title: The meaning of self-reported death anxiety in advanced cancer.
abstract: Death anxiety is important but understudied in palliative care. New self-report measurements have been developed, but their interpretation and clinical utility may not be evident.
  
  
  
  To inform our understanding of death anxiety in patients with advanced cancer by exploring the relationship between this self-reported symptom and its clinical presentation.
  
  
  
  Participants were part of a psychotherapy trial in advanced cancer. First therapy session transcripts were analyzed using interpretive description in patients reporting low, moderate, and high death anxiety on the Death and Dying Distress Scale (DADDS).
  
  
  
  A total of 16 participants (10 women and 6 men) with advanced or metastatic cancer were sampled from the Princess Margaret Cancer Centre, Toronto, Canada. Six participants reported low death anxiety scores (Death and Dying Distress Scale: 0-19), five moderate (Death and Dying Distress Scale: 20-50), and five high (Death and Dying Distress Scale: 51-75).
  
  
  
  The low death anxiety group exhibited psychological readiness for death, or contrastingly, non-reflectiveness about death. The moderate group recognized the imminence of mortality, which impacted treatment decisions and future plans. Prior experience with death was discussed as raising the salience of mortality. The high group felt dominated by powerful emotions and could not make sense of their situation. Their distress was exacerbated by substantial relational concerns.
  
  
  
  Self-reported death anxiety is affected by the awareness and ability to reflect on mortality. Death and Dying Distress Scale scores may facilitate exploration of this symptom as part of a clinical assessment and may serve to guide treatment approaches. Greater attention to death anxiety is consistent with and recommended by contemporary approaches to palliative care.
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors: Eryn
authors: E
authors: Tong
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors: Amy
authors: A
authors: Deckert
authors: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany.
authors: Nina
authors: N
authors: Gani
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors: Rinat
authors: R
authors: Nissim
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
authors: Anne
authors: A
authors: Rydall
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors: Sarah
authors: S
authors: Hales
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
authors: Gary
authors: G
authors: Rodin
authors: Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada Department of Psychiatry, University of Toronto, Toronto, ON, Canada Department of Psychology, University of Guelph-Humber, Toronto, ON, Canada chrislo@uhnresearch.ca.
authors: Chris
authors: C
authors: Lo
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001293:Attitude to Death; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D009864:Ontario; D010166:Palliative Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales
keywords: Affective symptoms; anxiety; end of life; neoplasms; palliative care