Social determinants of death anxiety in patients with advanced cancer receiving outpatient palliative care.

Abstract

Death anxiety is common in advanced cancer, but little is known about risk factors for its occurrence, frequency or severity in those receiving specialized palliative care. This study aimed to determine the prevalence and correlates of death anxiety in outpatients with advanced cancer receiving specialized palliative care. Cross-sectional observational study. We identified the prevalence of death anxiety in 203 patients with advanced cancer attending an outpatient palliative care clinic in a large tertiary care hospital, and examined its association with sociodemographic factors, time since advanced cancer diagnosis, time since initial palliative care consultation, and proximity to death. Death anxiety was measured using the Death and Dying Distress Scale (DADDS). Variables that demonstrated significant univariable associations were subsequently included in a multivariable regression analysis. Moderate to severe death anxiety (DADDS score ⩾ 25) was reported by 46.3% of participants. Multivariable analysis demonstrated that greater death anxiety was associated with lower household income (⩾$100,000+ vs <$30,000: <i>ß</i> = -0.30, <i>p</i> = 0.002; $60,000-$99,999 vs <$30,000: <i>ß</i> = -0.27, <i>p</i> = 0.004; $30,000-$59,999 vs <$30,000: <i>ß</i> = -0.31, <i>p</i> < 0.001) and living alone (<i>ß</i> = 0.16, <i>p</i> = 0.03), but not with time since advanced cancer diagnosis or initial palliative care consultation, or with proximity to death. Moderate to severe death anxiety is reported by almost half of patients with advanced cancer receiving outpatient palliative care and is associated with economic disadvantage and solitary living arrangements. Further research is needed to determine to what extent targeted psychosocial and palliative interventions can alleviate such distress in this population.