scholarly journals Exploring demoralization in end-of-life cancer patients: Prevalence, latent dimensions, and associations with other psychosocial variables

2019 ◽  
Vol 17 (5) ◽  
pp. 596-603 ◽  
Author(s):  
Andrea Bovero ◽  
Rossana Botto ◽  
Beatrice Adriano ◽  
Marta Opezzo ◽  
Valentina Tesio ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Rating Scales ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Well Being ◽  
Physical Symptoms ◽  
Psychosocial Variables ◽  
Cross Sectional ◽  
Spiritual Well Being

AbstractObjectiveDemoralization is an existential distress syndrome that consists of an incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, and impaired self-esteem. It can affect cancer patients, and the Demoralization Scale is a valid instrument to assess it. The present study aimed to investigate the prevalence of demoralization in end-of-life cancer patients and its associations with the medical and psychosocial variables. In addition, the latent dimensions of demoralization emerging in this distinctive population were explored.MethodThe study is cross-sectional. The sample consisted of 235 end-of-life cancer patients with a Karnofsky performance status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and medical data was gathered by a palliative physician and a set of validated rating scales, assessing demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity, was administered by a psychologist during the first consultation.ResultSixty-four participants (27.2%) had low demoralization, 50.2% (n = 118) had medium demoralization, and 22.6% (n = 53) had high demoralization. Factor analysis evidenced a five-factor solution that identified the following demoralization factors: Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure, and Dysphoria. All the considered variables were associated with demoralization, except for pain, nausea, breathing problems, and sociodemographic and clinical variables.Significance of resultsEnd-of-life cancer patients showed higher levels of demoralization than has been reported in other studies with advanced cancer. These data could suggest that demoralization could increase in proximity to death and with impaired clinical condition. In particular, the five demoralization dimensions that emerged could represent the typical concerns around which the syndrome evolves in end-of-life cancer patients. Finally, spiritual well-being could play a protective role with respect to demoralization.

scholarly journals Demoralization and associated features in an Italian sample of end-of-life cancer patients.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e23004-e23004
Author(s):  
Mario Airoldi ◽  
Andrea Bovero ◽  
Rossana Botto ◽  
Beatrice Adriano ◽  
Marta Opezzo ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Clinical Condition ◽  
Rating Scales ◽  
Karnofsky Performance Status ◽  
Well Being ◽  
Physical Symptoms ◽  
Existential Distress ◽  
Number Of Patients ◽  
Spiritual Well Being

e23004 Background: Demoralization is an expression of cancer-related existential distress that emerges from feelings of loss and changes linked to a life-threatening clinical condition. It is characterized by subjective incompetence, sense of failure, hopelessness, loss of purpose/meaning and low self-esteem. The study aimed to explore prevalence, latent dimensions and associated features of demoralization in a sample of end-of-life cancer patients. Methods: Participants were recruited for a cross-sectional assessment. For each patient, demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity were evaluated through validated rating scales and personal and medical data were gathered by a clinician. Final sample consisted of 235 end-of-life cancer patients with a Karnofsky Performance Status (KPS) lower than 50 and a life expectancy of few weeks. Results: High levels of demoralization occurred in 22.6% (n = 53) of patients. Sixty-four participants (27.2%) had low demoralization and 50.2% (n = 118) had moderate demoralization. Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure and Dysphoria were the five latent dimensions of demoralization emerged from the factor analysis. Demoralization was significantly associated with depression, anxiety, dignity, spiritual well-being and the physical symptoms except for nausea and breathing problems. Conclusions: Demoralization levels seem to be higher in this distinctive population than in advanced cancer patients. This could be due to the fact that end-of-life cancer patients are in a severe clinical condition and nearing death. The emerged demoralization dimensions could be five forms of expression of the existential distress typical of this illness phase. The considerable number of patients suffering from demoralization strengthen the need for psychological interventions in order to reduce the existential distress at the end of life, focusing on finding meaning and detecting spiritual concerns.

