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

Engelmann, D.; Scheffold, Katharina; Friedrich, Michael; Hartung, Tim; Schulz-Kindermann, Frank; Lordick, Florian; Schilling, Georgia; Lo, Chris; Rodin, Gary; Mehnert, Anja

doi:10.1016/j.jpainsymman.2016.07.002

Cited by 34 publications

(30 citation statements)

References 23 publications

(23 reference statements)

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“…Christians, adherents of other religions, and nonreligious patients had to endure suffering and death-related anxiety; this reportedly frequent challenge 3 , 47 , 48 overwhelmed 75 (93.8%) patients, also 25 from a total of 27 who had no fear at time of admission. According to King et al, religious/spiritual attitudes do not predict later levels of anxiety or depression.…”

Section: Discussionmentioning

confidence: 99%

Fear, Pain, Denial, and Spiritual Experiences in Dying Processes

Renz

Reichmuth

Bueche

et al. 2017

Am J Hosp Palliat Care

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Purpose:Approaching death seems to be associated with physiological/spiritual changes. Trajectories including the physical–psychological–social–spiritual dimension have indicated a terminal drop. Existential suffering or deathbed visions describe complex phenomena. However, interrelationships between different constituent factors (e.g., fear and pain, spiritual experiences and altered consciousness) are largely unknown. We lack deeper understanding of patients’ inner processes to which care should respond. In this study, we hypothesized that fear/pain/denial would happen simultaneously and be associated with a transformation of perception from ego-based (pre-transition) to ego-distant perception/consciousness (post-transition) and that spiritual (transcendental) experiences would primarily occur in periods of calmness and post-transition. Parameters for observing transformation of perception (pre-transition, transition itself, and post-transition) were patients’ altered awareness of time/space/body and patients’ altered social connectedness.Method:Two interdisciplinary teams observed 80 dying patients with cancer in palliative units at 2 Swiss cantonal hospitals. We applied participant observation based on semistructured observation protocols, supplemented by the list of analgesic and psychotropic medication. Descriptive statistical analysis and Interpretative Phenomenological Analysis (IPA) were combined. International interdisciplinary experts supported the analysis.Results:Most patients showed at least fear and pain once. Many seemed to have spiritual experiences and to undergo a transformation of perception only partly depending on medication. Line graphs representatively illustrate associations between fear/pain/denial/spiritual experiences and a transformation of perception. No trajectory displayed uninterrupted distress. Many patients seemed to die in peace. Previous near-death or spiritual/mystical experiences may facilitate the dying process.Conclusion:Approaching death seems not only characterized by periods of distress but even more by states beyond fear/pain/denial.

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Section: Discussionmentioning

confidence: 99%

Fear, Pain, Denial, and Spiritual Experiences in Dying Processes

Renz

Reichmuth

Bueche

et al. 2017

Am J Hosp Palliat Care

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“…32 Additionally, patients feel themselves more guilty because of their family's burden. 33 These factors render the patient more susceptible to death anxiety. Considering the prominent role of resorting to religion in coping with cancer which is supported also by findings in this study, we may conclude that it is even more important for end stage cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Depression, Anxiety and Coping Strategies in Cancer Patients: A Case Control Study

