Exploring demoralization in end-of-life cancer patients: Prevalence, latent dimensions, and associations with other psychosocial variables

Abstract

ObjectiveDemoralization is an existential distress syndrome that consists of an incapacity of coping, helplessness, hopelessness, loss of meaning and purpose, and impaired self-esteem. It can affect cancer patients, and the Demoralization Scale is a valid instrument to assess it. The present study aimed to investigate the prevalence of demoralization in end-of-life cancer patients and its associations with the medical and psychosocial variables. In addition, the latent dimensions of demoralization emerging in this distinctive population were explored.MethodThe study is cross-sectional. The sample consisted of 235 end-of-life cancer patients with a Karnofsky performance status (KPS) lower than 50 and a life expectancy of a few weeks. For each patient, personal and medical data was gathered by a palliative physician and a set of validated rating scales, assessing demoralization, anxiety, depression, physical symptoms, pain, spiritual well-being, and dignity, was administered by a psychologist during the first consultation.ResultSixty-four participants (27.2%) had low demoralization, 50.2% (n = 118) had medium demoralization, and 22.6% (n = 53) had high demoralization. Factor analysis evidenced a five-factor solution that identified the following demoralization factors: Emotional Distress and Inability to Cope, Loss of Purpose and Meaning, Worthlessness, Sense of Failure, and Dysphoria. All the considered variables were associated with demoralization, except for pain, nausea, breathing problems, and sociodemographic and clinical variables.Significance of resultsEnd-of-life cancer patients showed higher levels of demoralization than has been reported in other studies with advanced cancer. These data could suggest that demoralization could increase in proximity to death and with impaired clinical condition. In particular, the five demoralization dimensions that emerged could represent the typical concerns around which the syndrome evolves in end-of-life cancer patients. Finally, spiritual well-being could play a protective role with respect to demoralization.

Personality matters: relationship between personality characteristics, spirituality, demoralization, and perceived quality of life in a sample of end-of-life cancer patients

“…In recent years, the study of demoralization has arisen as a result of the increasing interest in this syndrome as a relevant clinical dimension in cancer patients [1,2]. Demoralization is defined as an existential syndrome characterized by feelings of helplessness and hopelessness, a reduced ability to cope, impaired self-esteem, and a loss of purpose and meaning in life [3][4][5].…”

“…Demoralization typically arises from events or situations such as chronic, medical diseases or psychiatric disorders. In such critical moments, the subjective feeling of inability to cope adequately with the event leads the person to perceive him/herself as blocked and unable to react [2,5,6]. Many studies on the demoralization syndrome are focused on end-of-life patients and on their experience of disease as a life-threatening or a life-limiting in this regard [2,7].…”

“…In such critical moments, the subjective feeling of inability to cope adequately with the event leads the person to perceive him/herself as blocked and unable to react [2,5,6]. Many studies on the demoralization syndrome are focused on end-of-life patients and on their experience of disease as a life-threatening or a life-limiting in this regard [2,7]. Furthermore, it is well documented that this syndrome has a negative impact on patients' quality of life [8,9].…”

Dignity Therapy Helps Terminally Ill Patients Maintain a Sense of Peace: Early Results of a Randomized Controlled Trial

“…There is strong evidence of associations between demoralization and depression, anxiety, physical symptoms, low quality of life, and desire for hastened death ( Robinson et al, 2015 ; Julião et al, 2016 ). Demoralization was also associated with dignity-related distress and lower spiritual well-being ( Bovero et al, 2019 ). It is worth noting, however, that demoralization is treatable ( Griffith and Gaby, 2005 ) with a variety of interventions, including meaning-centered therapy and DT ( Kissane, 2014 ).…”

Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial

“…Engaging in life while facing impending mortality is a paradoxical phenomenon that has been termed “double awareness” [ 1 ]. The failure to accomplish this task in the context of advanced cancer, may lead to adverse psychological consequences including depression, severe death anxiety, demoralization, and existential distress [ [2] , [3] , [4] , [5] , [6] ]. In that regard, clinically significant depression has been reported in 16%–25% patients with advanced cancer, a three-fold higher prevalence than in the general population [ 7 , 8 ].…”