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.

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.

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

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.

Understanding the concept of a “good death” among bereaved family caregivers of cancer patients in Singapore

2012 ◽  
Vol 11 (1) ◽  
pp. 37-46 ◽  
Author(s):  
Geok Ling Lee ◽  
Ivan Mun Hong Woo ◽  
Cynthia Goh
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Family Caregivers ◽  
Family Caregiver ◽  
Well Being ◽  
Good Death ◽  
Advanced Cancer Patients ◽  
The Family ◽  
Spiritual Well Being ◽  
Bereaved Family

AbstractObjective:The aim of this study was to examine the concept of a good death from the perspectives of both the dying person and the family caregiver, as perceived by bereaved family caregivers of advanced cancer patients.Method:The data were gathered from five focus group discussions and one face-to-face qualitative interview conducted over 8 months among 18 bereaved family caregivers recruited from a local hospice. The transcripts of the focus groups and the interview were entered into NVivo Version 8 and were analyzed using the thematic approach.Results:A good death may be understood as having the biopsychosocial and spiritual aspects of life handled well at the end of life. Five major themes were identified. These were preparation for death, family and social relationships, moments at or near death, comfort and physical care, and spiritual well-being. Differences were also noted in what is important at the end of life between the patients and caregivers. Having a quick death with little suffering was perceived to be good by the patient, but the family caregiver wanted to be able to say a final goodbye to the patient. Patients tend to prefer not to die in their children's presence but the children wished to be present for the final moment. In addition, family caregivers reported it was important for them to be able to give the patients permission to die, to feel recognized for the efforts made, and to have had a fulfilling caregiving experience.Significance of results:Whereas there are global attributes of a good death, our findings suggest that patients and family caregivers may define a good death differently. Therefore, there is a need to respect, address, and reconcile the differences, so that all parties may have a good experience at the end of a person's life.

scholarly journals Exploring the relationship between spiritual well-being and death anxiety in patients with gynecological cancer: a cross-section study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Yue Feng ◽  
Xingcan Liu ◽  
Tangwei Lin ◽  
Biru Luo ◽  
Qianqian Mou ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Cross Section ◽  
Death Anxiety ◽  
Religious Beliefs ◽  
Gynecological Cancer ◽  
Well Being ◽  
Life Questionnaire ◽  
Section Study ◽  
Spiritual Well Being ◽  
The Relationship

Abstract Background In recent years, spiritual well-being has gradually gained the attention of health care providers in China, especially those in oncology departments, who have recognized the importance of improving spiritual well-being in cancer patients. Since most of the current research on spiritual well-being has been carried out in areas with religious beliefs, this study was conducted in the context of no development of formal religion. The purpose of this study was to explore the relationship between death anxiety and spiritual well-being and the related factors of spiritual well-being among gynecological cancer patients. Methods This cross-section study was conducted among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32) and Templer's Death Anxiety Scale (T-DAS) were used to measure spiritual well-being and death anxiety. The Multiple Linear Regression Model was used to determine the relationship between spiritual well-being and death anxiety. Results For all participants, the highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale. The mean Death Anxiety score was 5.31 (SD 3.18). We found that Relationship with Someone or Something Greater was the only scale not associated with death anxiety. Overall, patients with lower death anxiety have a higher level of spiritual well-being. Besides, a high Relationship with Other score was associated with living with a partner (B = 2.471, P < 0.001) and married (B = -6.475, P = 0.001). Patients with higher Global-SWB were retired (B = 0.387, P = 0.019). Conclusions Our study found that the spiritual well-being of patients with gynecological cancer in China was no worse than in other countries with religious beliefs and patients with lower death anxiety have a higher level of spiritual well-being. Clinical staff should pay attention to the spiritual health of cancer patients, and spiritual care should be regarded as an essential element in cancer care.

Meaning-Centered Psychotherapy

2021 ◽  
pp. 489-494
Author(s):  
Melissa Masterson Duva ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
William S. Breitbart
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Psychosocial Care ◽  
Well Being ◽  
Cancer Center ◽  
Existential Psychology ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

A pilot study of transformation, attributed meanings to the illness, and spiritual well-being for terminally ill cancer patients

2008 ◽  
Vol 6 (4) ◽  
pp. 335-340 ◽  
Author(s):  
Michiyo Ando ◽  
Tatsuya Morita ◽  
Virginia Lee ◽  
Takuya Okamoto
Keyword(s):  
Cancer Patients ◽  
Terminally Ill ◽  
Well Being ◽  
Clinical Psychologist ◽  
Semistructured Interview ◽  
Search For Meaning ◽  
Terminally Ill Cancer Patients ◽  
Spiritual Well Being ◽  
Positive Meaning ◽  
High Level

ABSTRACTObjective:The present study investigated what types of transformation terminally ill cancer patients experienced from diagnosis until the terminal stage, what meanings terminally ill cancer patients attributed to their illness, and whether or not those who attributed positive meaning to their illness achieved high levels of spiritual well-being as a preliminary study.Method:Ten terminally ill cancer patients in the hospice wards of two general hospitals participated. A clinical psychologist conducted a semistructured interview with the patients individually for about 60 min. Patients completed the FACIT-Sp and HADS before the interview and talked about the meanings of cancer experience. The contents of the interviews were analyzed qualitatively. Patients were separated into high and low levels of spiritual-well being by the median of FACIT-Sp scores.Results:Three types of transformation were extracted: “group with peaceful mind,” “group with both positive attitude and uneasy feeling,” and “groups with uneasy feeling.” As attributed meanings to the illness, five categories were extracted: “positive meaning,” “natural acceptance,” “negative acceptance,” “search for meaning,” and “regret and sorrow.” Patients in the high level spiritual well-being group attributed the meaning of illness to “positive meaning” and “natural acceptance,” and those in the low level spiritual well-being group attributed it to “regret and sorrow” and “search for meaning.”Significance of results:Some Japanese terminally ill cancer patients experienced positive transformation, and patients who attributed “positive meaning” and “natural acceptance” to their illness experience achieved high levels of spiritual well-being.

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