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Michael N, Jones D, Kernick L, Kissane D. Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method study. BMJ Support Palliat Care 2024:spcare-2024-004946. [PMID: 38871403 DOI: 10.1136/spcare-2024-004946] [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: 04/27/2024] [Accepted: 05/15/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES We aimed to explore the relationship between the pursuit of voluntary assisted dying (VAD) and the delivery of quality palliative care in an Australian state where VAD was newly available METHODS: We adopted a retrospective convergent mixed-methods design to gather and interpret data from records of 141 patients who expressed an interest in and did or did not pursue VAD over 2 years. Findings were correlated against quality domains. RESULTS The mean patient age was 72.4 years, with the majority male, married/partnered, with a cancer diagnosis and identifying with no religion. One-third had depression, anxiety or such symptoms, half were in the deteriorating phase, two-thirds required help with self-care and 83.7% reported moderate/severe symptoms. Patients sought VAD because of a desire for autonomy (68.1%), actual suffering (57.4%), fear of future suffering (51.1%) and social concerns (22.0%). VAD enquiries impacted multiple quality domains, both enhancing or impeding whole person care, family caregiving and the palliative care team. Open communication promoted adherence to therapeutic options and whole person care and allowed for timely access to palliative care. Patients sought VAD over palliative care as a solution to suffering, with the withholding of information impacting relationships. SIGNIFICANCE OF RESULTS As legislation is expanded across jurisdictions, palliative care is challenged to accompany patients on their chosen path. Studies are necessary to explore how to ensure the quality of palliative care remains enhanced in those who pursue VAD and support continues for caregivers and staff in their accompaniment of patients.
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Affiliation(s)
- Natasha Michael
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
| | - David Jones
- Anscombe Bioethics Centre, Oxford, UK
- St Mary's University Twickenham, London, UK
| | - Lucy Kernick
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
| | - David Kissane
- Monash University Faculty of Medicine Nursing and Health Sciences, Melbourne, VIC, Australia
- Faculty of Medicine, University of Notre Dame, Australia, Sydney, NSW, Australia
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Mao S, Liu L, Miao C, Wang T, Chen Y, Jiang Z, Hua C, Li C, Cao Y. Electronic symptom monitoring for home-based palliative care: A systematic review. Palliat Med 2024:2692163241257578. [PMID: 38835179 DOI: 10.1177/02692163241257578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
BACKGROUND Coordination and communication challenges in home-based palliative care complicate transitions from hospital care. Electronic symptom monitoring enables real-time data collection, enhancing patient-provider communication. However, a systematic evaluation of its effectiveness in home-based palliative care is lacking. AIM To analyze the feasibility, effectiveness, and limitations of electronic symptom monitoring in home-based palliative care, assess the evidence quality, identify the evidence gap, and suggest implications for future research and practice. DESIGN This study uses systematic review, meta-analysis, and narrative synthesis (CRD42023457977) to analyze relevant studies until September 2023. DATA SOURCES Electronic searches in MEDLINE, CENTRAL, and Embase until September 2023, complemented by hand-searching of references and citations. RESULTS This study included twenty studies. The majority of patients positively engage in electronic symptom monitoring, which could improve their quality of life, physical and emotional well-being, and symptom scores without a significant increase in costs. However, firm conclusions about the effects of electronic symptom monitoring on outcomes like survival, hospital admissions, length of stay, emergency visits, and adverse events were limited due to significant variability in the reported data or inadequate statistical power. CONCLUSION Introducing electronic symptom monitoring in home-based palliative care holds potential for enhancing patient-reported outcomes, potentially decreasing hospital visits and costs. However, inconsistency in current studies arising from diverse monitoring systems obstructs comparability. To advance, future high-quality research should employ standardized follow-up periods and established scales to better grasp the benefits of electronic symptom monitoring in home-based palliative care.
