--- - |2+ Abstract Objective Cancer patients often have to face increasing levels of existential distress (ED) during disease progression, especially when nearing death. This cross‐sectional study aimed to assess the prevalence of the dignity‐related existential distress (DR‐ED) in a sample of end‐of‐life cancer patients, and to explore the “existential distress” Patient Dignity Inventory (PDI‐IT) subscale internal structure and its associations with different coping strategies. Methods Two hundred seven cancer inpatients with a Karnofsky Performance Status ≤50 and a life expectancy of 4 months or less have been examined with the following self‐report measures: PDI‐IT, Demoralization Scale (DS‐IT) and Brief Coping Orientation to Problem Experienced (Brief‐COPE). The existential distress PDI‐IT subscale factor structure was explored through principal component analysis, and the DR‐ED associations with the other considered variables were examined through X2 tests, MANOVA, and multivariate regression analysis. Results Dignity‐related existential distress was a problem/major problem for 18.8% of the patients, especially for the younger (F(1, 205) = 3.40; P = 0.020) and more demoralized (F(1, 205) = 20.36; P < 0.001) individuals. Factor analysis supported 2 dimensions labeled “self‐discontinuity” and “loss of personal autonomy,” accounting for 58% of the variance. Positive reframing (β = −0.146, P < 0.05) and self‐blame (β = 0.247, P < 0.001) coping styles emerged as DR‐ED significant predictors. Conclusions This study showed how DR‐ED is a relevant problem for patients nearing death and furthermore highlighted 2 underlying factors. Finally, the research has shown that positive reframing and self‐blame coping styles might be clinically relevant elements for interventions on ED. - Psycho-Oncology, EarlyView.