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Chapman K, Dixon A, Kendall E, Clanchy K. Defining dignity at the intersection of disability: a scoping review. Disabil Rehabil 2024:1-11. [PMID: 38265032 DOI: 10.1080/09638288.2024.2302582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 12/27/2023] [Indexed: 01/25/2024]
Abstract
PURPOSE This scoping literature review aimed to determine the definition of dignity in relation to disability. It also examined the extent to which inclusive research methods have been used to develop working definitions. MATERIALS AND METHODS A comprehensive search was conducted in five electronic databases, using a modified framework by Arksey and O'Malley. Narrative synthesis and qualitative content analysis were employed to examine definitions of dignity and the use of inclusive research methods. RESULTS 22 peer-reviewed studies were included. The majority of the studies were qualitative (72.72%) and examined various disability populations in diverse settings. Although 19 studies offered a definition of dignity, there was no clear consensus. Dignity was frequently defined from a utilitarian perspective, emphasising affordances and barriers. However, engagement with theoretical constructs was superficial and limited. Further, no studies mentioned the use of inclusive research methods. CONCLUSIONS The absence of inclusive research methods hinders the development of a comprehensive definition of dignity that is accepted by and relevant to people with disability. Engaging with both theoretical and empirical perspectives of dignity is crucial to develop a meaningful and inclusive definition, which can inform interventions and policies that enhance dignity for people with disability across diverse settings and contexts.
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Affiliation(s)
- Kelsey Chapman
- Inclusive Futures, Griffith University, Nathan, Queensland, Australia
- The Hopkins Centre, Griffith University, Nathan, Queensland, Australia
| | - Angel Dixon
- Inclusive Futures, Griffith University, Nathan, Queensland, Australia
| | - Elizabeth Kendall
- Inclusive Futures, Griffith University, Nathan, Queensland, Australia
- The Hopkins Centre, Griffith University, Nathan, Queensland, Australia
| | - Kelly Clanchy
- Inclusive Futures, Griffith University, Nathan, Queensland, Australia
- The Hopkins Centre, Griffith University, Nathan, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Nathan, Queensland, Australia
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Chapman K, Dixon A, Ehrlich C, Kendall E. Dignity and the Importance of Acknowledgement of Personhood for People With Disability. QUALITATIVE HEALTH RESEARCH 2024; 34:141-153. [PMID: 37902052 PMCID: PMC10714705 DOI: 10.1177/10497323231204562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Exploring the intricate relationship between individual and collective experiences, this study explores dignity from the perspectives of people with disability. Using an extreme citizen science approach, we engaged people with disability as active partners in gathering data through qualitative surveys and focus groups. Framework Analysis was employed to ensure the validity of findings while privileging the voices of people with lived experience of disability. Dignity was contingent on the acknowledgement of personhood and the delivery of human rights. Our research identified five key aspects to maintain and protect dignity: (1) acknowledging personhood; (2) recognising people with disability as decision-makers of their lives; (3) realising the right to access information; (4) maintaining the right to privacy; and (5) eliminating or minimising barriers to accessibility and inclusion. Undignified experiences that resulted from a lack of acknowledgement negatively affected participants' wellbeing, and healthcare settings were identified as particularly challenging environments for dignity. These findings have significant implications for healthcare systems and services within an international and interdisciplinary context. They emphasise the need for adaptable, flexible services, co-designed with people with lived experience of disability. Addressing organisational constraints, resource limitations, and expectations is paramount to ensuring dignity is maintained through the acknowledgement of personhood and safeguarding of human rights.