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Affiliation(s)
- Suning Mao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Liu Liu
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Conservative Dentistry and Endodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Cheng Miao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Tianyi Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yue Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Orthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Zhishen Jiang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chengge Hua
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Dental Emergency and General Dentistry, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Chunjie Li
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Head and Neck Oncology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
| | - Yubin Cao
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China
- Department of Evidence-Based Stomatology, West China Hospital of Stomatology, Sichuan University, Chengdu, China
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Rodríguez-Prat A, Pergolizzi D, Crespo I, Julià-Torras J, Balaguer A, Kremeike K, Voltz R, Monforte-Royo C. The wish to hasten death in patients with life-limiting conditions. A systematic overview. J Pain Symptom Manage 2024:S0885-3924(24)00743-7. [PMID: 38703862 DOI: 10.1016/j.jpainsymman.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/07/2024] [Accepted: 04/21/2024] [Indexed: 05/06/2024]
Abstract
CONTEXT A systematic review of the wish to hasten death among people with life-limiting conditions was published in 2011. Since then, other reviews and primary studies have been published that have added to knowledge regarding the conceptual definition, aetiology and assessment of the wish to hasten death. OBJECTIVES To provide an updated synthesis of the literature on the wish to hasten death in people with life-limiting conditions. METHODS An overview of systematic reviews and primary studies was conducted, using an integrative review method. PubMed, CINAHL, Scopus and Web of Science databases were searched, from their inception until 2023. We included all systematic reviews published to date and all primary studies not included in these systematic reviews. RESULTS Eleven systematic reviews and 35 primary studies were included. We propose that the phenomenon may usefully be considered as existing along a continuum, defined by the extent to which thoughts of dying are linked to action. A total of nine assessment tools have been described. The reported prevalence of the wish to hasten death appears to be influenced by the wording used in assessment instruments, as well as by the cut-off used when applying a particular tool. Depression, pain, functional disability, decreased sense of meaning in life, the sense of being a burden and reduced quality of life are the most widely reported related factors. CONCLUSION This overview underscores the need for clinical strategies that can identify different manifestations of the wish to hasten death among people with life-limiting conditions.
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Affiliation(s)
- Andrea Rodríguez-Prat
- Faculty of Humanities, Universitat Internacional de Catalunya. Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona. Spain
| | - Iris Crespo
- Department of Psychology, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona, Spain
| | - Joaquim Julià-Torras
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona. Spain; Department of Palliative Care, Institut Català d'Oncologia Badalona, Badalona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain. Josep Trueta s/n, 08195 Sant Cugat del Vallès, Barcelona. Spain
| | - Kerstin Kremeike
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Cristina Monforte-Royo
- Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, Spain..
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Brown CK, Wallace CL. Psychosocial Distress Screening Among Interprofessional Palliative Care Teams: A Narrative Review. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:161-184. [PMID: 38652646 DOI: 10.1080/15524256.2024.2343052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
With increased need for palliative care and limited staffing resources, non-social workers are increasingly responsible for screening for urgent psychosocial distress. The National Consensus Project guidelines call for all palliative care team members to be competent in screening across domains. Yet, in contrast to an abundance of evidence-informed tools for palliative social work assessments, standardization for interprofessional psychosocial screening is lacking. This lack of standardized practice may lead to harmful disparities in care delivery. The purpose of this narrative review is to examine current literature on evidence-informed practices for psychosocial screening within palliative care. Google Scholar, a university Summon library search engine, and prominent palliative care journals were searched using the same phrases to locate articles for inclusion. Each article was reviewed and synthesized across common themes. Although an abundance of validated screening tools exists for outpatient oncology-specific settings, there is minimal guidance on psychosocial screening tools intended for specialty palliative care. The most oft-cited tools have been met with concern for validity across diverse palliative care populations and settings. Additional research is needed to operationalize and measure brief psychosocial screening tools that can be validated for use by interprofessional palliative care teams, a stepping-stone for increased equity in palliative care practice.