Hope in end-of-life cancer patients: A cross-sectional analysis

2021 ◽  
pp. 1-7
Author(s):  
Andrea Bovero ◽  
Marta Opezzo ◽  
Rossana Botto ◽  
Francesco Gottardo ◽  
Riccardo Torta
Keyword(s):  
End Of Life ◽  
Rating Scales ◽  
Depressive Symptomatology ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Depression Scale ◽  
Well Being ◽  
Religious Practice ◽  
Oncology Patients ◽  
Cross Sectional

Abstract Objective Hope promotes oncology patients’ adaptability to their illness, regardless of the stage of cancer. This study aimed to determine the prevalence of hope in a sample of end-of-life patients and to investigate the possible relationships between hope and a set of clinical and psychosocial measures. Method Three hundred and fifty end-of-life oncology patients, with a presumed life expectancy of 4 months or less and a Karnofsky Performance Status (KPS) of 50 or lower, were administered the Italian validated versions of a set of rating scales during their first consultation with a psychologist. This included the Herth Hope Index (HHI), Patient Dignity Inventory (PDI), Demoralization Scale (DS), Hospital Anxiety and Depression Scale (HADS), Functional Assessment of Chronic Illness Therapy (FACIT-Sp), and the Visual Analogue Scale for pain (VAS). Results On average, the sample scored between moderate and high on the HHI and the average level of spirituality was high. However, most patients had clinically relevant anxious and depressive symptomatology and high levels of demoralization. Other than the pain scale, the total HHI score significantly correlated with the total scores of all rating scales and their subscales, as well as with the measure of personal religious practice. The “Meaning” FACIT-Sp subscale was found to be the main predictor of hope. Significance of results Since hope represents a core need and a tool for patients dealing with their illness, it is essential to implement stage-specific and realistic hope-facilitating interventions and support patients in their search for meaning, which promotes spiritual well-being and appears relevant in fostering hope.

scholarly journals Associations with worry about dying and hopelessness in ambulatory ovarian cancer patients

2009 ◽  
Vol 7 (3) ◽  
pp. 299-306 ◽  
Author(s):  
Eileen Huh Shinn ◽  
Cindy L. Carmack Taylor ◽  
Kelly Kilgore ◽  
Alan Valentine ◽  
Diane C. Bodurka ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
End Of Life ◽  
Cancer Patients ◽  
Well Being ◽  
Psychosocial Variables ◽  
Advanced Cancer Patients ◽  
Cross Sectional ◽  
White Ethnicity ◽  
Independent Association ◽  
Cross Sectional Design

AbstractObjective: Women with ovarian cancer face a poor prognosis, with prolonged periods of treatment but relatively high levels of physical functioning. Their thoughts and feelings regarding the prospect of dying are complex and have not been adequately studied. Various demographic, medical and psychosocial factors were examined to determine their independent associations with fear of dying and hopelessness in a cross-sectional design.Method: Two hundred fifty-four ovarian cancer patients were assessed at the beginning of a new chemotherapy regimen. Separate logistic regressions were performed for worry about dying and loss of hope. For each analysis, psychosocial variables were entered after the demographic and medical variables to determine whether the psychosocial variables had an independent association with the respective outcome.Results: Fifty-five percent of the sample acknowledged fear of dying, and 31.6% acknowledged loss of hope in the fight against their illness. Being younger (p = .001), being of non-Hispanic White ethnicity (p = .026), and having poorer physical well-being (p = .000) were significantly associated with worry about dying after controlling for all other variables in the model. Regarding loss of hope, depressive symptoms (p = .002), lack of social support/well-being (p = .001), and number of treatments (p = .04) were significant.Significance of results: This is one of the largest studies to examine end-of-life concerns in a sample of advanced cancer patients. Our results underscore the importance of demographic and psychosocial variables in the examination of ovarian cancer patients' end-of-life concerns. Their fears and concerns should be openly acknowledged, even when the clinical focus is still on curative treatment.

Assessment of Quality of Life in Outpatients With Advanced Cancer: The Accuracy of Clinician Estimations and the Relevance of Spiritual Well-Being—A Hoosier Oncology Group Study

2003 ◽  
Vol 21 (14) ◽  
pp. 2754-2759 ◽  
Author(s):  
Michael J. Fisch ◽  
Michael L. Titzer ◽  
Jean L. Kristeller ◽  
Jianzhao Shen ◽  
Patrick J. Loehrer ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Performance Status ◽  
Well Being ◽  
Categorical Variables ◽  
Therapeutic Trial ◽  
Slight Variation ◽  
Cross Sectional ◽  
Spiritual Well Being

