Psycho-Oncology Unit, Department of Neuroscience, University of Turin, "Città della Salute e della Scienza" Hospital, Turin, Italy.
Psychooncology. 2018 Nov;27(11):2631-2637. doi: 10.1002/pon.4884. Epub 2018 Sep 24.
Cancer patients often have to face increasing levels of existential distress (ED) during disease progression, especially when nearing death. This cross-sectional study aimed to assess the prevalence of the dignity-related existential distress (DR-ED) in a sample of end-of-life cancer patients, and to explore the "existential distress" Patient Dignity Inventory (PDI-IT) subscale internal structure and its associations with different coping strategies.
Two hundred seven cancer inpatients with a Karnofsky Performance Status ≤50 and a life expectancy of 4 months or less have been examined with the following self-report measures: PDI-IT, Demoralization Scale (DS-IT) and Brief Coping Orientation to Problem Experienced (Brief-COPE). The existential distress PDI-IT subscale factor structure was explored through principal component analysis, and the DR-ED associations with the other considered variables were examined through X tests, MANOVA, and multivariate regression analysis.
Dignity-related existential distress was a problem/major problem for 18.8% of the patients, especially for the younger (F(1, 205) = 3.40; P = 0.020) and more demoralized (F(1, 205) = 20.36; P < 0.001) individuals. Factor analysis supported 2 dimensions labeled "self-discontinuity" and "loss of personal autonomy," accounting for 58% of the variance. Positive reframing (β = -0.146, P < 0.05) and self-blame (β = 0.247, P < 0.001) coping styles emerged as DR-ED significant predictors.
This study showed how DR-ED is a relevant problem for patients nearing death and furthermore highlighted 2 underlying factors. Finally, the research has shown that positive reframing and self-blame coping styles might be clinically relevant elements for interventions on ED.
癌症患者在疾病进展过程中经常面临越来越多的存在性困扰（ED），尤其是在接近死亡时。本横断面研究旨在评估终末期癌症患者样本中与尊严相关的存在性困扰（DR-ED）的患病率，并探讨“存在性困扰”患者尊严评估量表（PDI-IT）分量表的内部结构及其与不同应对策略的关系。
对 207 名 Karnofsky 表现状态≤50 分且预期寿命为 4 个月或更短的癌症住院患者进行了以下自我报告量表的检查：PDI-IT、沮丧量表（DS-IT）和简要应对取向问题体验量表（Brief-COPE）。通过主成分分析探讨存在性困扰 PDI-IT 分量表的因子结构，并通过卡方检验、MANOVA 和多元回归分析探讨 DR-ED 与其他考虑变量的关系。
尊严相关的存在性困扰是 18.8%患者的问题/主要问题，尤其是对于年轻（F（1，205）= 3.40；P=0.020）和更沮丧（F（1，205）= 20.36；P<0.001）的个体。因子分析支持两个维度，分别标记为“自我不连续性”和“丧失个人自主性”，占方差的 58%。积极重新框架（β=-0.146，P<0.05）和自责（β=0.247，P<0.001）应对方式是 DR-ED 的显著预测因子。
本研究表明，DR-ED 是接近死亡的患者的一个相关问题，此外还强调了两个潜在因素。最后，研究表明，积极重新框架和自责应对方式可能是干预 ED 的临床相关因素。
