Relationship between symptom burden, distress, and sense of dignity in terminally ill cancer patients.
BACKGROUND
Maintaining a sense of dignity in terminally ill patients and enabling a dignified dying are important aims of palliative care.


OBJECTIVE
To evaluate the impact of symptom burden, distress, overall condition, and individual patient characteristics on self-perceived dignity in terminally ill cancer patients.


METHODS
In this cross-sectional study, 61 patients were recruited through a palliative care inpatient ward within 48 hours after admission. Patients completed the Patient Dignity Inventory, a modified version of the Memorial Symptom Assessment Scale, the National Comprehensive Cancer Network Distress Thermometer, and a single-item scale rating subjective of overall condition. Sociodemographic parameters and performance status were taken from the patients' records.


RESULTS
Dignity total score correlated highest with lack of energy (P<0.001), anxiety (P<0.001), sadness (P=0.002), pain (P=0.009), shortness of breath (P=0.019), irritability (P=0.023), thirst (P=0.029), and tiredness (P=0.041). Psychological symptoms showed more consistent associations with the different dignity dimensions than physical symptoms except for the dependency dimension. Psychological distress correlated with all dignity dimensions: symptom distress (P<0.001), existential distress (P<0.001), dependency (P=0.020), peace of mind (P<0.001), and social support (P=0.024). Overall condition was significantly associated with existential distress (P=0.013), but not with symptom distress, dependency, peace of mind, or social support. Performance status showed significant association with dependency (P=0.001).


CONCLUSIONS
Self-perceived dignity in terminally ill cancer patients is significantly associated with physical as well as psychological symptoms, distress, overall condition, performance status, and comorbidities. Knowledge of these specific interactions is essential for adequate, comprehensive palliative care.
Department of Oncology/Hematology/Bone Marrow Transplantation/Pneumology, University Medical Center Eppendorf, Hamburg, Germany. Electronic address: k.oechsle@uke.de.
Karin
K
Oechsle
Department of Oncology/Hematology/Bone Marrow Transplantation/Pneumology, University Medical Center Eppendorf, Hamburg, Germany.
Marie Carlotta
MC
Wais
Institute of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany.
Sigrun
S
Vehling
Department of Oncology/Hematology/Bone Marrow Transplantation/Pneumology, University Medical Center Eppendorf, Hamburg, Germany.
Carsten
C
Bokemeyer
Institute of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany; Section of Psychosocial Oncology, Institute of Medical Psychology and Medical Sociology, University Medical Center Leipzig, Leipzig, Germany.
Anja
A
Mehnert
D000328:Adult; D000369:Aged, 80 and over; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology*; D010166:Palliative Care; D028723:Personhood; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology*
Dignity; advanced cancer; dignity-related distress; distress; palliative care; self-perceived dignity; symptom burden; terminally ill