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Wang C, Deng Y, Yao Y, Tan H. Demoralization syndrome in burn patients: A cross-sectional study. Burns 2024; 50:1640-1651. [PMID: 38555238 DOI: 10.1016/j.burns.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/08/2024] [Accepted: 02/21/2024] [Indexed: 04/02/2024]
Abstract
AIMS To investigate the status of demoralization syndrome and the factors affecting demoralization in burn patients. METHODS This study employed a cross-sectional research design and utilized a face-to-face questionnaire to gather data from adult burn patients with burn depths classified as second-degree or higher. The Demoralization Scale Mandarin Version, the Perceived Social Support Scale, the Herth Hope Index, and the Medical Coping Method Questionnaire were used to assess the level of demoralization, perceived social support, sense of hope, and coping strategies, respectively. General information, including socio-demographic data and disease characteristics, were collected. The patients' level of demoralization was categorized as the mean ± 1 standard deviation of the DS-MV scores. The data was analyzed using IBM SPSS 26.0 software to explore the relationship between the variables. RESULTS This study included 381 burn patients with a mean DS-MV score of 34.62 ± 18.319. Of these, 66 (17.3%) had mild demoralization, 241 (63.3%) had moderate demoralization, and 74 (19.4%) had severe demoralization. Cause of burn, total burn area, average monthly income of the individual, occupation, sense of hope, perceived social support, and medical coping strategies were the important factors associated with the severity of demoralization in burn patients. CONCLUSIONS Patients with burn injuries exhibit a notable prevalence and severity of demoralization indicating focused attention. By considering associated risk factors, healthcare professionals can devise and execute tailored intervention strategies aimed at mitigating the occurrence and intensity of demoralization in burn patients.
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Affiliation(s)
- Chang Wang
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China
| | - YunYun Deng
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China
| | - YiMing Yao
- Department of Nursing, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfu Middle Road, Haizhu District, Guangzhou, China
| | - HuiYi Tan
- School of Nursing, Guizhou Medical University, No. 9 Beijing Road, Yunyan District, Guiyang, China; Department of Nursing, Guangzhou Red Cross Hospital, Jinan University, No. 396, Tongfu Middle Road, Haizhu District, Guangzhou, China.
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Ernst M, Schwinn T, Hirschmiller J, Cleare S, Robb KA, Brähler E, Zwerenz R, Wiltink J, O'Connor RC, Beutel ME. To what extent are psychological variables considered in the study of risk and protective factors for suicidal thoughts and behaviours in individuals with cancer? A systematic review of 70 years of research. Clin Psychol Rev 2024; 109:102413. [PMID: 38518584 DOI: 10.1016/j.cpr.2024.102413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 11/29/2023] [Accepted: 03/08/2024] [Indexed: 03/24/2024]
Abstract
Psychological variables substantially shape the risk of suicidal thoughts and behaviours (STBs). However, it is unclear to what extent they are considered in individuals with cancer. We synthesized the quantitative research landscape concerning psychological risk/protective factors of STBs in the (psycho-) oncological context. This pre-registered review (PROSPERO-ID CRD42022331484) systematically searched the databases PubMed/Medline, CINAHL, PsycInfo, Cochrane Library, and Web of Science (as well as the grey literature and preprints). Risk of bias (RoB) was estimated using the ROBINS-I tool. Of 11,159 retrieved records, 319 studies were eligible for inclusion. Of those, 163 (51.1%) had investigated psychological factors (affective: n = 155; social: n = 65; cognitive: n = 63; personality/individual differences: n = 37; life events: n = 6), in a combined 3,561,741 participants. The most common STBs were suicidal ideation (n = 107) or death wishes (n = 20) rather than behaviour (suicide deaths: n = 26; attempts: n = 14). Most studies had a serious RoB. Thus, a large body of research investigated STBs in cancer patients/survivors, but it rarely aligned with the theoretical or clinical developments in suicide research. We propose a conceptual model of STBs in cancer delineating moderation and mediation effects to advance the integration of the fields, and to inform future research and practice.
