Department of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Psychooncology. 2018 Nov;27(11):2587-2593. doi: 10.1002/pon.4823. Epub 2018 Jul 20.
Advanced diseases pose a great burden on patients and go hand in hand with existential concerns. Demoralization is considered as a syndrome of existential distress with a perceived inability to cope with loss of meaning in life and feelings of helplessness and hopelessness. Professional health care providers play an important role in providing support for patients and unfavorable conversational styles in their relationship can increase patient's distress. In this study, we examine the association between the patient's perceived relationship to health care providers and demoralization.
We used baseline data of a randomized control trial intervention study for advanced cancer patients (UICC-Stage ≥ III; PHQ ≥ 9 and/or Distress-Thermometer ≥5). We used a subscale of the QUAL-EC-P for assessing doctor-patient relationship, Beck Depression Inventory-II for depressive symptoms, a modified version of the MSAS as physiological symptom checklist, and the Demoralization Scale to assess demoralization. A hierarchical regression analysis was calculated.
In our sample of 187 patients with stage III or IV cancer (62% women), demoralization was present in 53.4% (16% moderate demoralization; 37.4% high demoralization) of the patients. Relationship to health care provider was an independent predictor (β = -.33, t(186) = -6.70, P < .001) of demoralization.
Our findings underline the importance of the physician-patient relationship in the context of coping with existential challenges in advanced cancer patients. Trainings on how to communicate and build a sustainable relationship with patients and their specific needs may increase the buffering effect of social support by the physicians on patient's existential distress.
晚期疾病给患者带来了巨大的负担，同时也伴随着存在主义的担忧。沮丧被认为是一种存在困扰的综合征，表现为无法应对生活意义的丧失、无助和无望感。专业的医疗保健提供者在为患者提供支持方面发挥着重要作用，而他们在医患关系中的不利谈话方式会增加患者的痛苦。在这项研究中，我们研究了患者对医疗保健提供者的感知关系与沮丧之间的关系。
我们使用了一项针对晚期癌症患者（UICC 分期≥III；PHQ≥9 和/或痛苦温度计≥5）的随机对照试验干预研究的基线数据。我们使用 QUAL-EC-P 的一个子量表来评估医患关系，使用贝克抑郁量表 II 评估抑郁症状，使用 MSAS 的一个修改版本作为生理症状清单，使用沮丧量表来评估沮丧。我们计算了一个层次回归分析。
在我们的 187 名 III 期或 IV 期癌症患者样本中（62%为女性），53.4%（16%为中度沮丧；37.4%为高度沮丧）的患者存在沮丧。与医疗保健提供者的关系是沮丧的独立预测因素（β=-.33，t(186)=-6.70，P<.001）。
我们的发现强调了在晚期癌症患者应对存在主义挑战的背景下，医患关系的重要性。关于如何与患者及其特定需求进行沟通和建立可持续关系的培训，可能会增加医生的社会支持对患者存在主义痛苦的缓冲作用。
