Depression and anxiety during the year before death from cancer

The impact of malignancy on death anxiety and psychological well-being in middle-aged and older patients undergoing abdominal surgery: a quasi-experimental study

BACKGROUND

Malignancy is a critical factor affecting death anxiety and psychological well-being. This study examined the impact of malignancy on death anxiety and psychological well-being in middle-aged and older adult patients undergoing abdominal surgery and projected it along with sociodemographic profiles.

METHODS

This study is quasi-experimental in design. It was conducted with patients undergoing abdominal surgery at a university hospital due to suspected malignancy. A total of 93 patients participated in the study: 57 patients diagnosed with malignancy were included in the experimental group, while 36 patients without a malignancy diagnosis were included in the control group. Data were collected using a questionnaire developed by the researchers based on the literature, the 'Turkish Death Anxiety Scale', and the 'Psychological Well-being Scale'. The analyses revealed that the data were normally distributed, and parametric tests were used to analyze differences between demographic variables and groups. Cohen's d and r values were examined to assess the effect size in the tests.

RESULTS

The study found a significant difference in death anxiety between the experimental and control groups (P < 0.05), with higher mean scores in the experimental group. Malignancy had a large effect on death anxiety (d = 1.42). Additionally, the control group had significantly higher mean psychological well-being scores compared to the experimental group (P < 0.05).

CONCLUSIONS

The study found that malignancy significantly affects death anxiety and psychological well-being. Increased death anxiety in patients with malignancy was associated with reduced psychological well-being. Thus, assessing death anxiety and providing targeted nursing care are essential for supporting the psychological well-being of these patients.

The Efficacy of Virtual Reality-Based Interventions on Pain, Anxiety, Depression, and Quality of Life Among Patients With Cancer: A Meta-analysis of Randomized Controlled Trials

BACKGROUND

Although cancer patients are living longer, the numerous physical and psychological outcomes of cancer can still be burdensome. Pain, anxiety, depression, and decreased quality of life are symptoms that are highly impacted by cancer. The availability of modalities to cope with these symptoms is critical. Virtual reality-based interventions have been used among patients with cancer, but their effects on pain, anxiety, depression, and quality of life remain unclear.

OBJECTIVE

To determine the efficacy of virtual reality-based interventions on pain, anxiety, depression, and quality of life among cancer patients and to assess the efficacy of different contents and duration.

METHODS

Nine databases were retrieved from inception to July 31, 2024. The methodological quality was evaluated via the Cochrane Risk of Bias 2.0 tool. Data synthesis was conducted with Stata version 16.0, and sensitivity analysis and subgroup analysis were also performed.

RESULTS

Virtual reality-based interventions can soothe pain and anxiety. Subgroup analysis revealed that interventions focused on playing games and watching videos were effective at reducing pain. In addition, enjoying landscapes, receiving treatment-related health education, and watching videos were effective at decreasing anxiety; moreover, short-term (≤6 weeks) interventions were effective at relieving pain.

CONCLUSIONS

Virtual reality-based interventions are effective at decreasing pain and anxiety. The contents and duration of the intervention had an impact on their effectiveness.

IMPLICATIONS FOR NURSING PRACTICE

Symptom management is a paramount aspect of clinical cancer care. In daily oncology nursing, we encourage nurses to utilize the benefits of virtual reality-based interventions to improve cancer patients' experience with medical treatment.

Mental Health Service Integration in Hospice Organizations: A National Survey of Hospice Clinicians and Medical Leadership

Background: Unmet mental health needs are associated with a range of negative consequences for individuals at the end of life. Despite the high prevalence of mental health needs among individuals enrolled in hospice, there is a paucity of data describing mental health service integration in hospices in the United States. Objectives: 1. To identify patterns of mental health service integration in hospice organizations nationally; 2. To characterize gaps in mental health service delivery in hospice settings as perceived by hospice clinicians and medical leadership. Methods: A cross-sectional survey querying hospice clinicians and hospice medical leadership nationally. Results: A total of 279 surveys were included. Clinically significant mental health symptoms were common among hospice patients; the most frequently encountered symptom groups were depression, anxiety, dementia, and delirium. A minority of hospices maintained relationships with psychiatrists (23%, n = 60), psychiatric nurse practitioners (22%, n = 56), or psychologists (19%, n = 49). Only 38% (n = 99) of respondents were satisfied with their patients' access to services and only 45% (n = 118) were satisfied with the quality of these services. Common limitations to providing adequate mental health services included lack of specialist services, short length of stay for patients, and reluctance of patients to engage in these services. Conclusions: Significant mental health symptoms are common among hospice patients, and hospice organizations perceive these needs are not being met. Further research is needed to better understand the current treatment landscape and design interventions to address these needs.

Acceptance and Commitment Therapy (ACT) for people with advanced progressive illness, their caregivers and staff involved in their care: A scoping review

BACKGROUND

People with an advanced progressive illness and their caregivers frequently experience anxiety, uncertainty and anticipatory grief. Traditional approaches to address psychological concerns aim to modify dysfunctional thinking; however, this is limited in palliative care, as often concerns area valid and thought modification is unrealistic. Acceptance and Commitment Therapy is a mindfulness-based behavioural therapy aimed at promoting acceptance and valued living even in difficult circumstances. Evidence on its value in palliative care is emerging.

