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Chen F, Ou M, Xiao Z, Xu X. The relationship between fear of cancer recurrence and death anxiety among Chinese cancer patients: the serial mediation model. BMC Psychiatry 2024; 24:416. [PMID: 38834978 DOI: 10.1186/s12888-024-05819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 05/06/2024] [Indexed: 06/06/2024] Open
Abstract
AIMS This study aims to investigate the association between fear of cancer recurrence (FCR) and death anxiety (DA) among Chinese cancer patients, while considering the mediating effects of experiential avoidance (EA) and meaning in life (MIL). METHODS From February to June 2023, convenience sampling was used to select newly diagnosed cancer patients in a tertiary Cancer Hospital in Chinese Hunan Province as the survey objects. A total of 436 cancer patients completed the Fear of Cancer Recurrence Inventory, the Meaning in Life Questionnaire, the Acceptance and Action Questionnaire-II, and the Templer's death anxiety scale. Descriptive analysis and Pearson correlation analysis were conducted using SPSS 28.0 software. Serial mediation analysis was performed by Hayes' PROCESS macro. RESULTS Gender, age, educational level, marital status, residence, occupation, per capita monthly household income, tumor type, and cancer stage were controlled in the model. The results revealed that fear of cancer recurrence had a significant direct effect on death anxiety (Effect = 0.075, 95% CI: 0.064 to 0.087). Additionally, three indirect pathways were identified: (1) through experiential avoidance (Effect = 0.037, 95% CI: 0.026 to 0.049), (2) through meaning in life (Effect = 0.022, 95% CI: 0.014 to 0.031), and (3) through the serial mediators involving meaning in life and experiential avoidance (Effect = 0.016, 95% CI: 0.010 to 0.023). The total indirect effect of the three mediation paths was 63.56%. CONCLUSION Fear of cancer recurrence is a significant psychological distress experienced by cancer patients, which not only directly contributes to death anxiety but also may triggers changes, such as experiential avoidance and meaning in life. Ultimately, this comprehensive psychological distress leads to death anxiety.
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Affiliation(s)
- Furong Chen
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
- School of Nursing, University of South China, Hengyang, Hunan, 421001, China
| | - Meijun Ou
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China
| | - Zhirui Xiao
- School of Nursing, University of South China, Hengyang, Hunan, 421001, China
| | - Xianghua Xu
- The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University/Hunan Cancer Hospital, Changsha, Hunan, 410013, China.
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Li Y, Dong W, Tang H, Guo X, Wu S, Lu G, Li X, Chen C. Correlates of death anxiety for patients with cancer: A systematic review and meta-analysis. J Clin Nurs 2024; 33:1933-1947. [PMID: 38284499 DOI: 10.1111/jocn.17021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/24/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
OBJECTIVE A systematic review and meta-analysis was performed to identify the factors related to cancer death anxiety based on available evidence. DESIGN This systematic review and meta-analysis followed the PRISMA 2020 guidelines. METHODS Seven databases were searched to identify studies on the relationships of cancer death anxiety with demographic characteristics, disease factors and psychosocial factors from inception to May 2023. The Agency for Medical Research and Quality (AHRQ) scale was used to evaluate the quality of the included studies. After two researchers independently completed the literature search, data extraction and quality evaluation, meta-analysis was conducted by using RevMan5.3 and Stata 17.0 software. RESULTS In total, 52 studies were included in this review. The results revealed that there were positive correlations of death anxiety with female sex, the symptom burden, anxiety levels, depression levels, fear of recurrence, attachment avoidance, psychological distress, resignation and confrontation coping. Death anxiety was negatively correlated with age, education level, ability to perform daily activities, self-esteem, spiritual well-being, sense of meaning in life, resilience, quality of life, social support and religious beliefs. CONCLUSIONS Our results can inform the design of interventions to address death anxiety and improve the overall quality of life of cancer patients. Healthcare professionals should promptly identify and focus on death anxiety in high-risk populations of cancer patients. RELEVANCE TO CLINICAL PRACTICE Cancer patients commonly experience death anxiety, and this anxiety has a nonnegligible impact on patients' mental health and overall quality of life. This study can inform the development of interventions by clinical healthcare professionals. NO PATIENT OR PUBLIC CONTRIBUTION This was a meta-analysis based on data from previous studies.
