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Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model
Author(s) -
Vehling Sigrun,
Mehnert Anja
Publication year - 2014
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.3417
Subject(s) - dignity , distress , clinical psychology , existentialism , cancer , mediation , psychology , medicine , psychological intervention , psychiatry , philosophy , epistemology , political science , law
Background Demoralization is a syndrome of existential distress that occurs in a substantial minority of cancer patients and is associated with a higher number of physical problems. Loss of dignity refers to a range of specific existential concerns. This study examines whether the association between number of physical problems and demoralization is mediated by loss of dignity. Methods This cross‐sectional study examined N = 112 inpatients with mixed tumor sites at early and advanced disease stages using the following standardized self‐report questionnaires: Physical problems list of the National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), Patient Dignity Inventory (PDI), Demoralization Scale (DS), Patient Health Questionnaire‐9 (PHQ‐9) and Illness‐Specific Social Support Scale Short Version‐8 (ISSS‐8). The mediation hypothesis was tested by multiple regression analyses controlling for age, gender, curative versus palliative treatment phase, and social support. Results Patients reported M = 4.7 (SD = 6.0) dignity‐related problems; 20% showed moderate to severe demoralization. Loss of dignity significantly mediated 81% of the effect of the number of physical problems on demoralization (Sobel z s = 4.4, p < .001). Testing the reverse direction, we found that demoralization mediated only 53% of the association between physical problems and loss of dignity ( z s = 3.7, p < .001). Conclusions By supporting the mediation hypothesis, our results indicate that loss of dignity partially explains the association between physical problems and demoralization. Early recognition of dignity‐related existential concerns and interventions to enhance the sense of dignity may prevent demoralization in patients with cancer. Results provide a conceptual link between existential concerns (loss of dignity) and existential distress (demoralization) as two approaches to existential suffering in patients with cancer. Copyright © 2013 John Wiley & Sons, Ltd.