title: Death-Related Anxiety in Patients With Advanced Cancer: Validation of the German Version of the Death and Dying Distress Scale.
abstract: 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.
authors: Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
authors: Dorit
authors: D
authors: Engelmann
authors: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Katharina
authors: K
authors: Scheffold
authors: Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
authors: Michael
authors: M
authors: Friedrich
authors: Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
authors: Tim J
authors: TJ
authors: Hartung
authors: Department and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors: Frank
authors: F
authors: Schulz-Kindermann
authors: University Cancer Center Leipzig (UCCL), University Medical Center Leipzig, Leipzig, Germany.
authors: Florian
authors: F
authors: Lordick
authors: Hamburg Cancer Society, Hamburg, Germany.
authors: Georgia
authors: G
authors: Schilling
authors: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Chris
authors: C
authors: Lo
authors: Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors: Gary
authors: G
authors: Rodin
authors: Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany. Electronic address: anja.mehnert@medizin.uni-leipzig.de.
authors: Anja
authors: A
authors: Mehnert
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000175:diagnosis* / Q000209:etiology*; D001293:Attitude to Death; D003863:Depression / Q000175:diagnosis / Q000209:etiology; D005163:Factor Analysis, Statistical; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology; D010166:Palliative Care; D010865:Pilot Projects; D011594:Psychometrics; D011788:Quality of Life; D057566:Self Report; D014175:Translating
keywords: Death anxiety; advanced cancer; assessment; distress; palliative care