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Affiliation(s)
- Mareike Ernst
- Department of Clinical Psychology, Psychotherapy and Psychoanalysis, Institute of Psychology, University of Klagenfurt, Klagenfurt am Wörthersee, Austria; Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom; Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| | - Tamara Schwinn
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Judith Hirschmiller
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Seonaid Cleare
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Kathryn A Robb
- Cancer Behaviour Research Group, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany; Department of Medical Psychology and Medical Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Xu G, Zheng J, Lin X, Wu H, Yang S, Xiao H, Lin X. Existential distress and associated factors in advanced cancer patients: A cross-sectional study. Palliat Support Care 2024:1-8. [PMID: 38362710 DOI: 10.1017/s147895152400018x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
BACKGROUND Advanced cancer patients often experience existential distress (ED). However, the factors associated with ED remain unclear. This study investigated the current state of ED and identified the associated factors in Chinese patients with advanced cancer. METHODS A cross-sectional study was conducted among 352 advanced cancer patients from 3 tertiary hospitals in Fujian, China. Participants were invited to complete the Existential Distress Scale, Number Rating Scale, Self-Perceived Burden Scale, Quality of Life Concerns in the End-of-Life Questionnaire, and Hospital Anxiety and Depression Scale. OBJECTIVES This study aimed to investigate the level of existential distress among advanced cancer patients in China and identify the associated factors. RESULTS A total of 352 advanced cancer patients were recruited for this study. The average score for ED was 8.48 ± 7.12 among the advanced cancer patients. Multiple regression showed that the associated factors included depression (β = 0.32, p = 0.000), self-perceived burden (SPB) (β = 0.18, p = 0.001), the presence of a spouse (β = -0.10, p = 0.050), and reception of government subsidies (β = 0.17, p = 0.001). The factors accounted for 30.1% of the total variance in ED (F = 8.472, p < 0.001). SIGNIFICANCE OF RESULTS Among the advanced cancer patients queried, ED was found to be positively influenced by depression, SPB, and reception of government subsidies and negatively influenced by the presence of a spouse. Depression was the most important risk factor, and thus future ED interventions should target depression.
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Affiliation(s)
- Guiru Xu
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Jianwei Zheng
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaodan Lin
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hong Wu
- Fujian Provincial Hospice, Fuzhou, China
| | - Shangwang Yang
- Department of Oncology, Affiliated Rehabilitation Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China
| | - Huimin Xiao
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Xiaoyan Lin
- Department of Oncology, Fujian Medical University Union Hospital, Fuzhou, China
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Dong L, Li L, Wu Y, Zhao X, Zhong H, Cheng X, Liu L, Cheng C, Ouyang M, Tao L. A Systematic Review of Interventions for Demoralization in Patients with Chronic Diseases. Int J Behav Med 2024:10.1007/s12529-024-10262-w. [PMID: 38316668 DOI: 10.1007/s12529-024-10262-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Demoralization, a significant mental health concern in patients with chronic diseases, can have a large impact on physical symptom burden and quality of life. The present review aimed to evaluate the effectiveness of interventions for demoralization among patients with chronic diseases. METHOD PubMed, Scopus, Embase, and Web of Science were systematically searched. Research on providing interventions to patients with chronic diseases that included quantitative data on demoralization was then systematically reviewed. RESULTS Fourteen studies were included, most of which considered demoralization as a secondary outcome. Interventions included evidence-based meaning-centered psychotherapy, dignity therapy, psilocybin-assisted psychotherapy, and others. Ten studies used randomized controlled designs. Six of these investigated evidence-based meaning-centered therapy, and four investigated dignity therapy, showing the best empirical support for these intervention types. Most studies showed significant impacts on demoralization in patients with chronic diseases. CONCLUSION This systematic review provides insights into potential psychological interventions for reducing demoralization in patients with chronic diseases. Randomized controlled designs and adequately powered samples, with demoralization as the primary outcome, are needed to more clearly evaluate its effectiveness.
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Affiliation(s)
- Li Dong
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Li Li
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Yunlian Wu
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Xiaoling Zhao
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Hui Zhong
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Xi Cheng
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Lixia Liu
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Changxia Cheng
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Mingqiu Ouyang
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China
| | - Liande Tao
- Department of Nursing, The Second People's Hospital of Yibin, Yibin, 644000, China.
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Wang Y, Sun H, Ji Q, Wu Q, Wei J, Zhu P. Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review. Am J Hosp Palliat Care 2023; 40:1216-1230. [PMID: 36718669 DOI: 10.1177/10499091231154887] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Demoralization has been extensively studied in oncology and palliative care settings, and is characterized by a loss of meaning and purpose in life, a sense of powerlessness over life events, and a sense of helplessness. The objective of this systematic review is to synthesize the prevalence, associated factors, and adverse outcomes of demoralization in cancer patients by reviewing the literature of the last decade. Seven databases (PubMed, PsycINFO, Embase, Web of Science, Medline, CINAHL and Cochrane Library databases) were systematically searched from January 2012 to June 2022. Roughly speaking, the prevalence of demoralization in cancer patients ranges from 13.50% to 49.4%. A total of 45 factors are associated with demoralization, of which psychological factors have been studied more frequently in the last decade. There are nine outcomes related to demoralization, with the strongest evidence for the correlation between demoralization and suicidal ideation. The study emphasizes the complexity of factors associated with demoralization in cancer patients. There appears to be a intersection between the constructs of demoralization and depression, anxiety, and suicidal ideation, which may explain the correlation between them.
