The Relationship Between Authenticity and Death Anxiety in Cancer Patients

When meaning in life protects against fear of death: The moderating role of self-alienation

OBJECTIVE

A sense of meaning in life (MIL) is thought to help protect people against experiencing explicit anxiety about death. However, the experience of meaning is complex and subjective and may relate to death anxiety in nuanced ways. We examine how self-alienation-a feeling of not knowing/being disconnected from one's self-might moderate the relationship between MIL and death anxiety.

METHOD

Across five studies, we tested the hypothesis that MIL would negatively predict death anxiety more strongly for people relatively low in self-alienation. These studies were similar in design and included exploratory, confirmatory, and pre-registered tests.

RESULTS

A meta-regression across our five studies (N = 2001) provided clear evidence that MIL was most strongly associated with lower death anxiety at low self-alienation. We also observed that MIL was positively associated with death anxiety at high self-alienation. These effects were consistent in direction but inconsistent in strength.

CONCLUSIONS

We interpreted these results as evidence that MIL is existentially protective when experienced in combination with a relatively strong, clear, and connected sense of self. In contrast, MIL may be existentially problematic when people feel relatively unaware and disconnected from themselves. These findings align with aspects of terror management theory and highlight the potentially complex ways that MIL might relate to death anxiety.

Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis

OBJECTIVE

A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence.

DESIGN

This systematic review and meta-analysis followed the PRISMA 2020 guidelines.

METHODS

Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software.

RESULTS

In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs.

CONCLUSIONS

Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients.

RELEVANCE TO CLINICAL PRACTICE

Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals.

NO PATIENT OR PUBLIC CONTRIBUTION

This was a meta-analysis based on data from previous studies.

The effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer

OBJECTIVES

This study was conducted to determine the effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer.

METHODS

This cross-sectional and correlational study was conducted with 125 patients with cancer who were admitted to the oncology clinic of a university hospital in the Central Anatolian Region of Turkey between March and December 2022 and who met the research criteria and accepted to participate in the study. The data were collected with "Patient descriptive information form," "Brief Illness Perception Questionnaire (BIPQ)," "Scale of Death Anxiety (SDA)," and "Satisfaction with Life Scale (SWLS)."

RESULTS

It was found that mean BIPQ score of the patients was 39.54 ± 12.82, the mean SDA score was 8.02 ± 3.16, and the mean SWLS score was 14.74 ± 5.19. BIPQ total score was found to affect SDA total score positively (β = .751) and SWLS total score negatively (β = - .591). SDA total score was found to affect SWLS total score negatively (β = -.216) (p < .05).

SIGNIFICANCE OF RESULTS

It was found that patients with advanced gastrointestinal cancer had moderate level of illness perception and life satisfaction, and high death anxiety. It was found that as illness perception of the patients increased, their death anxiety increased and satisfaction with life decreased. In addition, it was found that as the death anxiety of patients increased, their satisfaction with life decreased.

The Relationship Between Spirituality and Religiosity with Death Anxiety Among Cancer Patients: A Systematic Review

This systematic review aimed to summarize the evidence regarding the relationship between spirituality and religiosity with death anxiety (DA) among cancer patients. This systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) checklist. An extensive search was conducted on electronic databases such as Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database (SID) via keywords extracted from Medical Subject Headings from the earliest to February 9, 2022. The quality of the included studies was assessed using the appraisal tool for cross-sectional studies (AXIS tool). Fifteen studies were selected for inclusion in this systematic review. Nine and six studies assessed the relationship between spirituality and religiosity with DA in cancer patients, respectively. Most studies had a negative relationship between spirituality (n = 8) and religiosity (n = 4) with DA. In sum, most studies showed that religion and spirituality are negatively related to DA in patients with cancer.

Nobody Likes the Forgotten Guardians of the Departed: A Critical Ethnographic Study on Social Isolation of Ghassals

In Islam, the ritual of burial including washing, shrouding and burying the dead body (Ghusl/Kafan/Dafan) has always been problematic. Burial in Iran has always been a well-ordered custom and there have always been specific people for this ritual (Ghassals). Due to dealing with the dead, their lives are always the focus of social discussions. Drawn on Carspecken's (1996) five-stage approach, this research examined the social isolation of Ghassals in Yazd province, Iran. The data were obtained through participant observation (first covert then overt) and in-depth interviews with six Ghassals in Yazd. The main themes extracted included stigma and isolation, the experience of hegemonic violence, problematic companionship/not companionship, forced choice, job dissatisfaction, and social discouragement. Our findings indicate an undesirable social status for the Ghassals who are often unwelcomed by the society and in some cases even by the family. These behaviors ultimately lead to social isolation and depression among Ghassals.

Does Spiritual Well-Being Affect Death Anxiety and Psychological Resilience in Cancer Patients?

This study was conducted to research the effects of spiritual well-being on death anxiety and psychological resilience in cancer patients. This cross-sectional, descriptive and correlational study was carried out with 260 cancer patients who were admitted to oncology and haematology outpatient clinic of a university hospital in east of Turkey between October 2021 and April 2022. The data were collected by using "Personal Information Form", "Spiritual Well-being Scale (FACIT-sp), Death Anxiety Scale (DAS) and The Brief Resilience Scale (BRS). It was found that mean DAS total score of cancer patients was 12.51 ± 3.39, while their mean FACIT-sp total score was 26.10 ± 6.93 and their mean BRS total score was 16.1 ± 7.05. It was found that FACIT-sp total score affected DAS and BRS total score positively, while DAS total score affected BRS total score negatively (p < .001). It was found that cancer patients had moderate level of spiritual well-being and psychological resilience and high level of death anxiety. It was also found that death anxiety and psychological resilience of cancer patients increased as their spiritual well-being levels increased. Psychological resilience was found to decrease as death anxiety increased.

Death anxiety among advanced cancer patients: a cross-sectional survey

PURPOSE

This study aimed to investigate death anxiety in advanced cancer patients and identify associated factors in the context of Chinese culture.

METHODS

Participants (N = 270) with advanced cancer in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of a Likert-type Templer-Death Anxiety Scale, Rosenberg's Self-esteem Scale, Medical Coping Modes Questionnaire, the Social Support Rating Scale, and Connor-Davidson Resilience Scale. Data were analyzed in SPSS using descriptive statistics, Student's t test, Pearson correlation test, and linear regression.

RESULTS

Respondents returned 252 (93.33%) of the 270 questionnaires. The total CL-TDAS score was 39.56 ± 10.20. The top three items were "I fear dying a painful death" (3.59 ± 1.41), "I often think about how shortly life really is" (3.11 ± 1.33), and "1 am not particularly afraid of getting cancer" (3.09 ± 1.35). Associated factors of death anxiety (R² = .333, F = 15.756, p < .001) were the medical coping mode (resignation, confronce), self-esteem, the participants' adult children, the patient-primary caregivers' relationship, resilience, and the level of activity of daily living.

CONCLUSIONS

Our results demonstrate high levels of death anxiety in advanced cancer patients. Generally, patients with adult children, high self-esteem and resilience had low death anxiety. Conversely, patients with low levels of activity of daily living and high coping mode (resignation, confrontation) reported high death anxiety. We determined that associated factors contributed to reduce death anxiety. Social interventions are recommended to improve the end-of-life transition for patients and caregivers.