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Affiliation(s)
- Kelsey Chapman
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Nathan, QLD, Australia
- Inclusive Futures: Reimagining Disability, Griffith University, Southport, QLD, Australia
| | - Angel Dixon
- Inclusive Futures: Reimagining Disability, Griffith University, Southport, QLD, Australia
| | - Carolyn Ehrlich
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Nathan, QLD, Australia
| | - Elizabeth Kendall
- The Hopkins Centre: Research for Rehabilitation and Resilience, Griffith University, Nathan, QLD, Australia
- Inclusive Futures: Reimagining Disability, Griffith University, Southport, QLD, Australia
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3
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Isbell LK, Uibeleisen R, Friedl A, Burger E, Dopatka T, Scherer F, Orban A, Lauer E, Malenica N, Semenova I, Vreden A, Valk E, Wendler J, Neumaier S, Fricker H, El Rabih AAH, GloggengieĂźer C, Hilbig D, Bleul S, Weis J, Gmehlin D, Backenstrass M, Wirtz S, Ihorst G, Finke J, Illerhaus G, Schorb E. Age-adjusted high-dose chemotherapy followed by autologous stem cell transplantation or conventional chemotherapy with R-MP as first-line treatment in elderly primary CNS lymphoma patients - the randomized phase III PRIMA-CNS trial. BMC Cancer 2023; 23:767. [PMID: 37596517 PMCID: PMC10436648 DOI: 10.1186/s12885-023-11193-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/19/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Older primary central nervous system lymphoma (PCNSL) patients have an inferior prognosis compared to younger patients because available evidence on best treatment is scarce and treatment delivery is challenging due to comorbidities and reduced performance status. High-dose chemotherapy and autologous stem cell transplantation (HCT-ASCT) after high-dose methotrexate (MTX)-based immuno-chemotherapy has become an increasingly used treatment approach in eligible elderly PCNSL patients with promising feasibility and efficacy, but has not been compared with conventional chemotherapy approaches. In addition, eligibility for HCT-ASCT in elderly PCNSL is not well defined. Geriatric assessment (GA) may be helpful in selecting patients for the best individual treatment choice, but no standardized GA exists to date. A randomized controlled trial, incorporating a GA and comparing age-adapted HCT-ASCT treatment with conventional chemotherapy is needed. METHODS This open-label, multicenter, randomized phase III trial with two parallel arms will recruit 310 patients with newly diagnosed PCNSL > 65 years of age in 40 centers in Germany and Austria. The primary objective is to demonstrate that intensified chemotherapy followed by consolidating HCT-ASCT is superior to conventional chemotherapy with rituximab, MTX, procarbazine (R-MP) followed by maintenance with procarbazine in terms of progression free survival (PFS). Secondary endpoints include overall survival (OS), event free survival (EFS), (neuro-)toxicity and quality of life (QoL). GA will be conducted at specific time points during the course of the study. All patients will be treated with a pre-phase rituximab-MTX (R-MTX) cycle followed by re-assessment of transplant eligibility. Patients judged transplant eligible will be randomized (1:1). Patients in arm A will be treated with 3 cycles of R-MP followed by maintenance therapy with procarbazine for 6 months. Patients in arm B will be treated with 2 cycles of MARTA (R-MTX/AraC) followed by busulfan- and thiotepa-based HCT-ASCT. DISCUSSION The best treatment strategy for elderly PCNSL patients remains unknown. Treatments range from palliative to curative but more toxic therapies, and there is no standardized measure to select patients for the right treatment. This randomized controlled trial will create evidence for the best treatment strategy with the focus on developing a standardized GA to help define eligibility for an intensive treatment approach. TRIAL REGISTRATION German clinical trials registry DRKS00024085 registered March 29, 2023.
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Affiliation(s)
- Lisa K Isbell
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Roswitha Uibeleisen
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Alexander Friedl
- Department of Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, PrieĂźnitzweg 24, 70374, Bad Cannstatt, Germany
| | - Elvira Burger
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Tatja Dopatka
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Florian Scherer
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Andras Orban
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Eliza Lauer
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Natalie Malenica
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Inna Semenova
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Annika Vreden
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Elke Valk
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Julia Wendler
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Simone Neumaier
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Heidi Fricker
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Abed Al Hadi El Rabih
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Cora GloggengieĂźer
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Daniela Hilbig
- Stuttgart Cancer Center - Tumorzentrum Eva Mayer-Stihl, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Sabine Bleul
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Joachim Weis
- Endowed Professorship Self-Help Research, Comprehensive Cancer Center, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Dennis Gmehlin
- Institute for Clinical Psychology, Klinikum Stuttgart, PrieĂźnitzweg 24, 70374, Bad Cannstatt, Germany
| | - Matthias Backenstrass
- Institute for Clinical Psychology, Klinikum Stuttgart, PrieĂźnitzweg 24, 70374, Bad Cannstatt, Germany
| | - Sebastian Wirtz
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110, Freiburg, Germany
| | - Gabriele Ihorst
- Clinical Trials Unit, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2, 79110, Freiburg, Germany
| | - JĂĽrgen Finke
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany
| | - Gerald Illerhaus
- Clinic of Hematology, Oncology and Palliative Care, Klinikum Stuttgart, KriegsbergstraĂźe 60, 70174, Stuttgart, Germany
| | - Elisabeth Schorb
- Department Medicine I, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter StraĂźe 55, 79106, Freiburg, Germany.