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Affiliation(s)
- Yuejuan Wang
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Haichao Sun
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qiaoying Ji
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Qiwei Wu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
| | - Jinrong Wei
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
- Department of Nursing, Yangzhou Hospital of Traditional Chinese Medicine, Yangzhou, China
| | - Pingting Zhu
- School of Nursing and Public Health, Yangzhou University, Yangzhou, China
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Garcia ACM, Schneiders M, da Mota KS, da Conceição VM, Kissane DW. Demoralization and spirituality in oncology: an integrative systematic review. Support Care Cancer 2023; 31:259. [PMID: 37052721 DOI: 10.1007/s00520-023-07722-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 04/01/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE To synthesize the scientific findings on demoralization and spirituality in the oncology context. METHODS This is an integrative systematic review, in line with the PRISMA 2020 guidelines, as proposed by Whittemore and Knalf (2005). The MEDLINE via PubMed, Scopus, Web of Science, APA PsycNet, CINAHL, Cochrane Library, EMBASE, and LILACS databases were searched without limitations regarding language or year of publication. The studies were screened for inclusion according to the predefined eligibility criteria. Data extraction and evidence quality assessment were performed. RESULTS Out of the 1587 articles evaluated, 10 studies were included in this review. In general, it was found that demoralization tends to increase with the proximity of death and seems to be inversely related to spirituality, with spiritual well-being being a protective factor against demoralization, while the non-fulfillment of spiritual needs is related to increased demoralization in people with cancer. Furthermore, even among caregivers of people with advanced cancer, demoralization seems to be associated, among other factors, with spiritual suffering. These results should be analyzed with caution, considering that the studies included in this review are all observational studies, which prevents establishing cause and effect relationships. CONCLUSIONS Demoralization tends to increase with growing frailty and the proximity of death in people with cancer, and it seems to be inversely related to spirituality, both in these patients and in their caregivers.
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Affiliation(s)
- Ana Cláudia Mesquita Garcia
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil.
| | - Milena Schneiders
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil
| | - Kárita Santos da Mota
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, Brazil
| | - Vander Monteiro da Conceição
- Interdisciplinary Center for Studies in Palliative Care, School of Nursing, Federal University of Alfenas (UNIFAL-MG), Gabriel Monteiro da Silva Street, 700, Centro, Alfenas, MG, 37130-001, Brazil
- Department of Nursing, Federal University of Fronteira Sul, Chapecó, Brazil
| | - David W Kissane
- University of Notre Dame, Sydney, Australia
- Cunningham Centre, St Vincent's Hospital, Sydney, Australia
- Szalmuk Family Psycho Oncology Research Unit, Cabrini Health and Monash Partner's Comprehensive Cancer Centre, Melbourne, Australia
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Sarode GS, Sengupta N, Yuwanati M, Gondivkar S, Gadbail A, Upadhyay P, Sarode SC. Perspective on the risk of suicide associated with oral cancer diagnosis. Future Oncol 2022; 18:3863-3865. [PMID: 36346066 DOI: 10.2217/fon-2022-0991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Gargi S Sarode
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
| | - Namrata Sengupta
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
| | - Monal Yuwanati
- Saveetha Dental College & Hospitals, Saveetha Institute of Medical & Technical Sciences, Saveetha University, Chennai, 600077, India
| | - Shailesh Gondivkar
- Department of Oral Medicine & Radiology, Government Dental College & Hospital, Nagpur, Maharashtra, India
| | - Amol Gadbail
- Department of Dentistry, Indira Gandhi Government Medical College & Hospital, Nagpur, Maharashtra, India
| | - Prashit Upadhyay
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
| | - Sachin C Sarode
- Department of Oral Pathology & Microbiology, Dr. D. Y. Patil Dental College & Hospital, Dr. D. Y. Patil Vidyapeeth, Sant-Tukaram Nagar, Pimpri, Pune, Maharashtra, 411018, India
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Chang TG, Hung CC, Huang PC, Hsu CY, Yen TT. Demoralization and Its Association with Quality of Life, Sleep Quality, Spiritual Interests, and Suicide Risk in Breast Cancer Inpatients: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912815. [PMID: 36232107 PMCID: PMC9566266 DOI: 10.3390/ijerph191912815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/03/2022] [Accepted: 10/05/2022] [Indexed: 05/16/2023]
Abstract
With decreasing mortality, the quality of life, spiritual needs, and mental health of breast cancer patients have become increasingly important. Demoralization is a poor prognostic factor for cancer patients. The extent of demoralization in breast cancer patients and its association with these factors remains unclear. This cross-sectional study was conducted at a Taiwanese medical center. We enrolled 121 participants (34 with high demoralization and 87 with low demoralization, as per the Mandarin Version of Demoralization Scale). High demoralization was associated with reduced quality of life, sleep quality, and spiritual interests. Multivariate analyses revealed that the scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire ≥ 62.5 (OR = 0.21, p = 0.002) and Spiritual Interests Related to Illness Tool Chinese Version ≥ 3.66 (OR = 0.11, p < 0.001) were associated with low demoralization. Demoralized patients with depression had a poorer quality of life and sleep quality. Although not statistically significant, depressed and demoralized participants were at a higher risk of suicide. Cancer patients with both depression and demoralization had the worst prognosis. Breast cancer patients exhibited demoralization when they had unmet bio-psycho-social-spiritual needs. An early assessment of demoralization may improve holistic healthcare for breast cancer patients.
