Liu Hui, Liu Xiaocheng, Liu Zhili, Wang Yao, Feng Ruiling, Zheng Ruihua, Xie Rongzhi, Tao Hongmei, Wu Yanchun, Li Xiaomin, Ying Wenjuan, Wu Xiaoying
Nursing Department, Cancer Hospital of Shantou University Medical College, Shantou, China.
Nursing Department, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China.
Asia Pac J Oncol Nurs. 2022 Aug 26;9(10):100134. doi: 10.1016/j.apjon.2022.100134. eCollection 2022 Oct.
This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety.
Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety.
Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety ( = 0.335, = 20.072, < 0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F = 5.892, = 0.003). Multivariate analysis revealed no significant association between family function and death anxiety.
Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.
本研究探讨影响晚期癌症患者死亡焦虑的因素，调查家庭功能在死亡焦虑中的作用，以及生命意义与死亡焦虑之间的相关性。
本横断面研究招募了2020年11月至2021年5月在三家机构住院的晚期癌症患者。使用中文版的死亡与临终困扰量表、晚期癌症患者生命意义量表和家庭APGAR指数来评估死亡焦虑、生命意义和家庭功能。疼痛症状采用数字评分量表进行评估。还记录了卡氏功能状态、患者的社会人口统计学和临床变量。使用IBM SPSS Statistics for Windows（版本26.0）进行统计分析。进行多变量回归分析以检验社会人口统计学和临床变量与家庭功能和死亡焦虑的相关性。
本研究纳入了328例晚期癌症患者。结果显示，12.2%的患者经历了中度至重度死亡焦虑。晚期癌症患者生命意义量表（对死亡的接受度、对生活的掌控感）、机构类型（三级医院肿瘤科）、自我感知的经济负担（极重）、卡氏功能状态评分、年龄和医疗保险状态（自费、跨省医保）被确定为死亡焦虑的相关因素（F = 0.335，P = 20.072，P < 0.001）。在单变量分析中，家庭功能得分良好的患者死亡焦虑水平显著较低（F = 5.892，P = 0.003）。多变量分析显示家庭功能与死亡焦虑之间无显著关联。
我们的结果表明，三级医院肿瘤科、极高的自我感知经济负担、自费和跨省医保可能与晚期癌症患者较高的死亡焦虑有关。较低水平的死亡焦虑与较高水平的对死亡的接受度、更强的生活掌控感、更好的身体状况和年龄较大有关。未来有必要进一步证实晚期癌症患者家庭功能与死亡焦虑之间的关联。
