Relations of perceived injustice to psycho‐spiritual outcomes in advanced lung and prostate cancer: Examining the role of acceptance and meaning making

Abstract

Objective: Many advanced cancer patients struggle with anxiety, depressive symptoms, and anger toward God and illness-related stressors. Patients may perceive their illness as an injustice (i.e., appraise their illness as unfair, severe, and irreparable or blame others for their illness), which may be a risk factor for poor psychological and spiritual outcomes. This study examined relations between cancer-related perceived injustice and psycho-spiritual outcomes as well as potential mediators of these relationships.Methods: Advanced lung (n = 102) and prostate (n = 99) cancer patients completed a one-time survey. Using path analyses, we examined a parallel mediation model including the direct effects of perceived injustice on psycho-spiritual outcomes (i.e., anxiety, depressive symptoms, anger about cancer, anger towards God) and the indirect effects of perceived injustice on psycho-spiritual outcomes through two parallel mediators: meaning making and acceptance of cancer. We then explored whether these relations differed by cancer type.Results: Path analyses indicated that perceived injustice was directly and indirectlythrough acceptance of cancer but not meaning making-associated with psychospiritual outcomes. Results did not differ between lung and prostate cancer patients.Conclusions: Advanced cancer patients with greater perceived injustice are at higher risk for poor psycho-spiritual outcomes. Acceptance of cancer, but not meaning making, explained relationships between cancer-related perceived injustice and psycho-spiritual outcomes. Findings support testing acceptance-based interventions to address perceived injustice in advanced cancer patients.

Peace, Equanimity and Acceptance in the Cancer Experience: Validation of the German version (PEACE-G) and associations with mental health, health-related quality of life and psychological constructs

“…The high correlations between PA and SwI with psychological symptoms, HRQoL, resilience, psychological exibility, and mindfulness, underline the importance of acceptance for mental health and HRQoL. These results are in line with previous studies showing the importance of acceptance of cancer for mental health in patients with cancer [35].…”

“…Our ndings imply that perceived injustice and anger might not be related to SwI, as measured by other items like concerns about physical appearance. A recent study found negative associations between perceived injustice and cancer acceptance and positive associations with psychosocial outcomes, including depression, anxiety, and anger [35]. In their model, the association between perceived injustice and psychosocial outcomes was mediated by acceptance (not meaning making), suggesting that acceptance is the central mediating process in this adjustment process.…”

Correlation of death anxiety with coping strategies among Palestinian women with breast cancer: a cross-sectional study

“…Furthermore, distressed cancer patients frequently blame God, causing intense rage toward God and potentially increasing their death anxiety ( 45 ). Other studies, however, found a negative correlation between religion and death anxiety ( 49 ). Many other studies in the literature review ( 17 , 50 ) focused on religion's role in reducing death anxiety in breast cancer patients.…”

Perceived injustice: a historical and clinical review of a useful concept for psychiatry

“…10 In patients with advanced lung and prostate cancer, perceived injustice significantly affected symptoms of depression and anxiety along with anger towards the cancer and anger towards God. 11 In patients with mild traumatic brain injury, significant correlations were reported between perceived injustice and self-reported depressive, post-traumatic stress, pain and post-concussion symptoms. 12…”