Ersoy¹,

İnci²,

İnci³

et al. 2019

Ankara Medical Journal

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Objectives: Psychiatric disorders frequently accompany chronic diseases especially cancer. The aim of this study was to investigate the depression and anxiety levels and the coping strategies in cancer patients. Materials and Methods: This was a case control study conducted in Karabuk University Research Hospital (KURH) between January 2018 and December 2018. Case group constituted of patients with an established diagnosis of cancer and control group included healthy individuals. Coping Strategies Questionnaire (COPE), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were performed for all participants. Statistical analyzes were carried out using Minitab 17 Statistical Software. Case versus control comparison for continues variables was conducted using Mann Whitney U test. Degree of relationship between continues variables were measured using Spearman's rank correlation. Chi-Squared test was used to evaluate cross tabulated categorical data. Results: 94 individuals were included in the study. Both cancer and control groups consisted of 23 males and 24 females. Mean age was found 59.77±12.01 years for cancer patients and 59.06±12.36 for control group. BDI and BAI scores of the patients were significantly higher compared to healthy individuals. Considering the cutoff values; 60% (28/47) of the cancer patients were found depressed and 62% (29/47) of them were found to have anxiety while in the control group both the depression and anxiety prevalence was 28% (13/47) (p=0.004 and p=0.002 respectively). Both groups were similar regarding the coping strategies total score (p=0.779). Turning to religion, humor, mental disengagement, denial and substance use were seen more frequently in cancer patients compared to control group (p=0.004, p=0.001, p=0.005, p=0.001 and p=0.004 respectively); whereas active coping, restraint coping, acceptance and behavioral disengagement were significantly more frequent in control group (p=0.001, p=0.039, p=0.026 and p=0.055 respectively). Humor, mental disengagement, denial and substance use were positively correlated with BDI scores (r=0.30 p=0.003, r=0.38 p=0.001, r=0.29 p=0.004, r=0.22 p=0.03 respectively). Turning to religion, humor, mental disengagement and substance use were positively correlated with BAI scores (r=0.24 p=0.015, r=0.25 p=0.013, r=0.31 p=0.001, r=0.23 p=0.024 respectively). Conclusion: The results of the current study revealed that cancer patients had higher levels of depression and anxiety compared to healthy individuals and they had higher risk of being depressed or anxious. Furthermore, the patients developed different strategies in order to cope with the burden of this catastrophic disease. Therefore, cancer is a multifaceted condition which must be approached in a multidimensional manner, by taking psychological features of each individual into account.

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“…The DADDS assesses specific concerns of advanced cancer patients with regard to insecurity about ones end of life, being a burden to others, as well as lost time and opportunities [ 62 – 64 ]. The German adaptation includes 9 instead of 15 items [ 65 ]. Additionally, the Likert-scale was shortened from a six-point to a five-point Likert-scale with mild and moderate distress put together to one label.…”

Section: Methods/ Designmentioning

confidence: 99%

The DEsire to DIe in Palliative care: Optimization of Management (DEDIPOM) – a study protocol

et al. 2018

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BackgroundA desire to die (DD) is frequent in palliative care (PC). However, uncertainty remains as to the appropriate therapeutic response. (Proactive) discussion of DD is not usually part of standard care. To support health practitioners' (HPs) reactions to a patient’s DD, a training program has been developed, piloted and evaluated. Within this framework, a first draft of a semi-structured clinical interview schedule with prompts (CISP) has been developed, including recommendations for action to support HPs’ self-confidence. The aim of this study is the further development of the CISP to support routine exploration of death and dying distress and proactive addressing of a DD.MethodsThis observatory, prospective health services study comprises a three step study design: 1. Revision of the CISP and consensus finding based on semi-structured interviews with patients and a Delphi process with (inter-)national experts, patient representatives and relatives; 2. Increasing confidence in HPs through a 2 day-training program using the consented CISP; 3. A formative quantitative evaluation of conversations between HPs and patients (300 palliative patients at three time points) and a qualitative evaluation based on interview triads of patients, relatives and HPs. The evaluation of conversations will include patient-oriented outcomes, including perceived relationships with HPs and death and dying distress. We will also consider aspects of social inequality and gender.DiscussionThe intervention can provide a framework for open discussion of DD and a basis for enhancing a trustful HP-patient relationship in which such difficult topics can be addressed. The benefits of this study will include (a) the creation of the first consented semi-structured approach to identify and address DD and to respond therapeutically, (b) the multi-professional enhancement of confidence in dealing with patients’ DD and an intervention that can flexibly be integrated into other training and education programs and (c) an evaluation of effects of this intervention on patients, relatives and HPs, with attention to social inequality and gender.Trial registrationThe study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

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

Abstract: 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.

Cited by 34 publications

References 23 publications

Fear, Pain, Denial, and Spiritual Experiences in Dying Processes

Fear, Pain, Denial, and Spiritual Experiences in Dying Processes

Depression, Anxiety and Coping Strategies in Cancer Patients: A Case Control Study

The DEsire to DIe in Palliative care: Optimization of Management (DEDIPOM) – a study protocol

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