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MartĂn-Abreu CM, Hernández R, Cruz-Castellanos P, Fernández-Montes A, Lorente-EstellĂ©s D, LĂłpez-Ceballos H, Ostios-Garcia L, Antoñanzas M, JimĂ©nez-Fonseca P, GarcĂa-GarcĂa T, Calderon C. Dignity and psychosocial related variables in elderly advanced cancer patients. BMC Geriatr 2022; 22:732. [PMID: 36064353 PMCID: PMC9446795 DOI: 10.1186/s12877-022-03423-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Most cancers occur in older individuals, who are more vulnerable due to functional impairment, multiple comorbidities, cognitive impairment, and lack of socio-familial support. These can undermine patients' sense of dignity. This study seeks to compare dignity scores in older patients with advanced cancer on sociodemographic and clinical variables and analyze the predictive value of anxiety, depression, functional limitations, and social support on dignity scores. METHODS A prospective, multicenter, observational study conducted with participation of 15 hospitals in Spain from February 2020 to October 2021. Patients with newly-diagnosed, advanced cancer completed the dignity (PPDS), anxiety and depression (BSI), Social Support (Duke-UNC-11), and functional limitations (EORTC-C30) scales. Lineal regression analyses explored the effects of anxiety, depression, functional status, and social support on dignity, adjusting for sociodemographic and clinical variables. RESULTS A total of 180 subjects participated in this study. The results of the correlation analysis revealed that dignity correlated negatively with anxiety, depression, and sex, and positively with social support, functional status, and longer estimated survival. Thus, women, and more anxious and depressed individuals scored lower on the dignity scale, whereas patients with more social support, fewer functional limitations, and longer estimated survival scored higher. CONCLUSION In conclusion, being female, having a lower educational level, lower estimated survival, depression, anxiety, less social support, and limited functionality are correlated with less dignity in the elderly with advanced cancer. It is a priority to manage both physical and psychological symptoms in patients with unresectable advanced cancer to mitigate psychological distress and increase their sense of dignity.
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Affiliation(s)
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense - CHUO, Ourense, Spain
| | - David Lorente-Estellés
- Department of Medical Oncology, Hospital Provincial de CastellĂłn, CastellĂł de la Plana, Spain
| | | | | | - Mónica Antoñanzas
- Department of Medical Oncology, Hospital Universitario ClĂnico San Carlos, Madrid, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | | | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.
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Obispo B, Cruz-Castellanos P, Hernandez R, Gil-Raga M, González-Moya M, Rogado J, LĂłpez-Ceballos H, GarcĂa-Carrasco M, JimĂ©nez-Fonseca P, Calderon C. Perceived Dignity of Advanced Cancer Patients and Its Relationship to Sociodemographic, Clinical, and Psychological Factors. Front Psychol 2022; 13:855704. [PMID: 35693507 PMCID: PMC9177410 DOI: 10.3389/fpsyg.2022.855704] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Loss of dignity is one of the main reasons for wishing for an early death in patients with incurable diseases such as cancer and is strongly associated with psychological distress and loss of quality of life. The present study aims to analyze the perceived dignity of patients with advanced cancer undergoing systemic treatment and their relationship with sociodemographic, clinical, and psychological factors. Methods A prospective, cross-sectional, multicenter study was conducted in 15 oncology departments in Spain. Patients with locally advanced, unresectable, or metastatic cancer who were candidates for systemic treatment were included. Participants completed demographic information and Palliative Patients’ Dignity Scale, Brief Symptom Inventory, Mental Adjustment to Cancer, Functional Social Support Questionnaire, and Illness Uncertainty. Results A total of 508 patients were recruited between February 2020 and October 2021. Most were male, aged > 65 years, with digestive tumors (41%), and metastatic disease at diagnosis. Subjects were classified as having low (56%, N = 283) or high (44%, N = 225) perceived dignity. Patients ≥ 65 years, with worse baseline status (ECOG ≥ 1), and worse estimated 18-month survival had lower levels of perceived dignity. People with lower perceived dignity scored higher for anxious preoccupation and hopelessness and lower for positive attitude. They also displayed higher levels of anxiety, depression, and somatic symptoms, greater uncertainty, and less social support. Conclusion Self-perceived dignity in advancer cancer patients is significantly associated with psychological factors, psychological distress, uncertainty, less social support. Knowledge of these specific interactions is importance for adequate, comprehensive palliative care.
