Ekaterina An1,2, Christopher Lo1,2,3,4,5, Sarah Hales1,3,6, Camilla Zimmermann1,2,4,6, Gary Rodin1,2,3,4,6. 1. Department of Supportive Care, Princess Margaret Cancer Center, University Health Network, Toronto, Canada. 2. Institute of Medical Science, University of Toronto, Toronto, Canada. 3. Department of Psychiatry, University of Toronto, Toronto, Canada. 4. Institute for Life Course and Aging, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada. 5. Department of Psychology, University of Guelph-Humber, Toronto, Canada. 6. Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
Abstract
OBJECTIVE: The circumstances of advanced cancer can cause considerable psychological distress, including death anxiety and demoralization. Although these states of existential distress have a negative impact on the quality of life of patients with advanced cancer, they are rarely evaluated as outcomes or targets of interventions in this population. In an effort to improve understanding of existential distress, a structural model of relationships among death anxiety, demoralization, symptom burden, and social relatedness was tested in patients with advanced cancer. METHODS: A total of 307 patients with advanced cancer completed baseline measures including the Death and Dying Distress Scale, the Demoralization Scale, the modified Experiences in Close Relationships Scale, the Life Completion subscale of the Quality of Life Evaluation-Cancer scale, the Memorial Symptom Assessment Scale, and Karnofsky Performance Status. A structural equation model of protective and risk factors for demoralization and death anxiety was tested. RESULTS: The final model had good fit (SRMR = 0.061; RMSEA = 0.077; CFI = 0.927; NNFI = 0.902) in which death anxiety was positively associated with demoralization (β = 0.71), and demoralization was positively associated with symptom burden (β = 0.31) and negatively associated with social relatedness (β = -0.74). CONCLUSIONS: The findings of this study suggest that demoralization and death anxiety are closely linked in patients with advanced cancer. The contribution of both symptom burden and low social relatedness to demoralization suggests that an integrated intervention addressing both physical and psychosocial disease factors may be most effective at alleviating such states of existential distress.
OBJECTIVE: The circumstances of advanced cancer can cause considerable psychological distress, including death anxiety and demoralization. Although these states of existential distress have a negative impact on the quality of life of patients with advanced cancer, they are rarely evaluated as outcomes or targets of interventions in this population. In an effort to improve understanding of existential distress, a structural model of relationships among death anxiety, demoralization, symptom burden, and social relatedness was tested in patients with advanced cancer. METHODS: A total of 307 patients with advanced cancer completed baseline measures including the Death and Dying Distress Scale, the Demoralization Scale, the modified Experiences in Close Relationships Scale, the Life Completion subscale of the Quality of Life Evaluation-Cancer scale, the Memorial Symptom Assessment Scale, and Karnofsky Performance Status. A structural equation model of protective and risk factors for demoralization and death anxiety was tested. RESULTS: The final model had good fit (SRMR = 0.061; RMSEA = 0.077; CFI = 0.927; NNFI = 0.902) in which death anxiety was positively associated with demoralization (β = 0.71), and demoralization was positively associated with symptom burden (β = 0.31) and negatively associated with social relatedness (β = -0.74). CONCLUSIONS: The findings of this study suggest that demoralization and death anxiety are closely linked in patients with advanced cancer. The contribution of both symptom burden and low social relatedness to demoralization suggests that an integrated intervention addressing both physical and psychosocial disease factors may be most effective at alleviating such states of existential distress.
Authors: Ashlee R Loughan; Kelcie D Willis; Sarah Ellen Braun; Gary Rodin; Autumn Lanoye; Alexandria E Davies; Dace Svikis; Suzanne Mazzeo; Mark Malkin; Leroy Thacker Journal: J Neurooncol Date: 2022-04-18 Impact factor: 4.506
Authors: Susan Koranyi; Andreas Hinz; Julia M Hufeld; Tim J Hartung; Leonhard Quintero Garzón; Uta Fendel; Anne Letsch; Matthias Rose; Peter Esser; Anja Mehnert-Theuerkauf Journal: Front Psychol Date: 2021-11-24
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