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Affiliation(s)
- Yuanyuan Li
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Wanglin Dong
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Haishan Tang
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Xiajun Guo
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Sijia Wu
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Guangli Lu
- Institute of Business Administration, School of Business, Henan University, Kaifeng, China
| | - Xia Li
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
| | - Chaoran Chen
- Institute of Nursing and Health, School of Nursing and Health, Henan University, Kaifeng, China
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Dadashi N, Pazokian M, Yadollahzade N, Taheri M, Kamian S. Predictors of death anxiety among Iranian cancer patients: Contribution of sense of Coherence. J Psychosoc Oncol 2024:1-14. [PMID: 38459951 DOI: 10.1080/07347332.2024.2319292] [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: 03/11/2024]
Abstract
BACKGROUND Death anxiety is a negative consequence of cancer that influences the quality of life of many patients. This study determined the predictors of death anxiety and the contribution of the sense of coherence to this disorder among Iranians with cancer. METHODS The present research was a descriptive-analytical study that examined cancer patients referring to one of the educational hospitals in Tehran, Iran. Two hundred eligible patients selected by purposeful sampling filled out a clinical and demographic questionnaire. The data were analyzed by the SPSS 20 software. RESULTS The correlational results revealed a negative and significant relationship between death anxiety and a sense of coherence (r = -0.610). Likewise, age, gender, marital status, occupational and economic circumstances, and cancer type were among the variables that correlated with death anxiety and predicted 85% of this psychological state. CONCLUSION The researchers recommend mental assessment in oncological care to identify psychological challenges to realize the ultimate goal of palliative care, i.e. improving patients' quality of life.
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Affiliation(s)
- Nasrin Dadashi
- Department of Medical Surgical, School of Nursing and Midwifery, Babol University of Medical Sciences, Babol, Iran
| | - Marzieh Pazokian
- School of Nursing and Midwifery, Clinical Research Development Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nima Yadollahzade
- School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahbobeh Taheri
- Clinical Research Development Center, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shaghayegh Kamian
- Department of Radiotherapy, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhang Y, Pang Y, He Y, You M, Tang L. Feasibility of online managing cancer and living meaningfully (CALM) in Chinese patients with metastatic breast cancer: a pilot randomized control trial. Sci Rep 2024; 14:4892. [PMID: 38418478 PMCID: PMC10902284 DOI: 10.1038/s41598-024-52574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/20/2024] [Indexed: 03/01/2024] Open
Abstract
Metastatic breast cancer could cause various psychological symptoms. Managing Cancer and Living Meaningfully (CALM) is a brief, manualized psychotherapy that has been validated for advanced cancer patients. We conducted a pilot randomized control trial (RCT) to verify the feasibility and preliminary efficacy of CALM therapy in this population. Patients who met the inclusion criteria were randomly assigned into CALM or Wait-list Control (WLC) groups. Patients in the CALM group received CALM therapy and usual care; patients in WLC group first received usual care and then underwent CALM therapy after completing all assessments. All patients were asked to complete three assessments: T0(baseline), T1(3 months), and T2(6 months). The primary outcomes was death anxiety; other outcomes were depression, distress, suicide ideation, attachment security, spiritual well-being and quality of life at the end of life. Analysis of Covariance (ANCOVA) and t-test were used for statistics analysis. Thirty-six patients were randomly assigned to either of the two groups, with 34 patients completing the three assessments. At six months, we found significant between group differences in suicide ideation, distress, and life completion between the CALM and WLC groups. At T2, patients in CALM group reported lower levels of depression (F = 5.016, p = 0.033, partial η2 = 0.143), distress (F = 7.969, p = 0.010, partial η2 = 0.257), attachment avoidance (F = 4.407, p = 0.044, partial η2 = 0.128), and better sense of life completion (F = 5.493, p = 0.026, partial η2 = 0.155) than patients in the WLC group. Compared with results of the T0 assessments, we found significant differences in socres for depression (T2&T0, t = - 2.689, p = 0.011, Cohen's d = 0.940) and distress (T2&T0, t = - 2.453, p = 0.022, Cohen's d = 0.965) between the two groups. CALM therapy was well received by the study population, and CALM therapy can reduce depression, distress, attachment avoidance while improving quality of life in Chinese metastatic breast cancer patients. A Phase III RCT was recommended to verify the impact of CALM therapy on psychological burden and survival in this population.Trial registration: This study is part of the "Preliminary application study for Managing Cancer and Living Meaningfully (CALM) therapy in Chinese advanced cancer patients" clinical trial, with the Trial Registration Number of ChiCTR1900023129 (13/05/2019) in the Chinese Clinical Trial Registry (ChiCTR) website. ( https://www.chictr.org.cn/index.html ).