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Affiliation(s)
- Berta Obispo
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Raquel Hernandez
- Department of Oncology Medical, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Mireia Gil-Raga
- Department of Medical Oncology, Consorci Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Jacobo Rogado
- Department of Medical Oncology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Helena LĂłpez-Ceballos
- Department of Medical Oncology, Hospital San Pedro de Alcántara de Cáceres, Cáceres, Spain
| | | | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- *Correspondence: Caterina Calderon,
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Heyne S, Esser P, Geue K, Friedrich M, Mehnert-Theuerkauf A. Frequency of Sexual Problems and Related Psychosocial Characteristics in Cancer Patients-Findings From an Epidemiological Multicenter Study in Germany. Front Psychol 2021; 12:679870. [PMID: 34367002 PMCID: PMC8339199 DOI: 10.3389/fpsyg.2021.679870] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/28/2021] [Indexed: 12/21/2022] Open
Abstract
Background Multimodal cancer treatments are often associated with sexual problems. Identifying patients with sexual problems could help further elucidate serious issues with their sexuality and thus promote or maintain patients’ sexual health. We aimed to assess the occurrence of sexual problems in patients across different tumor locations and to explore associated sociodemographic, medical and psychosocial factors. Methods We included 3,677 cancer patients (mean age 58 years, age range 18–75 years, 51.4% women) from a large epidemiological multicenter study in Germany on average 13.5 months after cancer diagnosis. The occurrence and frequency of sexual problems were assessed via a binary item on the problem checklist of the Distress Thermometer (DT). Controlled associations of these problems with sociodemographic, medical and psychosocial factors including distress (DT), anxiety (GAD-7), depression (PHQ-9), quality of life (EORTC-QLQ-C30), and social support (SSUK-8) are analyzed using logistic regression analysis. Results We found that 31.8% of patients reported sexual problems, with a significant higher proportion in men (40.5%) compared to women (23.7%), OR 2.35, 95% CI [1.80–3.07] and a higher proportion in patients with a partner (35.6%) compared to those without a partner (3.5%), OR 2.83, 95% CI [2.17–3.70]. Tumor location was associated with occurrence of sexual problems: patients with cancer, affecting the male genital organs had the highest chance for sexual problems, OR 2.65, 95% CI [1.18–3.95]. There was no significant difference in the occurrence of sexual problems between age groups OR 0.99, 95% CI [2.13–3.53] and type of therapy (e.g., operation OR 0.91, 95% CI [0.72–1.15]). Sexual problems were further associated with elevated levels of anxiety, OR 1.05, 95% CI [1.02–1.10], less social support, OR 0.93, 95% CI [0.90–0.97] and lower quality of life in terms of impaired functioning (e.g., social function, OR 0.99, 95% CI [0.99–1.00]). Conclusions Sexual problems are commonly reported by patients. Male patients and those living with a partner are more likely to report sexual problems. Sexual problems are associated with different aspects of well-being. The findings imply the practical relevance to screen for sexual problems among patients and identified groups that should be particularly monitored.
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Affiliation(s)
- Svenja Heyne
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Peter Esser
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Kristina Geue
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Michael Friedrich
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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Xiao J, Ng MSN, Yan T, Chow KM, Chan CWH. How patients with cancer experience dignity: An integrative review. Psychooncology 2021; 30:1220-1231. [PMID: 33893677 DOI: 10.1002/pon.5687] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/19/2021] [Accepted: 03/22/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND A diagnosis of cancer and its treatments can be associated with a prominent issue of loss of dignity or an undermined sense of dignity for patients. Research is increasingly being conducted into how patients with cancer experience dignity, with the aim to build clinical foundations for care that preserves patients' sense of dignity. AIM This review summarises and synthesises the available empirical literature on the experience of dignity in patients with cancer regarding both the perception of dignity and associated factors. METHOD An integrative review method was used. A literature search was conducted in 11 databases using the search terms 'dignity' OR 'existential' OR 'existentialism' combined with 'cancer'. The Mixed Methods Appraisal Tool (version 2011) was adopted to appraise the methodological quality of the included studies. RESULTS Nine qualitative studies and 13 quantitative studies met the selection criteria and were included in the review. The ways that patients with cancer perceived dignity include autonomy/control, respect, self-worth, family connectedness, acceptance, hope/future and God/religious. Factors associated with dignity include demographics, physical and psychosocial distress, experiences of suffering and coping strategies. CONCLUSION Dignity-conserving care should respect patients' human autonomy to strengthen their sense of self-worth, acceptance, hope, reinforce family connectedness, and foster coping strategies to control the physical, psychosocial factors and experience of sufferings that threaten their sense of dignity.
