Dignity-related existential distress in end-of-life cancer patients: Prevalence, underlying factors, and associated coping strategies

Abstract

Objective: 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.

Methods: 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 X² tests, MANOVA, and multivariate regression analysis.

Results: 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.

Conclusions: 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.

Keywords: cancer; demoralization; dignity; end of life; existential distress; oncology; palliative care; psycho-oncology; styles of coping.