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Affiliation(s)
- Yening Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China
| | - Ying Pang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China
| | - Yi He
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China
| | - Miaoning You
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Bresat Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Lili Tang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Psycho-Oncology, Peking University Cancer Hospital and Institute, Fu-Cheng Road 52, Hai-Dian District, Beijing, 100142, China.
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Zhang M, Wang X, Shao M, Du R, Zhou H, Zhu J, Zhang H, Ma B, Chen C, Wang T. Supportive care needs and associated factors among caregivers of patients with colorectal cancer: a cross-sectional study. Support Care Cancer 2024; 32:194. [PMID: 38411723 PMCID: PMC10899272 DOI: 10.1007/s00520-024-08390-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/16/2024] [Indexed: 02/28/2024]
Abstract
To assess the level of supportive care needs of caregivers of colorectal cancer patients and explore the related key influencing factors. Totaling 283 caregivers of patients with colorectal cancer were investigated in this study. Firstly, caregivers were invited to complete a set of questionnaires, including the general information questionnaire, the Supportive Care Needs Survey-Partners and the Caregivers of cancer patients, the Caregiver Preparedness Scale, the Benefit Finding Scale, and the Comprehensive Score for Financial Toxicity. Univariate and multivariate linear regression were performed to investigate the associated factors of supportive care needs. The caregivers of patients with colorectal cancer have a moderate level of needs, scored at 2.71 ± 0.42. Caregiver preparedness, benefit finding, and financial toxicity were significantly negatively associated with the supportive care needs of caregivers (r = - 0.555, P < 0.001; r = - 0.534, P < 0.001; and r = - 0.615, P < 0.001, respectively). Our multivariate regression analysis identified some factors that directly affected the supportive care needs of caregivers, including the duration of illness, tumor stage, the age and educational level of caregivers, caregiver preparedness, benefit finding, and financial toxicity (R2 = 0.574, F = 23.337, P < 0.001). Supportive care needs are common among caregivers of colorectal cancer patients. Higher caregiver preparedness, benefit finding, and financial toxicity tend to ease these needs. Healthcare workers should have an in-depth understanding of the needs of caregivers of colorectal cancer patients and actively provide targeted financial/informational/technical/emotional support to promote nursing skills and reduce caregivers' burdens.
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Affiliation(s)
- Menghan Zhang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Xin Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Mengwei Shao
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Ruofei Du
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
- Academy of Medical Sciences of Zhengzhou University, Zhengzhou, 450001, China
| | - Huiyue Zhou
- Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510000, China
| | - Jizhe Zhu
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Haoning Zhang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China
| | - Bin Ma
- School of Medical, Molecular and Forensic Sciences, Murdoch University, Perth, 6149, Australia
| | - Changying Chen
- Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.
| | - Tao Wang
- The College of Nursing and Health of Zhengzhou University, Zhengzhou, 450001, China.
- Telethon Kids Institute, Perth, WA, 6872, Australia.
- Medical School, University of Western Australia, Perth, WA, 6872, Australia.
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Kantabanlang Y, Lin CP, Nilmanat K, Guo P. Palliative care needs of patients with hematologic malignancies and family caregivers and challenges of palliative care provision in Asia: A review of evidence. Semin Hematol 2023; 60:220-225. [PMID: 37517948 DOI: 10.1053/j.seminhematol.2023.07.002] [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: 05/15/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Patients with hematologic malignancies often experience fatigue, lack of vitality, and energy, and high psychological distress. High levels of unmet care needs of patients with hematologic malignancies in Asia were identified. This review provides an overview of current evidence on the experiences and palliative care needs of patients with hematologic malignancies and their families and the barriers and challenges of integrating palliative care into hematology care in Asia. Patients with hematologic malignancies who received palliative care could benefit from less aggressive end-of-life treatments. However, the uncertain and variable nature of the prognosis and illness trajectories of hematologic malignancies increase the difficulties of integrating palliative care into hematologic care. Patients and their families are often referred to palliative care services late, which leaves a short window for palliative care teams to provide holistic needs assessment and person-centered care for those who need it. In addition, cultural differences in medical decision-making patterns and complex social norms and interactions among patients, families, and healthcare staff make it even more challenging to initiate palliative care conversations in Asia. Future research should focus on the development and evaluation of culturally appropriate palliative care for patients with hematologic malignancies and their family caregivers in Asia, given that the low rate of service intake and poor public awareness of the important role of palliative care in disease trajectories were reported. The socio-cultural context surrounding individuals should be taken into consideration to ensure the provision of person-centered care for this group of patients. Digital health could be one of the possible solutions forward to address local needs and challenges.