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Affiliation(s)
- Jinnan Xiao
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China.,The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Marques S N Ng
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Tingting Yan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, SAR, China
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Philipp R, Mehnert-Theuerkauf A, Koranyi S, Härter M, Vehling S. The role of attachment avoidance: A longitudinal mediation model predicting existential distress in patients with advanced cancer. Psychooncology 2021; 30:1059-1067. [PMID: 33507601 DOI: 10.1002/pon.5640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time. METHODS We studied 206 patients with advanced cancer (mean age = 59.6, 61% female) participating in an intervention trial. Patients completed self-report measures for demoralization, anxiety, perceived relatedness, attachment insecurity, and death anxiety. Our mediated path model included perceived relatedness and death anxiety at baseline as predictors, attachment avoidance at baseline as mediator, and demoralization and anxiety at 6-month follow-up (N = 125) as outcomes. RESULTS Attachment avoidance partially mediated the relationship between death anxiety and demoralization (β = 0.07, 95% CI 0.02-0.12) and anxiety (β = 0.05, 95% CI 0.001-0.10). Findings for perceived relatedness were less conclusive. Its indirect effects through attachment avoidance were significant for both outcomes (demoralization: β = -0.07, 95% CI -0.13 to -0.02, anxiety: β = -0.05, 95% CI -0.11 to -0.003). CONCLUSIONS Due to its trait-like quality, attachment avoidance may play a less central role in explaining the course of existential distress over time than previous research indicated. Addressing change-sensitive relational concerns in psychosocial interventions may be more effective to alleviate existential distress.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Susan Koranyi
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Perceived relatedness, death acceptance, and demoralization in patients with cancer. Support Care Cancer 2019; 28:2693-2700. [DOI: 10.1007/s00520-019-05088-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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10
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Onken J, Goerling U, Heinrich M, Pleissner S, Krex D, Vajkoczy P, Misch M. Patient Reported Outcome (PRO) Among High-Grade Glioma Patients Receiving TTFields Treatment: A Two Center Observational Study. Front Neurol 2019; 10:1026. [PMID: 31681134 PMCID: PMC6797850 DOI: 10.3389/fneur.2019.01026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 09/10/2019] [Indexed: 01/05/2023] Open
Abstract
Study design: A two center, observational study. Introduction: Patient reported outcome (PRO) plays an increasingly important role in the evaluation of novel therapies for tumor patients. It has been shown that tumor treating fields (TTFields) in combination with standard therapy prolong survival in high-grade glioma (hgG) patients. But critics claim that TTFields significantly impacts patients' everyday life due to side effects and average daily time on therapy (18 h) in a patient population with very limited life expectancy and high symptom burden. However, very limited data exist on PRO for TTFields treatment. Methods: This two center, observational study describes PRO of 30 hgG patients receiving TTFields in combination with chemotherapy. We introduced a device-specific questionnaire (DSQ) addressing device-specific restrictions and impact on daily live after 2 months of therapy. Additionally following questionnaires were used: EORTC (European Organization for Research and Treatment of Cancer), QLQ-30 (Quality of life of cancer patients), QLQ BN20 (Quality of life brain cancer module), QLQ FA13 (Cancer-related fatigue), and SSUK-8 (social support). Results: Surveys have been completed by 91% of enrolled patients. EORTC QLQ-30 revealed better physical, emotional, and cognitive function than social and role function of study cohort. TTFields users reported frequently on positive social support and a low level of detrimental interactions. Seventy one percent of patients felt affected in daily life due to TTFields at least 2-3 times per week up to several times per day while maintaining high therapy compliance. Most frequent device-specific restrictions were duration of therapy (74%), size (66%), and weight (70%) of the device and changing time and bonding of the transducer arrays (66%, mean duration: 43.6 min). Restrictions on exercise of hobbies/work (63%/61%), body care (71%), and sexuality/relationship (64%) were most relevant. Seventy percent would recommend TTFields to others and 67% would reuse TTFields treatment again based on their current experience. Conclusion: The study shows that although TTFields treatment frequently affects everyday life in all aspects, therapy compliance was high and 67% of patients would reconsider TTFields for themselves. We propose that findings of PRO be taken into account for medical consultation about TTFields and in future device development to deliver high-value patient-centered care.
