1. I feel anxious about death.
Neither agree nor disagree
2. The fact that I will die someday is terrifying.
Neither agree nor disagree
3. I am scared of dying.
Neither agree nor disagree
4. Death frightens me.
Neither agree nor disagree
5. It would be terrible to not have time to experience everything I want to.
Sometimes have the thought
6. It would be horrible to die alone.
Sometimes have the thought
7. My death will be a painful experience.
Sometimes have the thought
8. I couldn't cope with growing old without my loved ones.
Sometimes have the thought
9. I will lose a loved one suddenly and it will destroy me.
Sometimes have the thought
10. On my deathbed, I will not be able to face death as bravely as I should.
Sometimes have the thought
11. I couldn't cope if someone I care for developed a fatal illness.
Sometimes have the thought
12. Watching or reading media stories about dying.
13. Thinking about being diagnosed with a terminal illness.
14. Reading a novel with a character who is dying.
15. Thinking about a loved one dying.
16. Watching a film or TV show with a character who is dying.
17. Thinking about myself dying.
18. Reading a memoir or essay by someone diagnosed with a terminal illness.
The presented answer sheet is not an original form and is not intended for printing or use as a handout.