| Autor: |
Emanuel LL; Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.; Department of Medicine, Northwestern Medicine, Chicago, Illinois, USA., Solomon S; Department of Psychology, Skidmore College, Saratoga Springs, New York, USA., Chochinov HM; Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.; CancerCare Manitoba, Winnipeg, Manitoba, Canada., Delgado Guay MO; Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA., Handzo G; Health Services Research and Quality, HealthCare Chaplaincy Network, New York, New York, USA., Hauser J; Department of Medicine, Northwestern Feinberg School of Medicine, Chicago, Illinois, USA.; Jesse Brown VA Medical Center, Chicago, Illinois, USA., Kittelson S; Division of Palliative Care, Department of Medicine and University of Florida, Gainesville, Florida, USA., O'Mahony S; Section of Palliative Medicine, Department of Internal Medicine and Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA., Quest TE; Department of Family and Preventive Medicine and Emory University School of Medicine, Atlanta, Georgia, USA.; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA., Rabow MW; Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, California, USA., Schoppee TM; Community Hospice and Palliative Care, Jacksonville, Florida, USA.; Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA., Wilkie DJ; Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA., Yao Y; Center for Palliative Care Research and Education, University of Florida, Gainesville, Florida, USA., Fitchett G; Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, Illinois, USA. |
| Abstrakt: |
Background: Death anxiety is powerful, potentially contributes to suffering, and yet has to date not been extensively studied in the context of palliative care. Availability of a validated Death Anxiety and Distress Scale (DADDS) opens the opportunity to better assess and redress death anxiety in serious illness. Objective: We explored death anxiety/distress for associations with physical and psychosocial factors. Design: Ancillary to a randomized clinical trial (RCT) of Dignity Therapy (DT), we enrolled a convenience sample of 167 older adults in the United States with cancer and receiving outpatient palliative care (mean age 65.9 [7.3] years, 62% female, 84% White, 62% stage 4 cancer). They completed the DADDS and several measures for the stepped-wedged RCT, including demographic factors, religious struggle, dignity-related distress, existential quality of life (QoL), and terminal illness awareness (TIA). Results: DADDS scores were generally unrelated to demographic factors (including religious affiliation, intrinsic religiousness, and frequency of prayer). DADDS scores were positively correlated with religious struggle ( p < 0.001) and dignity-related distress ( p < 0.001) and negatively correlated with existential QoL ( p < 0.001). TIA was significantly nonlinearly associated with both the total DADDS ( p = 0.007) and its Finitude subscale ( p ≤ 0.001) scores. There was a statistically significant decrease in Finitude subscale scores for a subset of participants who completed a post-DT DADDS ( p = 0.04). Conclusions: Findings, if replicable, suggest that further research on death anxiety and prognostic awareness in the context of palliative medicine is in order. Findings also raise questions about the optimal nature and timing of spiritual and psychosocial interventions, something that might entail evaluation or screening for death anxiety and prognostic awareness for maximizing the effectiveness of care. |