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Affiliation(s)
- Julia Onken
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Integrative Oncology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ute Goerling
- Psychooncology, Charité Comprehensive Cancer Center, Berlin, Germany
| | - Marcel Heinrich
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephanie Pleissner
- Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Dietmar Krex
- Department of Neurosurgery, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Misch
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
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11
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Hashemi BM, Sarabian S, Kashani Lotfabadi M, Hosseini S, Mohammadi A. The Effect of Spiritual Intelligence Training on Human Dignity in Patients with Cancer: Clinical Trial. ACTA ACUST UNITED AC 2019. [DOI: 10.30699/ajnmc.27.4.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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12
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Köhler M, Steinmann E, Maximilian Mehdorn H, Pedersen A, Goebel S. The importance of social relationships for brain tumor patients' quality of life: A case for the inclusion of the concept of disclosure in psycho-oncological care. J Psychosoc Oncol 2019; 38:310-327. [PMID: 31347472 DOI: 10.1080/07347332.2019.1642283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: Interpersonal factors are of major importance for cancer patients' physical and mental health. Brain tumor patients rank amongst those cancer patients with the highest psychosocial burden. Changes in language, cognition, and personality pose specific risk factors for impeding interpersonal functioning in this patient group. Despite this, role and relevance of social support including both supportive (e.g., emotional support) and detrimental interactions causing distress (e.g., critical remarks) are not well understood. Aims of this study were thus (1) to investigate the association of social support and patients' Health Related Quality of Life (HRQoL) and (2) to assess whether this relationship is mediated by the patients' disclosure behavior.Methods: Seventy-four ambulatory brain tumor patients (mean age 54 years; 58% women) completed the following self-report questionnaires: Illness-specific Social Support Scale (SSUK) for assessment of positive support and detrimental interactions, the Disclosure of Trauma Questionnaire (DTQ) for assessment of patients' disclosure behavior, and the Short-Form Health Survey (SF-8) for assessment of QoL.Findings: Detrimental social interactions were significantly related to patients' mental and physical well-being while positive support was not. Our results support a model in which patients perceiving detrimental social interactions show more difficulties in talking about illness-specific contents in a functional manner. This, in turn, was associated with a lower physical and mental HRQoL.Conclusions: This was the first study in which the close associations of detrimental social interactions, brain tumor patients' dysfunctional disclosure behavior and patients' mental as well as physical well-being were empiricially validated. Thus, dysfunctional disclosure behavior might pose a relevant therapeutic target when offering psycho-oncological support for brain tumor patients and their families.
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Affiliation(s)
- Martina Köhler
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany
| | - Elisabeth Steinmann
- Department of Neurosurgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Anya Pedersen
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany
| | - Simone Goebel
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Kiel, Kiel, Germany
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13
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Wang L, Wei Y, Xue L, Guo Q, Liu W. Dignity and its influencing factors in patients with cancer in North China: a cross-sectional study. ACTA ACUST UNITED AC 2019; 26:e188-e193. [PMID: 31043826 DOI: 10.3747/co.26.4679] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Patients with cancer experience various levels of loss of dignity. Exploring levels of loss of dignity and the factors that influence such losses for patients with cancer is rare, but important in palliative care in China. Methods Participants were cancer patients with early and advanced cancer recruited from a tertiary cancer hospital in North China. Patients were surveyed to assess their level of loss of dignity and potentially relevant factors. Data were collected using the Patient Dignity Inventory, the MD Anderson Symptom Inventory-Chinese, the distress thermometer, the Hospital Anxiety and Depression Scale, and the 30-question core Quality of Life Questionnaire from the European Organisation for Research and Treatment of Cancer, and were analyzed using quantitative methods. Results The study included 202 cancer patients, 143 of whom experienced mild loss of dignity (71%); 37, moderate loss of dignity (18%); and 10, severe loss of dignity (5%). The problems with dignity were slightly different in patients with early-stage disease than in those with advanced-stage disease. Loss of dignity in the patients was significantly correlated with psychological distress, symptom burden, and quality of life (p < 0.05). Logistic regression showed that age, Karnofsky performance status, anxiety, and symptom burden were significant predictors of loss of dignity. Conclusions Most patients with early and advanced cancer experienced some level of loss of dignity. Loss of dignity was more likely for patients of younger age, high Karnofsky performance status, high symptom burden, and anxiety. Understanding the dignity of cancer patients and potentially relevant factors is of great value for implementing comprehensive palliative care in China.
