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Mossman B, Perry LM, Gerhart JI, McLouth LE, Lewson AB, Hoerger M. Emotional distress predicts palliative cancer care attitudes: The unique role of anger. Psychooncology 2023; 32:692-700. [PMID: 36799130 PMCID: PMC10164101 DOI: 10.1002/pon.6113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/21/2023] [Accepted: 02/02/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Although palliative care can mitigate emotional distress, distressed patients may be less likely to engage in timely palliative care. This study aims to investigate the role of emotional distress in palliative care avoidance by examining the associations of anger, anxiety, and depression with palliative care attitudes. METHODS Patients (N = 454) with heterogeneous cancer diagnoses completed an online survey on emotional distress and palliative care attitudes. Emotional distress was measured using the Patient-Reported Outcomes Measurement Information System anger, anxiety, and depression scales. The Palliative Care Attitudes Scale was used to measure palliative care attitudes. Regression models tested the impact of a composite emotional distress score calculated from all three symptom measures, as well as individual anger, anxiety, and depression scores, on palliative care attitudes. All models controlled for relevant demographic and clinical covariates. RESULTS Regression results revealed that patients who were more emotionally distressed had less favorable attitudes toward palliative care (p < 0.001). In particular, patients who were angrier had less favorable attitudes toward palliative care (p = 0.013) while accounting for depression, anxiety, and covariates. Across analyses, women had more favorable attitudes toward palliative care than men, especially with regard to beliefs about palliative care effectiveness. CONCLUSIONS Anger is a key element of emotional distress and may lead patients to be more reluctant toward timely utilization of palliative care. Although psycho-oncology studies routinely assess depression or anxiety, more attention to anger is warranted. More research is needed on how best to address anger and increase timely utilization of palliative cancer care.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, LA
| | - Laura M. Perry
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James I. Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan
| | - Laurie E. McLouth
- Department of Behavioral Science, Markey Cancer Center, Center for Health Equity Transformation, University of Kentucky College of Medicine, Lexington, KY
| | - Ashley B. Lewson
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, LA
- Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, LA
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Alonzi S, Perry LM, Lewson AB, Mossman B, Silverstein MW, Hoerger M. Fear of Palliative Care: Roles of Age and Depression Severity. J Palliat Med 2022; 25:768-773. [PMID: 34762507 PMCID: PMC9081062 DOI: 10.1089/jpm.2021.0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/12/2022] Open
Abstract
Background: Palliative care is underutilized due in part to fear and misunderstanding, and depression might explain variation in fear of palliative care. Objective: Informed by the socioemotional selectivity theory, we hypothesized that older adults with cancer would be less depressed than younger adults, and subsequently less fearful of utilizing palliative care. Setting/Subjects: Patients predominately located in the United States with heterogeneous cancer diagnoses (n = 1095) completed the Patient-Reported Outcomes Information System (PROMIS) Depression scale and rated their fear of palliative care using the Palliative Care Attitudes Scale (PCAS). We examined the hypothesized intercorrelations, followed by a bootstrapped analysis of indirect effects in the PROCESS macro for SPSS. Results: Participants ranged from 26 to 93 years old (mean [M] = 60.40, standard deviation = 11.45). The most common diagnoses were prostate (34.1%), breast (23.3%), colorectal (17.5%), skin (15.3%), and lung (13.5%) cancer. As hypothesized, older participants had lower depression severity (r = -0.20, p < 0.001) and were less fearful of palliative care (r = -0.11, p < 0.001). Participants who were more depressed were more fearful of palliative care (r = 0.21, p < 0.001). An indirect effect (β = -0.04, standard error = .01, 95% confidence interval: -0.06 to -0.02) suggested that depression severity may account for up to 40% of age-associated differences in fear of palliative care. Conclusions: Findings indicate that older adults with cancer are more likely to favor palliative care, with depression symptom severity accounting for age-related differences. Targeted interventions among younger patients with depressive symptoms may be helpful to reduce fear and misunderstanding and increase utilization of palliative care.
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Affiliation(s)
- Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M. Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Ashley B. Lewson
- Department of Psychology, Indiana University—Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | | | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
- Department of Palliative Medicine and Supportive Care, University Medical Center, New Orleans, Louisiana, USA
- Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
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Mossman B, Perry LM, Walsh LE, Gerhart J, Malhotra S, Horswell R, Chu S, Raines AM, Lefante J, Blais CM, Miele L, Melancon B, Alonzi S, Voss H, Freestone L, Dunn A, Hoerger M. Anxiety, depression, and end-of-life care utilization in adults with metastatic cancer. Psychooncology 2021; 30:1876-1883. [PMID: 34157174 DOI: 10.1002/pon.5754] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE End-of-life care for patients with cancer is often overly burdensome, and palliative and hospice care are underutilized. The objective of this study was to evaluate whether the mental health diagnoses of anxiety and depression were associated with variation in end-of-life care in metastatic cancer. METHODS This study used electronic health data from 1,333 adults with metastatic cancer who received care at two academic health centers in Louisiana, USA, and died between 1/1/2011-12/31/2017. The study used descriptive statistics to characterize the sample and logistic regression to examine whether anxiety and depression diagnoses in the six months before death were associated with utilization outcomes (chemotherapy, intensive care unit [ICU] visits, emergency department visits, mechanical ventilation, inpatient hospitalization, palliative care encounters, and hospice utilization), while controlling for key demographic and health covariates. RESULTS Patients (56.1% male; 65.6% White, 31.1% Black) commonly experienced depression (23.9%) and anxiety (27.2%) disorders within six months of death. Anxiety was associated with an increased likelihood of chemotherapy (odds ratio [OR] = 1.42, p = 0.016), ICU visits (OR = 1.40, p = 0.013), and inpatient hospitalizations (OR = 1.85, p < 0.001) in the 30 days before death. Anxiety (OR = 1.95, p < 0.001) and depression (OR = 1.34, p = 0.038) were associated with a greater likelihood of a palliative encounter. CONCLUSIONS Patients with metastatic cancer who had an anxiety disorder were more likely to have burdensome end-of-life care, including chemotherapy, ICU visits, and inpatient hospitalizations in the 30 days before death. Depression and anxiety both increased the odds of palliative encounters. These results emphasize the importance of mental health considerations in end-of-life care.
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Affiliation(s)
- Brenna Mossman
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Leah E Walsh
- Department of Psychology, Fordham University, Bronx, New York, USA
| | - James Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA.,Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Sonia Malhotra
- Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Section of General Internal Medicine & Geriatrics, Deming Department of Medicine, Tulane School of Medicine, New Orleans, Louisiana, USA
| | - Ronald Horswell
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - San Chu
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Amanda M Raines
- Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA.,Department of Psychiatry, School of Medicine, Louisiana State University, New Orleans, Louisiana, USA
| | - John Lefante
- Department of Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Christopher M Blais
- Department of Infectious Disease, Ochsner Clinic Foundation, New Orleans, Louisiana, USA
| | - Lucio Miele
- Department of Genetics and Louisiana Cancer Research Center, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Brian Melancon
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Sarah Alonzi
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Hallie Voss
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Lily Freestone
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Addison Dunn
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.,Department of Palliative Medicine & Supportive Care, University Medical Center, New Orleans, Louisiana, USA.,Departments of Psychiatry and Medicine, Tulane Cancer Center, and Freeman School of Business, Tulane University, New Orleans, Louisiana, USA
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