests in the research reported in this article.

Figures

FIG. 1.
FIG. 1.
Finitude subscale score by terminal illness awareness and cancer stage.
See this image and copyright information in PMC

References

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