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Affiliation(s)
- Chelsea K Brown
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cara L Wallace
- Trudy Busch Valentine School of Nursing, Saint Louis University, St. Louis, Missouri, USA
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Kissane DW, Bobevski I, Appleton J, Murphy G, Laverty-Wilson A, Kessel P, Michael N, Chye R, Lethborg C. Meaning and Purpose (MaP) therapy in advanced cancer patients: a randomised controlled trial. Support Care Cancer 2023; 31:734. [PMID: 38051407 DOI: 10.1007/s00520-023-08189-1] [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: 08/07/2023] [Accepted: 11/14/2023] [Indexed: 12/07/2023]
Abstract
PURPOSE We aimed to examine the efficacy of Meaning and Purpose (MaP) Therapy in promoting posttraumatic growth and meaningful life attitudes (choices and goal seeking) in people living with advanced cancer. METHODS Patients with a prognosis ≥ 1 year were stratified across two sites and randomised to receive MaP therapy and regular oncology/palliative care (Intervention) or usual care (Control). They completed measures at baseline (t0), post-intervention (12 weeks, t1) and 12 weeks later (t2). Our primary outcome was posttraumatic growth (PTGI); secondary outcome measures included life attitudes (LAPR), spiritual wellbeing (FACIT-Sp), anxiety, demoralization and depression. TRIAL REGISTRATION NUMBER ACTRN12618001751268, 7 January 2019. RESULTS We consented 107 from 404 eligible patients (26.5%) and randomised 55 to MaP Invention (35 completing t1, 25 t2) and 52 to Control (32 completing t1, 25 t2). Fidelity of the intervention was sustained. PTGI mean scores were significantly higher post-intervention on analysis by covariance (Cohen's d = 0.7 at t1 & d = 0.5 at t2). Secondary measures were significant, including LAPR (d = 0.4) and FACIT-Sp (meaning subscale d = 0.4; total d = 0.4). Participants completing six sessions achieved more noteworthy effect sizes. CONCLUSION This brief, structured individual intervention shows promise for sustaining sense of coherence, meaning and choices in life despite living with advanced cancer.
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Affiliation(s)
- David W Kissane
- School of Medicine, University of Notre Dame Australia, Sydney, Australia.
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia.
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia.
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia.
| | - Irene Bobevski
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Jane Appleton
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Genevieve Murphy
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Anna Laverty-Wilson
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Pauley Kessel
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Natasha Michael
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Departments of Palliative Care, Cabrini Health, Melbourne, Australia
- School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia
| | - Richard Chye
- School of Medicine, University of Notre Dame Australia, Sydney, Australia
- Department of Palliative Care, St Vincent's Hospital Sydney, Sydney, Australia
| | - Carrie Lethborg
- Centre for Rural Health, University of Tasmania, Launceston, Australia
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Gibson Watt T, Gillanders D, Spiller JA, Finucane AM. Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review. Palliat Med 2023; 37:1100-1128. [PMID: 37489074 PMCID: PMC10503261 DOI: 10.1177/02692163231183101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging. AIMS To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care. DESIGN Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023. RESULTS 1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function. CONCLUSION Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.
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Affiliation(s)
- Tilly Gibson Watt
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
| | - David Gillanders
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
| | - Juliet A Spiller
- University of Edinburgh Medical School, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
| | - Anne M Finucane
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Scotland, UK
- Marie Curie Hospice Edinburgh, Edinburgh, Scotland, UK
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Kissane DW, Bobevski I, Appleton J, Michael N, King T, Moss G, Eng D, White A, Carboon D, Eade R, Keighley L. Real World Experience of Change in Psycho-Existential Symptoms in Palliative Care. J Pain Symptom Manage 2023; 66:212-220.e2. [PMID: 37290732 DOI: 10.1016/j.jpainsymman.2023.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 05/21/2023] [Accepted: 05/30/2023] [Indexed: 06/10/2023]
Abstract
CONTEXT Psycho-existential symptoms in palliative care are addressed insufficiently. Routine screening, ongoing monitoring and meaningful treatment of psycho-existential symptoms may contribute to the relief of suffering in palliative care. OBJECTIVES We sought to explore longitudinal change in psycho-existential symptoms following the routine implementation of the Psycho-existential Symptom Assessment Scale (PeSAS) in Australian palliative care services. METHODS Using a multisite rolling design, we implemented the PeSAS to longitudinally monitor symptoms in a cohort of 319 patients. We assessed change scores for each symptom in groups with mild (≤3), moderate (4-7) and severe (≥8) symptomatology at baseline. We tested significance between these groups and used regression analyses to identify predictors. RESULTS While one half of patients denied clinically important psycho-existential symptoms, for the remainder, overall, more patients improved than deteriorated. Between 20% and 60% of patients with moderate and severe symptoms improved, while another 5%-25% developed new symptom distress. Patients with severe baseline scores improved significantly more than those with moderate baseline scores. CONCLUSION As we better recognize through screening patients carrying psycho-existential distress in palliative care programs, there is considerable room for improvement in ameliorating this suffering. Inadequate clinical skills, poor psychosocial staffing or a biomedical program culture may all contribute to inadequate symptom control. Person-centered care necessitates greater attention to authentic multidisciplinary care that ameliorates psycho-spiritual and existential distress.
