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

Published online by Cambridge University Press:  14 June 2019

Andrea Bovero Open the ORCID record for Andrea Bovero [Opens in a new window] ,
Rossana Botto ,
Beatrice Adriano ,
Marta Opezzo ,
Valentina Tesio  and
Riccardo Torta
Andrea Bovero
Affiliation:
Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) “Città della Salute e della Scienza” Hospital, Turin, Italy
Rossana Botto*
Affiliation:
Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) “Città della Salute e della Scienza” Hospital, Turin, Italy
Beatrice Adriano
Affiliation:
Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) “Città della Salute e della Scienza” Hospital, Turin, Italy
Marta Opezzo
Affiliation:
Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) “Città della Salute e della Scienza” Hospital, Turin, Italy
Valentina Tesio
Affiliation:
Department of Psychology, University of Turin, Turin, Italy
Riccardo Torta
Affiliation:
Clinical Psychology and Psycho-Oncology Unit, Department of Neuroscience, University of Turin, Azienda Ospedaliera Universitaria (A.O.U.) “Città della Salute e della Scienza” Hospital, Turin, Italy
*
Author for correspondence: Rossana Botto, Clinical Psychology and Psycho-Oncology Unit, A.O.U. “Città della Salute e della Scienza,” Corso Bramante n. 88 10126, Torino, Italy. E-mail: [email protected]
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Abstract

Objective

Demoralization 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.

Method

The 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.

Result

Sixty-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 results

End-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.

Keywords

DemoralizationEnd-of-life patientsCancerPalliative care
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 5 , October 2019 , pp. 596 - 603
Copyright
Copyright © Cambridge University Press 2019 

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