title: Predictors of suffering in advanced cancer.
abstract: BACKGROUND
  Suffering is a complex experience. Identifying its predictors is useful to signal at-risk patients.
  
  
  OBJECTIVE
  To identify suffering predictors in patients with advanced cancer in palliative care.
  
  
  METHODS
  A total of 98 patients participated in the study. A semistructured interview examining suffering levels and physical, psychological, social, and spiritual aspects was used. Instruments included Pictorial Representation of Illness and Self Measure (PRISM), Edmonton Symptom Assessment System (ESAS), Detection of emotional distress (DED), and Structured Interview of Symptoms and Concern (SISC). Variance-based structural equation model was used for the data analysis.
  
  
  RESULTS
  All measures were valid and reliable. The structural model explained 64% of the variance. Suffering levels were directly determined by psychological and adjustment problems and indirectly determined by physical, psychological, and spiritual aspects and coping strategies.
  
  
  CONCLUSIONS
  Our study supports the proposed theoretical model and signals the important mediating effect of psychological and spiritual variables between physical symptoms and suffering.
authors.affiliation: Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia aliciakriko@gmail.com.
authors.forename: Alicia
authors.initials: A
authors.lastname: Krikorian
authors.affiliation: Research Group on Stress and Health (GIES), Faculty of Psychology, Universitat Autònoma de Barcelona, Barcelona, Spain.
authors.forename: Joaquín T
authors.initials: JT
authors.lastname: Limonero
authors.affiliation: Faculty of Psychology, Universidad EAFIT, Medellín, Colombia.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Román
authors.affiliation: Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia Instituto de Cancerología, Clínica Las Américas, Medellín, Colombia.
authors.forename: John Jairo
authors.initials: JJ
authors.lastname: Vargas
authors.affiliation: Pain and Palliative Care Group, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia Instituto de Cancerología, Clínica Las Américas, Medellín, Colombia.
authors.forename: Carolina
authors.initials: C
authors.lastname: Palacio
mesh_terms: D000223:Adaptation, Psychological; D005260:Female; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology*; D012720:Severity of Illness Index; D058992:Social Participation / Q000523:psychology; D012959:Socioeconomic Factors; D029181:Spirituality; D013315:Stress, Psychological / Q000523:psychology*; D011795:Surveys and Questionnaires / Q000592:standards*
keywords: associated factors; cancer; distress; end of life; predictors; suffering