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Affiliation(s)
- L Wang
- Department of Medical Oncology, Fourth Hospital of Hebei Medical University, Hebei, P.R.C
| | - Y Wei
- Hebei General Hospital, Shijiazhuang, Hebei, P.R.C
| | - L Xue
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Palliative Care Center and Day Care, Peking University Cancer Hospital and Institute, Beijing, P.R.C
| | - Q Guo
- School of Nursing, Capital Medical University, Beijing, P.R.C
| | - W Liu
- Department of Medical Oncology, Fourth Hospital of Hebei Medical University, Hebei, P.R.C.,Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education-Beijing), Palliative Care Center and Day Care, Peking University Cancer Hospital and Institute, Beijing, P.R.C
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14
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Vehling S, Tian Y, Malfitano C, Shnall J, Watt S, Mehnert A, Rydall A, Zimmermann C, Hales S, Lo C, Rodin G. Attachment security and existential distress among patients with advanced cancer. J Psychosom Res 2019; 116:93-99. [PMID: 30655000 DOI: 10.1016/j.jpsychores.2018.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Felt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer. METHOD A mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance. RESULTS The prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = -0.54, 95%CI: -0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization. CONCLUSION Attachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals.
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Affiliation(s)
- S Vehling
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Y Tian
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - C Malfitano
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - J Shnall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - S Watt
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - A Mehnert
- Department of Medical Psychology and Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - A Rydall
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S Hales
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - C Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Canada
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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15
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Quintero Garzón L, Koranyi S, Engelmann D, Philipp R, Scheffold K, Schulz-Kindermann F, Härter M, Mehnert A. Perceived doctor-patient relationship and its association with demoralization in patients with advanced cancer. Psychooncology 2018; 27:2587-2593. [PMID: 29952046 DOI: 10.1002/pon.4823] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/27/2018] [Accepted: 06/12/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Advanced diseases pose a great burden on patients and go hand in hand with existential concerns. Demoralization is considered as a syndrome of existential distress with a perceived inability to cope with loss of meaning in life and feelings of helplessness and hopelessness. Professional health care providers play an important role in providing support for patients and unfavorable conversational styles in their relationship can increase patient's distress. In this study, we examine the association between the patient's perceived relationship to health care providers and demoralization. METHODS We used baseline data of a randomized control trial intervention study for advanced cancer patients (UICC-Stage ≥ III; PHQ ≥ 9 and/or Distress-Thermometer ≥5). We used a subscale of the QUAL-EC-P for assessing doctor-patient relationship, Beck Depression Inventory-II for depressive symptoms, a modified version of the MSAS as physiological symptom checklist, and the Demoralization Scale to assess demoralization. A hierarchical regression analysis was calculated. RESULTS In our sample of 187 patients with stage III or IV cancer (62% women), demoralization was present in 53.4% (16% moderate demoralization; 37.4% high demoralization) of the patients. Relationship to health care provider was an independent predictor (β = -.33, t(186) = -6.70, P < .001) of demoralization. CONCLUSIONS Our findings underline the importance of the physician-patient relationship in the context of coping with existential challenges in advanced cancer patients. Trainings on how to communicate and build a sustainable relationship with patients and their specific needs may increase the buffering effect of social support by the physicians on patient's existential distress.
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Affiliation(s)
- Leonhard Quintero GarzĂłn
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Susan Koranyi
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Dorit Engelmann
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
| | - Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Scheffold
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frank Schulz-Kindermann
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Mehnert
- Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany
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16
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Fischbeck S, Weyer-Elberich V, Zeissig SR, Imruck BH, Blettner M, Binder H, Beutel ME. Determinants of illness-specific social support and its relation to distress in long-term melanoma survivors. BMC Public Health 2018; 18:511. [PMID: 29665805 PMCID: PMC5904995 DOI: 10.1186/s12889-018-5401-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
Background Social support is considered to be one of the most important resources for coping with cancer. However, social interactions may also be detrimental, e. g. disappointing or discouraging. The present study explored: 1. the extent of illness-specific positive aspects of social support and detrimental interactions in melanoma survivors, 2. their relationships to mental health characteristics (e. g. distress, quality of life, fatigue, coping processes, and dispositional optimism) and 3. Combinations of positive social support and detrimental interactions in relation to depression and anxiety. Methods Based on the cancer registry of Rhineland-Palatinate, Germany, melanoma patients diagnosed at least 5 years before the survey were contacted by their physicians. N = 689 melanoma patients filled out the Illness-specific Social Support Scale ISSS (German version) and standardised instruments measuring potential psychosocial determinants of social support. Results Using principal component analysis, the two factor structure of the ISSS could be reproduced with acceptable reliability; subscales were “Positive Support” (PS) and “Detrimental Interactions” (DI); Cronbach’s α = .95/.72. PS was rated higher than DI. Multivariable linear regressions identified different associations with psychosocial determinants. Survivors living in a partnership and those actively seeking out support had a higher probability of receiving PS, but not DI. PS and DI interacted regarding their association with distress: Survivors reporting high DI but low PS were the most depressed and anxious. High DI was partly buffered by PS. When DI was low, high or low PS made no difference regarding distress. Conclusion Psycho-oncologic interventions should take into account both positive and negative aspects of support in order to promote coping with the disease.
