Search

This cross-sectional German study examined the frequency of health literacy (HL) in adolescents and young adult (AYA) cancer patients and the factors associated with HL. A sample of 206 AYA-aged patients (80.1% female; age 15–39 years) completed measures of HL, health-related quality of life (HRQoL), depression, and sociodemographic characteristics; 28% had a sufficient HL score. Males and patients with higher education levels reported higher HL scores. Regression revealed positive associations between HL and HRQoL and depressive symptoms. Results suggest the need to further examine HL and its predictors in AYAs with cancer to develop interventions for improving HL. [ABSTRACT FROM AUTHOR]

Background: Demoralization is a syndrome of existential distress characterized by loss of meaning and purpose in life, hopelessness, and helplessness. Empirical data on its occurrence and associated factors in terminally ill patients is limited. Objective: The study objective was to determine the frequency of demoralization and its association with individual and disease-related characteristics and to analyze the association between demoralization and the preference to discuss expected survival. Methods: We recruited N = 55 terminally ill cancer patients (54% women, mean age 67 years) within 48 hours after admission to a specialized palliative care inpatient ward (55% had a Karnofsky performance status of ≤50). Patients completed the Demoralization Scale (DS), the Generalized Anxiety Disorder Scale-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and a single-item question measuring preferences for discussion of expected survival with a physician. Results: We found clinically significant demoralization present in 19% and moderate demoralization present in 10% of participants. Better educated patients reported a higher level of demoralization (d = 0.74, p = .010). Patients with a preference to discuss expected survival reported higher levels in the 'loss of meaning and purpose' dimension of demoralization (d = 0.76, p = .010) and higher levels of anxiety (d = 0.88, p = .003) compared to those not wanting to discuss survival. Conclusions: Demoralization is a significant dimension of distress in terminally ill cancer patients. In the end-of-life inpatient care setting, the preference to discuss expected survival with a physician can parallel existential distress and anxiety. Further elucidation of patients' underlying existential needs will inform interventions that sustain meaning and hope in face of a limited life expectancy. [ABSTRACT FROM AUTHOR]

Background and Objective: Given the important role caregivers play in palliative care planning and decision making, anxiety and depression in caregivers of terminally ill cancer patients and their impact on the caregivers' evaluation of the patients' physical and psychological symptom burden were analyzed. Design and subjects: Thirty-three patients and their caregivers were recruited through the University Medical Center palliative care inpatient ward <24h after admission. Measurements: Patients completed the Memorial Symptom Assessment Scale (MSAS). Caregivers were instructed to evaluate the symptom burden of the patient. Anxiety and depression were measured in caregivers using the PHQ-9 and the GAD-7. Results: Fifty-five percent of male caregivers and 36% of female caregivers showed moderate or severe anxiety; 36% of male caregivers compared to 14% of female caregivers had moderate or severe depression. Caregivers' anxiety was associated with a discrepancy in the patients' symptom evaluation for shortness of breath ( p<0.05); nausea ( p<0.05); and frequency, intensity, and distress due to anxiety ( p<0.01). Depression was associated with a discrepancy in the patients' evaluation of distress due to constipation ( p<0.05), as well as intensity and distress due to anxiety ( p<0.05). Both the caregivers' anxiety and depression were not significantly associated with an underestimation of symptoms. There was a trend towards a higher risk of overestimation in caregivers with higher levels of anxiety (r=0.32) ( p=0.07) and depression (r=0.33) ( p=0.06). Conclusion: Integrative palliative care should offer psychooncological care for the caregivers on a routine basis to avoid misleading perspectives possibly influencing end-of-life treatment decisions. [ABSTRACT FROM AUTHOR]