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Affiliation(s)
- David W Kissane
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; St. Vincent's Hospital (D.W.K., J.A.), Sydney, New South Wales, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia.
| | - Irene Bobevski
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia
| | - Jane Appleton
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; St. Vincent's Hospital (D.W.K., J.A.), Sydney, New South Wales, Australia
| | - Natasha Michael
- School of Medicine (D.W.K., I.B., J.A., N.M.), University of Notre Dame Australia, Fremantle, Australia; Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia; School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia
| | - Tania King
- Eastern Palliative Care (T.K.), Victoria, Australia
| | - Graham Moss
- Clare Holland House (G.M.), Canberra, New South Wales, Australia
| | - Derek Eng
- Royal Perth Hospital (D.E., A.W.), Perth, Australia
| | - Alison White
- Royal Perth Hospital (D.E., A.W.), Perth, Australia; St. John of God Murdoch Community Hospice (A.W.), Murdoch, WA, Australia
| | - Danielle Carboon
- School of Clinical Sciences (D.W.K., I.B., N.M., D.C.), Monash University, Victoria, Australia
| | - Rachel Eade
- Eastern Health (R.E.), Melbourne, Victoria, Australia
| | - Luka Keighley
- Cabrini Health (D.W.K., I.B., N.M., L.K.), Melbourne, Victoria, Australia
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The Demoralization Interview: Reliability and validity of a new brief diagnostic measure among medically ill patients. Gen Hosp Psychiatry 2022; 79:50-59. [PMID: 36274426 DOI: 10.1016/j.genhosppsych.2022.10.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Demoralization is a state of low morale and poor coping that is being increasingly recognized in stressful circumstances, such as illness. Meta-analyses show prevalence of 30% in the medically and 50% in the mentally ill. A brief structured diagnostic interview is needed to assess for and diagnose demoralization. METHODS The Demoralization Interview (DI) was designed from items of the Demoralization Scale-II (DS-II) and common items used in other clinical interviews. The resultant 26 items were administered to 264 patients with serious progressive medical illnesses, together with the DS-II, measures of depression, anxiety, and quality of life. Rasch analysis was used to co-calibrate the DI against the DS-II. Sensitivity, specificity, and area under the receiver operating characteristics curve (AUROC) were assessed. Concurrent validation was conducted against measures of anxiety, depression, and quality of life. RESULTS A 14-item Demoralization Interview (DI) with a diagnostic threshold of 6 symptoms generated sensitivity of 78.0%, specificity of 90.9%, and AUROC of 0.84 against the DS-II. Unidimensionality was indicated, with a Cronbach's alpha of 0.81. For respondents with 6 or more symptoms on the DI, 98% recognized a current stressor and 66% described significant distress or functional impairment. Demoralized respondents carried significantly lower quality of life, higher physical disability, and higher depressive and anxiety symptoms. CONCLUSIONS The DI has good reliability and validity, with a threshold of 6 symptoms supporting a diagnosis of demoralization. It could be used as a stand-alone diagnosis, or as a specifier for adjustment disorder or depression.
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