Purpose: To evaluate the association between quality-of-life (QOL) impairment as reported by patients and QOL impairment as judged by nurses or physicians, with and without consideration of spiritual well-being (SWB). Patients and Methods: A total of 163 patients with advanced cancer were enrolled onto a therapeutic trial, and cross-sectional data were derived from clinical and demographic questionnaires obtained at baseline, including assessment of patient QOL and SWB. Clinicians rated the QOL impairment of their patients as mild, moderate, or severe. Clinician-estimated QOL impairment and patient-derived QOL categories were compared. Correlation coefficients were estimated to associate QOL scores using different instruments. The analysis of variance method was used to compare Functional Assessment of Cancer Therapy–General scores on categorical variables. Results: There was no significant association between self-assessment scores and marital status, education level, performance status, or predicted life expectancy. However, a strong relationship between SWB and QOL was noted (P < .0001). Clinician-estimated QOL impairment matched the level of patient-derived QOL correctly in approximately 60% of cases, with only slight variation depending on the method of categorizing patient-derived QOL scores. The accuracy of clinician estimates was not associated with the level of SWB. Interestingly, a subset analysis of the inaccurate estimates revealed an association between lower SWB and clinician underestimation of QOL impairment (P = .0025). Conclusion: Clinician estimates of QOL impairment were accurate in more than 60% of patients. SWB is strongly associated with QOL, but it is not associated with the overall accuracy of clinicians’ judgments about QOL impairment.

Individual Meaning-Centered Psychotherapy for Advanced Cancer Patients

2017 ◽  
Author(s):  
William Breitbart ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
Melissa Masterson
Keyword(s):  
Clinical Trials ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Therapeutic Intervention ◽  
Well Being ◽  
Existential Psychology ◽  
Advanced Cancer Patients ◽  
Spiritual Well Being ◽  
Existential Concerns

Among the advanced cancer population, existential concerns are major issues that promote significant distress. For patients who are facing death, meaning and the preservation of meaning are not only clinically and existentially important but also central concepts to a therapeutic intervention. Based on Viktor Frankl’s logotherapy and the principles of existential psychology and philosophy, “meaning-centered psychotherapy” was developed to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives. This chapter provides an overview of work developing and testing individual meaning-centered psychotherapy (IMCP). It provides an overview of the session content in the IMCP intervention. It also presents findings from clinical trials, which support the efficacy of IMCP as an intervention to increase a sense of meaning, spiritual well-being, and hope while decreasing end-of-life despair. Furthermore, it presents difficult scenarios that may arise when delivering IMCP for clinicians interested in this work.

Spirituality and religion in terminally ill patients with cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 19587-19587
Author(s):  
P. Heras ◽  
K. Kritikos ◽  
A. Georgopoulou ◽  
A. Hatzopoulos ◽  
N. Kritikos
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Negative Association ◽  
Terminally Ill Cancer Patients ◽  
Patients With Cancer ◽  
Spirituality And Religion ◽  
Spiritual Well Being ◽  
Strong Negative Association

19587 Background: The importance of spirituality and religion in coping with a terminal illness is becoming increasingly recognised. We aimed to assess the relation between spiritual well-being, religiosity, depression, and end-of-life despair in terminally-ill cancer patients. Methods: One hundred forty three terminally ill cancer patients with a life expectancy of less than 6 months were interviewed with a series of standardised instruments, including the FACIT Spiritual Well-Being Scale, a religiosity index similar to those used in previous research, the Hamilton depression rating scale, the Memorial Symptom Assessment Scale and the Duke-UNC Functional Social Support Questionnaire. Results: A strong negative association was observed between the FACIT Spiritual Well-Being scale and the HDRS, but no such relationship was found for religiosity. Similar patterns were observed for the FACIT subscales, finding a strong negative association between the meaning and peace subscale (which corresponds to the more existential aspects of spirituality) and HDRS scores, whereas a positive, albeit nonsignificant, association was observed for the faith subscale (which corresponds more closely to religiosity). Conclusions: These results suggest that the beneficial aspects of religion may be primarily those that relate to spiritual well-being rather than to religious practices per se. Spiritual well-being offers some protection against end-of-life despair in those for whom death is imminent. The area of spiritual work is fertile ground for further investigation, especially interventions aimed at improving spiritual health and general quality of life among terminally ill patients with cancer. No significant financial relationships to disclose.

Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients

The Lancet ◽  
2003 ◽  
Vol 361 (9369) ◽  
pp. 1603-1607 ◽  
Author(s):  
Colleen S McClain ◽  
Barry Rosenfeld ◽  
William Breitbart
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Terminally Ill Cancer Patients ◽  
Spiritual Well Being

Personality Traits and Sense of Dignity in End-of-Life Cancer Patients: A Cross-Sectional Study

2020 ◽  
Vol 38 (1) ◽  
pp. 39-46
Author(s):  
Andrea Bovero ◽  
Francesca Cotardo ◽  
Vanni Pierotti ◽  
Francesco Gottardo ◽  
Rossana Botto ◽  
...  
Keyword(s):  
Personality Traits ◽  
Coping Strategies ◽  
End Of Life ◽  
Cancer Patients ◽  
Rating Scales ◽  
Psychological Symptoms ◽  
Life Stage ◽  
Care Process ◽  
Cross Sectional ◽  
And Coping

Context: Patients’ personality traits can play an important role in the end-of-life care process. Objectives: The present study aimed to investigate the relationship between personality traits and dignity in cancer patients nearing death. In addition, the associations between personality traits and physical, psychological symptoms, and coping strategies during the end-of-life stage were explored. Methods: The study is cross-sectional. The sample consisted of 210 participants with a Karnofsky Performance Status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and clinical data were collected and a set of validated rating scales, assessing personality, dignity, physical, psychological symptoms and coping strategies was administered during the first psychological consultation. Results: The results highlighted significant associations between personality traits and dignity. In particular, Conscientiousness was negatively correlated with Social Support and Extroversion was negatively associated with Loss of Purpose and Meaning. Neuroticism was related to all the dimensions of dignity and Extroversion was significantly associated with the physical and psychological symptoms. Regarding coping styles, active coping strategies were predictors of Extroversion and Agreeableness. Conversely, anxiety symptoms predicted the Neuroticism trait. Conclusions: Personality traits seem to be actively involved into the loss of dignity. These findings highlighted the importance of including personality traits and dignity into the patient’s care process. Exploring individual differences and coping mechanisms at the end-of-life could improve palliative care and lead to better patient-tailored psychological interventions.

scholarly journals Low Quality of Life (QoL) in Indian Breast Cancer Patients : A Critical Analysis of Up

2020 ◽  
Author(s):  
Sanjiv Srivast ◽  
Alpana Srivast ◽  
Sandeep Tiwari
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Cancer Patients ◽  
Well Being ◽  
Fear Of Recurrence ◽  
Breast Cancer Patients ◽  
Cross Sectional ◽  
Psychological Well Being ◽  
Spiritual Well Being

Abstract BackgroundBreast cancer is the commonest of all cancers among women across the world and India being no exception to this deadly disease. There may be many symptoms due to cancer, some are complex but some are not complex. Measuring quality of life (QoL) is important to measure overall burden of disease. It is important to evaluate cancer specific QoL which is associated to all stages of this disease. Also Quality of Life is a term that adds various dimensions of quality of life such as physical, psychological, socio-economical, spiritual, cognitional & social dimensions. Balance between all the four domains (i.e. Physical, Psychological, Social and Spiritual) means good quality of life, but in India QoL in general is not good and if we talk of cancer patients its worst.ObjectiveThe aim of this study is assessment of QoL in breast cancer patients undergoing treatment through various modalities at different stages of disease.MethodsThis is a cross-sectional study, a total of 150 breast cancer patients were included. Patients quality of life were assessed by Ferrel‘s Quality of Life Instrument-Breast Cancer patient version and the instrument is already validated by Ferrel BR et al (2012). These questionnaires consist of general well-being, psychological well-being, distress, fearfulness, social concerns and spiritual well-being. The data obtained gives Cronbach alpha value of 0.642 which is reliable enough for further study. The QoL in for most subjects was around 50% and is a cause of concern as this is quite low as compare to global standards. ResultsA significant relationship between type of cancer, amount of pain, and fatigue (tiredness) was found. However, none of the demographic variables (age, marital status, income) were significantly related to QoL. Education and type of treatment were found to be correlated with QoL. The physical well-being score was found to be Mean = 4.82, SD = 2.19. The Psychological well-being score was found to be Mean=4.95, SD=2.02. For social well-being score was found to be Mean=4.98, SD=1.94. The highest score was for spiritual well-being Mean = 5.32, SD = 2.46.ConclusionInfluencing quality of life (QoL) is an important issue in Breast cancer patients. Apart from effect of treatment there are other factors like socioeconomic status, psychological well-being, fear of recurrence etc., Which plays a pivotal role in patients wellbeing and if counseled at various levels like family, hospital and society can improve QoL.

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