George Login S, Saraiya Biren, Mohile Supriya, Muha Emily, Sarwar Saba, Duberstein Paul R
Center for Healthy Aging Research, Rutgers Institute for Health, Health Care Policy and Aging Research.
Division of Medical Oncology, Rutgers Cancer Institute.
Health Psychol. 2025 Jun;44(6):587-596. doi: 10.1037/hea0001438. Epub 2024 Dec 16.
Theoretical work suggests that moral psychological processes-those pertaining to the interests or welfare of others-are a key driver of overtreatment at the end of life. We examined patient moral processes and their associations with distress and treatment decision-making.
During structured interviews with 116 patients with advanced cancer and a poor prognosis, Likert scale items were used to operationalize (a) moral emotions: feeling shame and guilt about cancer getting worse, (b) moral motives for cancer treatment: perceiving an obligation to family for continuing potentially nonbeneficial treatments, and (c) moral performance: putting up the appearance of feeling better than how one is really feeling (5-point response scale, ). Several distress and end-of-life decision-making variables were also assessed.
Most patients reported moral motives for cancer treatments and engaging in moral performance (35%-88% responded "a little" or higher for each of the 10 items). The mean moral motives score was associated with a higher likelihood of choosing life-extending care over comfort care ( = -3.16, = .002) and a lower likelihood of having an advance care planning discussion ( = 3.19, = .002). Moral performance was associated with worse distress regarding prognosis ( = .32, = .001), worse psychological symptoms ( = -.26, = .004), and less peaceful acceptance of cancer ( = -.25, = .006).
For patients with advanced cancer, moral processes are prevalent and influential on how they behave and make treatment decisions. Attention must be paid to how these moral processes can result in more intensive treatments than warranted. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
理论研究表明，道德心理过程——那些与他人利益或福祉相关的过程——是临终过度治疗的关键驱动因素。我们研究了患者的道德过程及其与痛苦和治疗决策的关联。
在对116名晚期癌症且预后不良的患者进行结构化访谈时，使用李克特量表项目来衡量：(a) 道德情绪：对癌症恶化感到羞耻和内疚；(b) 癌症治疗的道德动机：认为有义务为家人继续进行可能无益处的治疗；(c) 道德表现：表现出比实际感觉更好的样子（5分制反应量表）。还评估了几个痛苦和临终决策变量。
大多数患者报告了癌症治疗的道德动机并表现出道德行为（10个项目中每个项目有35%-88%的患者回答“有点”或更高）。道德动机得分均值与选择延长生命护理而非舒适护理的可能性更高相关（β = -3.16，p = .002），与进行预先护理计划讨论的可能性更低相关（β = 3.19，p = .002）。道德表现与对预后的更严重痛苦相关（β = .32，p = .001），与更严重的心理症状相关（β = -.26，p = .004），与对癌症的平静接受程度较低相关（β = -.25，p = .006）。
对于晚期癌症患者，道德过程普遍存在且会影响他们的行为和治疗决策方式。必须关注这些道德过程如何导致比合理情况更强化的治疗。（《心理学文摘数据库记录》(c) 2025美国心理学会，保留所有权利）
