Exposure to suicidality in professionals working with oncology patients: An online survey

Identifying Suicidal Ideation in Cancer Patients

EXTRACT   Keywords: Medical treatment, cancer diagnosis, suicide, suicidal thoughts, cancer patients, psychooncology. Introduction: Suicidality among oncology patients in Slovenia is still a relatively unexplored topic. After a review of the literature, it was found that the risk of suicide among people diagnosed with cancer is higher compared to the general population. Therefore, we wanted to determine the presence of suicidal ideation in patients undergoing cancer treatment. Methods: Qualitative research involved interviews (n=5) with people undergoing cancer treatment. In this paper, the transcripts of the interviews are analysed using grounded theory principles. Results. Some of them had a plan. Anxiety, insecurity, need for antidepressants and help from a psychologist were prominent. The very diagnosis and experience of the illness is extremely painful. They reported fear of starting treatment, a feeling of helplessness, of being affected, intertwined with a feeling of denial, then hope for a cure. The most disturbing aspect of the initial treatment process was the waiting for treatment and treatment. The illness itself and the treatment also have an impact on self-image, all leading to mental consequences due to physical changes. We found that a previous history of mental illness has a significant impact, but nevertheless all participants expressed a desire to live. The category analysis showed the category of support from family and surroundings, and the high importance of an orderly family status. In the experience of the medical staff, all participants felt that the need for individualised treatment in terms of person-centredness and the need for a psychooncologist at the beginning of treatment was inevitable.Pain is also an important element. More than physical pain, they mentioned psychological, internal pain, which was linked to feelings of helplessness and suicidal thoughts. Discussion and conclusion: Identification of suicidal oncology patients is a difficult process, as depressed mood and anxiety may be hidden during treatment. It is necessary to establish a trusting, empathic relationship with the patient. With mutual respect and trust, when suicidality occurs, healthcare staff can work together with the patient to try to solve the problem. Nurses who are present at all times with the patient should be educated in the identification of risk factors that increase the potential for suicide and in the use of prevention tools (e.g. questionnaires and interviews) and screening programmes that identify oncology patients at risk of suicidality at an early stage.

Suicidal ideation in patients with cancer: Its prevalence and results of structural equation modelling

OBJECTIVE

Patients with cancer have a higher risk of suicidal ideation (SI) and suicidality than the general population. This study was designed to investigate the prevalence of SI and its association with psychosocial and sociodemographic factors and tumour entity.

METHODS

In this observational cross-sectional study, 4372 adult patients with different cancer entities were enrolled. We assessed the outcome variables (i.e. SI, depressive and anxiety symptoms, mental and physical fatigue and sociodemographic data) using self-report questionnaires. Data were analysed via descriptive statistics, binomial logistic regression and structural equation modelling (SEM).

RESULTS

Among all patients, 627 (14.3%) reported SI, of whom 12.8% reported SI on several days, 0.9% on half of the days and 0.6% nearly every day. Age, anxiety, mental fatigue and the Patient Health Questionnaire-9 items 'feeling down, depressed and hopeless', 'feeling bad about oneself' and 'slowing or agitation' were significant predictors of SI. SEM, including all significant predictors with a latent depressiveness-demoralisation variable, explained 30.3% variance of SI, showing a good fit.

CONCLUSIONS

Our results showed that a significant number of patients with cancer show SI. Future long-term studies are needed to address the differential contribution of depression and demoralisation on SI in patients with cancer.

Attitudes and opinions towards suicidality in professionals working with oncology patients: results from an online survey

Objective

To explore and describe attitudes and opinions towards suicidality in healthcare professionals (HCPs) working with oncological patients.

Methods

A 48-item online questionnaire was developed and distributed to HCPs working with cancer patients. Three hundred fifty-four answered questionnaires were analyzed.

Results

The majority of HCPs reported that they were able to understand why a cancer patient would commit suicide (87.8%) or would seek help from an assisted suicide organization (ASO; 83.9%). The understandable reasons were pain and physical impairments (51.4%), social isolation (19.8%), loss of control and autonomy (18.1%), terminal disease (17.2%), loss of meaning (15.3%), desperation (14.7%), and psychic distress (9.3%). Personal experiences with suicidality lead only 44.8% of HCPs to believe that thereby they would be better able to understand a patients’ wish for suicide. Religion was negatively associated with understanding of suicide and why a cancer patient would seek help from an ASO. Knowledge of suicidality was positively associated with why a cancer patient would seek help from an ASO.

Conclusions

There is still little knowledge in oncology about the relation of HCPs’ attitudes toward suicidality in their patients and how those attitudes influence their behavior, especially care and treatment of patients. More research on this topic is needed. It stands to reason that more education about suicidality in cancer patients seems likely to improve understanding and attitudes and thereby influence care for cancer patients.

Suicidal ideation, distress, and related factors in a population of cancer patients treated in a general acute hospital

Purpose

Suicidality and suicidal ideation (SI) in oncology has long been an underestimated danger. Although there are cancer-specific distress screening tools available, none of these specifically incorporates items for SI. We examined the prevalence of SI in cancer patients, investigated the relation between SI and distress, and tried to identify additional associated factors.

Methods

A cross-sectional study with patients treated for cancer in a primary care hospital was conducted. Psychosocial distress and SI in 226 patients was assessed. An expert rating scale (PO-Bado-SF) and a self-assessment instrument (QSC-R23) were used to measure distress. SI was assessed with item 9 of the PHQ-9. Data was descriptively analyzed, and correlations and group comparisons between clinically distressed and non-distressed patients were calculated.

Results

SI was reported by 15% of patients. Classified as clinically distressed were 24.8% (QSC-R23) to 36.7% (PO-Bado-SF). SI was correlated with externally (r_τ = 0.19, p < 0.001) and self-rated distress (r_τ = 0.31, p < 0.001). Symptoms sufficiently severe for at least a medium major depressive episode were recorded in 23.5% of patients (PHQ-9). Factors associated with SI were feeling bad about oneself, feeling down, depressed, and hopeless, deficits in activities of daily life, psycho-somatic afflictions, social restrictions, and restrictions in daily life. Being in a steady relationship seemed to have a protective effect.

Conclusions

SI is common in cancer patients. Distress and associated factors are increased in patients with SI. A distress screening with the ability to assess SI could be an important step in prevention, but more research is necessary.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-021-06429-w.