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Affiliation(s)
- Yupawadee Kantabanlang
- Boromarajonani College of Nursing Suratthani, Faculty of Nursing, Praboromarajchanok Institute, Surat Thani, Thailand
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
| | - Kittikorn Nilmanat
- Division of Fundamental Nursing Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
| | - Ping Guo
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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Li C, Tang N, Yang L, Zeng Q, Yu T, Pu X, Wang J, Zhang H. Effect of caregiver burden on anticipatory grief among caregivers of elderly cancer patients: Chain mediation role of family functioning and resilience. Front Psychol 2023; 13:1020517. [PMID: 36704702 PMCID: PMC9872027 DOI: 10.3389/fpsyg.2022.1020517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
This study aimed to explore the relationship between caregiver burden and anticipatory grief among caregivers of elderly cancer patients, and to examine the chain mediation effects of family functioning and resilience. A total of 624 valid questionnaires were collected. The Structural Equation Model was established to test the mediating effects of family functioning and resilience. Results showed that caregiver burden has a direct positive effect on anticipatory grief, both family functioning and resilience have negative effects on caregiver burden and anticipatory grief, and that resilience moderates the mediating effect of family functioning. Our findings suggest that reducing the caregiver burden among caregivers of elderly cancer patients, improving family functioning, and enhancing resilience have important effects in alleviating the anticipatory grief of caregivers. Our findings provide some references for further research. Medical staff should better understand the grief experience of caregivers and implement interventions to enable caregivers to better cope with anticipatory grief and psychological stress, so as to promote the quality of care for elderly cancer patients.
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Affiliation(s)
- Caiyue Li
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Nan Tang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Lili Yang
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Qing Zeng
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Tana Yu
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiaojin Pu
- Lanzhou University First Hospital, Lanzhou, China
| | - Juan Wang
- Lanzhou University Second Hospital, Lanzhou, China
| | - Hongchen Zhang
- School of Nursing, Lanzhou University, Lanzhou, China,*Correspondence: Hongchen Zhang,
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Ledesma GCM, Reyes MES, Delariarte CF. Meaning in Life, Death Anxiety, and Spirituality in the Lesbian, Gay, and Bisexual Community: A Scoping Review. SEXUALITY & CULTURE 2022; 27:636-658. [PMID: 36405399 PMCID: PMC9645752 DOI: 10.1007/s12119-022-10032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 06/16/2023]
Abstract
The changes in people's way of life through the years raise questions on how they address existential needs and concerns, particularly those related to life and death and spiritual connections. Through a scoping review, we surveyed studies on meaning in life, death anxiety, and spirituality within the lesbian, gay, and bisexual (LGB) community. We determined the extent to which these variables have been studied among LGB participants. A total of 28 eligible articles were reviewed. Six studies were found about meaning in life, five studies about death anxiety, and 16 studies about spirituality. Results suggest that meaning in life was derived from experiences related to parenthood, couplehood, and work satisfaction. Studies on death anxiety among LGB participants, which date back to the 1980 and 1990s, indicated the need to conduct present studies in this area. The review showed that LGB members distinguished between spirituality and religion, giving them more positive recognition of the former than the latter. The forms of spiritual expression were anchored to religious practices, for some, and other expressions of belief and faith outside the confines of formally established religions. Spiritual expressions generally accorded the LGB members direction and satisfaction in life. Not all segments of the LGB community were represented in the studies. The available studies, dominantly quantitative, centered only on the LGB experience. Target age groups varied across the studies. The review indicates that future studies can work on exploring these existential factors considering the emerging contexts and paradigms. Future research can focus on determining what factors contribute to meaning in life, given the changes in time.
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Affiliation(s)
- Gian Carlo M. Ledesma
- The Graduate School, University of Santo Tomas, 1008 Manila, Philippines
- Department of Interdisciplinary Studies, Faculty of Arts and Letters, University of Santo Tomas, Manila, Philippines
| | - Marc Eric S. Reyes
- The Graduate School, University of Santo Tomas, 1008 Manila, Philippines
- Department of Psychology, College of Science, University of Santo Tomas, Manila, Philippines
| | - Clarissa F. Delariarte
- The Graduate School, University of Santo Tomas, 1008 Manila, Philippines
- Far Eastern University, Manila, Philippines
- De La Salle University, Manila, Philippines
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