Department of Psychology, Tulane University, New Orleans, Louisiana, USA.
Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Psychooncology. 2023 May;32(5):692-700. doi: 10.1002/pon.6113. Epub 2023 Feb 21.
Although palliative care can mitigate emotional distress, distressed patients may be less likely to engage in timely palliative care. This study aims to investigate the role of emotional distress in palliative care avoidance by examining the associations of anger, anxiety, and depression with palliative care attitudes.
Patients (N = 454) with heterogeneous cancer diagnoses completed an online survey on emotional distress and palliative care attitudes. Emotional distress was measured using the Patient-Reported Outcomes Measurement Information System anger, anxiety, and depression scales. The Palliative Care Attitudes Scale was used to measure palliative care attitudes. Regression models tested the impact of a composite emotional distress score calculated from all three symptom measures, as well as individual anger, anxiety, and depression scores, on palliative care attitudes. All models controlled for relevant demographic and clinical covariates.
Regression results revealed that patients who were more emotionally distressed had less favorable attitudes toward palliative care (p < 0.001). In particular, patients who were angrier had less favorable attitudes toward palliative care (p = 0.013) while accounting for depression, anxiety, and covariates. Across analyses, women had more favorable attitudes toward palliative care than men, especially with regard to beliefs about palliative care effectiveness.
Anger is a key element of emotional distress and may lead patients to be more reluctant toward timely utilization of palliative care. Although psycho-oncology studies routinely assess depression or anxiety, more attention to anger is warranted. More research is needed on how best to address anger and increase timely utilization of palliative cancer care.
尽管姑息治疗可以减轻情绪困扰，但情绪困扰的患者可能不太愿意及时接受姑息治疗。本研究旨在通过考察愤怒、焦虑和抑郁与姑息治疗态度的关系，探讨情绪困扰在姑息治疗回避中的作用。
患有各种癌症诊断的患者（N=454）完成了一项关于情绪困扰和姑息治疗态度的在线调查。使用患者报告的结果测量信息系统愤怒、焦虑和抑郁量表来衡量情绪困扰。使用姑息治疗态度量表来衡量姑息治疗态度。回归模型测试了由所有三种症状测量方法计算得出的复合情绪困扰评分，以及个体愤怒、焦虑和抑郁评分对姑息治疗态度的影响。所有模型均控制了相关的人口统计学和临床协变量。
回归结果表明，情绪困扰较严重的患者对姑息治疗的态度较差（p<0.001）。特别是，愤怒情绪更严重的患者对姑息治疗的态度较差（p=0.013），同时考虑了抑郁、焦虑和协变量。在所有分析中，女性对姑息治疗的态度比男性更积极，尤其是在姑息治疗效果的信念方面。
愤怒是情绪困扰的一个关键因素，可能导致患者更不愿意及时接受姑息治疗。尽管心理肿瘤学研究通常会评估抑郁或焦虑，但更需要关注愤怒。需要更多的研究来探讨如何最好地解决愤怒问题，以及如何增加姑息治疗癌症护理的及时性。