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Affiliation(s)
- Sabine Fischbeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Psychology and Medical Sociology, University Medical Center of the Johannes Gutenberg-University Mainz, Saarstr 21, D-55099, Mainz, Germany.
| | - Veronika Weyer-Elberich
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | | | - Barbara H Imruck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Harald Binder
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.,Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Freiburg im Breisgau, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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17
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Existential distress and meaning-focused interventions in cancer survivorship. Curr Opin Support Palliat Care 2018; 12:46-51. [DOI: 10.1097/spc.0000000000000324] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Ho SSM, Kwong ANL, Wan KWS, Ho RML, Chow KM. Experiences of aromatherapy massage among adult female cancer patients: A qualitative study. J Clin Nurs 2017; 26:4519-4526. [PMID: 28252835 DOI: 10.1111/jocn.13784] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences towards aromatherapy massage use, and to examine the perceived benefits and adverse effects of aromatherapy massage among adult female cancer patients. METHOD A qualitative research design was used. Fifteen women with cancer were recruited for semi-structured interviews. Sample recruitment was undertaken through cancer self-help groups and referrals of a private aromatherapy clinic by convenience sampling. The interview data were analysed by thematic analysis. RESULTS All participants had a positive experience towards aromatherapy massage. The perceived benefits of aromatherapy massage included physical and psychological dimensions: overall comfort, relaxation, reduced pain, muscular tension, lymphoedema and numbness, improved sleep, energy level, appetite and mood. Interestingly, a few participants reported that aromatherapy massage helped to enhance self-acceptance and coping with their altered torso. No adverse effects were reported. The findings focused on four main themes that emerged: (i) an immediate effect that brings all-round comfort and reconnection to daily life; (ii) a pleasurable moment to forget the disease with aroma as a booster; (iii) a pampering experience of being cared for with a sense of dignity preserved; and (iv) communicating with the failing body. CONCLUSIONS This study contributed by providing a better understanding in aromatherapy massage from female cancer patients' perspective which adds to the existing body of knowledge. The implications for nursing practice, education and future research were suggested. RELEVANCE TO CLINICAL PRACTICE Aromatherapy massage seems to have both physical and psychological benefits for women with cancer. The findings elucidated a wide range of benefits that are perceived in such complex intervention, and the contextual factors that may influence these perceived benefits. This will inform future nurse-led quantitative research in the clinical setting. The study highlights the importance of touch towards a caring relationship and the provision of cancer care with a gender-specific approach. Exploring of the lived experience of aromatherapy massage and its meaning enables the healthcare professionals to gain insights into the needs, preferences and values for cancer care among female cancer population. While nurses play a crucial role in collaborating with cancer patients in the choice of CAM therapies, nurses should advise them to attend practising aromatherapists with recognised training and competency who should be members of aromatherapy professional associations. As aromatherapy is an unregulated profession, nurses may also advise oncology patients on the international guideline and institutional policies for aromatherapy massage use in the hospital setting. Nurses may broaden the caring repertoire by expanding their knowledge and skills in aromatherapy massage such as understanding the basic essential oils pharmacology, massage skills and therapy efficacy for symptoms management in cancer care. Oncology clinicians and nurses should support and guide patients' decision in the use of aromatherapy massage by providing evidence-based and comprehensive advice on the potential benefits, risks and related safety issues.
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Affiliation(s)
- Simone S M Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Alice N L Kwong
- Department of Child Education, Elderly and Community Services, Institute of Vocational Education (Shatin), Shatin, Hong Kong
| | - Karen W S Wan
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Rosita M L Ho
- RositaCares Clinical Aromatherapy & Nursing Services, RositaCares School of Clinical Aromatherapy, International Cosmetology & Health Training Institute, Kowloon, Hong Kong
| | - Ka Ming Chow
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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