AIMS

To scope the evidence regarding Acceptance and Commitment Therapy for people with advanced progressive illness, their caregivers and staff involved in their care.

DESIGN

Systematic scoping review using four databases (Medline, PsychInfo, CINAHL and AMED), with relevant MeSH terms and keywords from January 1999 to May 2023.

RESULTS

1,373 papers were identified and 26 were eligible for inclusion. These involved people with advanced progressive illness (n = 14), informal caregivers (n = 4), palliative care staff (n = 3), bereaved carers (n = 3), and mixed groups (n = 2). Intervention studies (n = 15) showed that Acceptance and Commitment Therapy is acceptable and may have positive effects on anxiety, depression, distress, and sleep in palliative care populations. Observational studies (n = 11) revealed positive relationships between acceptance and adjustment to loss and physical function.

CONCLUSION

Acceptance and Commitment Therapy is acceptable and feasible in palliative care, and may improve anxiety, depression, and distress. Full scale mixed-method evaluation studies are now needed to demonstrate effectiveness and cost-effectiveness amongst patients; while further intervention development and feasibility studies are warranted to explore its value for bereaved carers and staff.

Depression and Anxiety Symptoms in Patients With Cirrhosis: A Prospective Study Before and After Liver Transplantation

BACKGROUND

Timely identification of possible psychiatric symptoms and/or disorders, such as depression and anxiety, in liver cirrhosis and liver transplant patients is important. This study aimed to determine whether patients with both liver cirrhosis and liver transplantation have depression and anxiety symptoms and, if so, to determine the relationship of these symptoms with the stage of the liver disease and other conditions.

METHODS

Ninety patients with liver cirrhosis and 31 who underwent liver transplantation for liver cirrhosis were included in the study. Patients were divided into 4 groups. Patients with Child-Pugh A cirrhosis were group 1, patients with Child-Pugh B cirrhosis were group 2, patients with Child-Pugh C cirrhosis were group 3, and transplanted patients were group 4. All patient groups answered Beck Depression Inventory and Beck Anxiety Inventory questionnaires.

RESULTS

Depression and anxiety scores were similar in patients who underwent liver transplantation and in the Child-Pugh A and Child-Pugh B groups. The lowest depression score was observed in the Child-Pugh A group. This was not statistically different from the patients in the liver transplantation group (3.19 ± 3.487, 7.13 ± 7.822, P > .05). Depression and anxiety scores were statistically higher in the Child-Pugh C group (25.55 ± 8.878, 21.66 ± 11.053, and 25.55 ± 8.878, respectively; P < .001), and depression and anxiety scores increased as the cirrhosis stage increased.

CONCLUSIONS

In patients with Child-Pugh C liver cirrhosis, evaluation for symptoms of anxiety and depression is strongly recommended.

Associations of prognostic-awareness-transition patterns with emotional distress and quality of life during terminally ill cancer patients' last 6 months of life

OBJECTIVE

Unprecedently investigate associations of prognostic-awareness-transition patterns with (changes in) depressive symptoms, anxiety symptoms, and quality of life (QOL) during cancer patients' last 6 months.

METHODS

In this secondary analysis study, 334 cancer patients in their last 6 months transitioned between four prognostic-awareness states (unknown and not wanting to know, unknown but wanting to know, inaccurate awareness, and accurate awareness), thus constituting three transition patterns: maintaining-accurate-, gaining-accurate-, and maintaining-inaccurate/unknown prognostic awareness. A multivariate hierarchical linear model evaluated associations of the transition patterns with depressive symptoms, anxiety symptoms, and QOL determined at final assessment and by mean difference between the first and last assessment.

RESULTS

At the last assessment before death, the gaining-accurate-prognostic-awareness group reported higher levels of depressive symptoms (estimate [95% confidence interval] = 1.59 [0.35-2.84]) and the maintaining- and gaining-accurate-prognostic-awareness groups suffered more anxiety symptoms (1.50 [0.44-2.56]; 1.42 [0.13-2.71], respectively) and poorer QOL (-7.07 [-12.61 to 1.54]; -11.06 [-17.76 to -4.35], respectively) than the maintaining-inaccurate/unknown-prognostic-awareness group. Between the first and last assessment, the maintaining- and gaining-accurate-prognostic-awareness groups' depressive symptoms (1.59 [0.33-2.85]; 3.30 [1.78-4.82], respectively) and QOL (-5.04 [-9.89 to -0.19]; -8.86 [-14.74 to -2.98], respectively) worsened more than the maintaining-inaccurate/unknown-prognostic-awareness group, and the gaining-accurate-prognostic-awareness group's depressive symptoms increased more than the maintaining-accurate-prognostic-awareness group (1.71 [0.42-3.00]).

CONCLUSIONS

Unexpectedly, patients who maintained/gained accurate prognostic awareness suffered more depression, anxiety, and poorer QOL at end of life. Promoting accurate prognostic awareness earlier in the terminal-cancer trajectory should be supplemented with adequate psychological care to alleviate patients' emotional distress and enhance QOL.

TRIAL REGISTRATION

ClinicalTrials.gov:NCT01912846.