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Affiliation(s)
- Ting-Gang Chang
- Department of Psychiatry, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- School of Psychology, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, College of Medicine, National Yung Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Chih-Chiang Hung
- Division of Breast Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- Department of Applied Cosmetology, College of Human Science and Social Innovation, Hungkuang University, Taichung 433304, Taiwan
| | - Pei-Ching Huang
- Cancer Prevention and Control Center, Taichung Veterans General Hospital, Taichung 407612, Taiwan
| | - Chiann-Yi Hsu
- Biostatistics Task Force, Taichung Veterans General Hospital, Taichung 407612, Taiwan
| | - Ting-Ting Yen
- School of Medicine, College of Medicine, National Yung Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Otorhinolaryngology, Taichung Veterans General Hospital, Taichung 407612, Taiwan
- Correspondence: ; Tel.: +886-23592525
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Tang PL, Lin HS, Wang HH, Hu LY, Chou FH. Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study. BMC Palliat Care 2022; 21:143. [PMID: 35948925 PMCID: PMC9364497 DOI: 10.1186/s12904-022-01033-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/02/2022] [Indexed: 12/04/2022] Open
Abstract
Background Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. It is affected by national characteristics, culture, disease characteristics and general conditions of the patient such as individual cultural features, nature of stress, personal expression preferences and social behavior. Compared with the results of previous studies on demoralization syndrome, patients with cancer in Taiwan exhibit a higher prevalence of demoralization. We aimed to investigate the prevalence of high demoralization and the changes in the level of demoralization in cancer patients during radiotherapy to explore the associated factors and the contributing factors to the high level of demoralization. Methods We used the Demoralization Scale-Mandarin Version to evaluate the demoralization level at six-time points in patients admitted for radiotherapy in a 3-month observational period. 101 patients allocated to three groups by cancer region completed the study. We applied the generalized estimating equation (GEE) to analyze the changes in the demoralization level among the three groups. The variables associated with the changes in the demoralization level were also investigated. Results In the analysis using univariate GEE, only patients in the chest and breast group exhibited significant changes at two different time points. The results obtained using multivariate GEE revealed that sociodemographic variables, stage of disease and use of surgery or chemotherapy had no impact on the changes in demoralization across three months. Conclusion The demoralization level certainly fluctuated in an extremely high range. The higher prevalence of demoralized patients may indicate that if medical staff neglect the importance of demoralization, demoralized patients with cancer may not receive appropriate care.
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Affiliation(s)
- Pei-Ling Tang
- Research Center of Medical Informatics, Kaohsiung Veterans General Hospital, 386, Dazhong 1st Rd., Zuoying Dist., Kaohsiung City, 813414, Taiwan (ROC).,School of Nursing, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC).,School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC)
| | - Huey-Shyan Lin
- Department of Health-Business Administration, Fooyin University, 151 Jinxue Rd., Daliao Dist., Kaohsiung City, 83102, Taiwan (ROC)
| | - Hsiu-Hung Wang
- School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC)
| | - Li-Yu Hu
- Department of Psychiatry, Taipei Veterans General Hospital, 201, Sec.2, ShihPai Rd., Beitou District., Taipei City, 11217, Taiwan (ROC).,Division of Psychiatry, National Yang-Ming University, 155, Sec.2, Linong St., Beitou District, Taipei City, 11221, Taiwan (ROC)
| | - Fan-Hao Chou
- School of Nursing, Kaohsiung Medical University, 100, Shin-Chuan 1st Road, Sanmin Dist., Kaohsiung City, 80708, Taiwan (ROC).
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