title: Distress, delay of gratification and preference for palliative care in men with prostate cancer.
abstract: BACKGROUND
  Patient-centered cancer care standards include routine psychosocial distress screening and referral for supportive care services. Although many cancer patients report psychosocial distress that could be alleviated by supportive services including palliative care, patients often decline such services for reasons that are poorly understood. Research on decision-making suggests that during periods of acute distress, individuals have more difficulty prioritizing long-term over immediate gains. Thus, distressed cancer patients may prioritize immediate gains (e.g., avoidance of palliative care discussions in the moment) over longer-term gains (e.g., improved quality of life in the future).
  
  
  METHODS
  This study investigated the associations between psychosocial distress, difficulties with delay of gratification (tendency to prioritize short-term over longer-term gains), and preference for palliative care in a sample of 212 men with a history of prostate cancer (94% white men and 27% advanced stage, age M = 62, SD = 8). It was hypothesized that psychosocial distress would be associated with lower preferences for palliative care, and this association would be explained, in part, by difficulty delaying gratification. Self-report measures included the depression anxiety stress scales, delay of gratification inventory, and ratings on an item assessing preferences for palliative care.
  
  
  RESULTS
  Consistent with the hypothesis, mediation models confirmed that the association of psychosocial distress with lower preference for palliative care was mediated by delay of gratification.
  
  
  CONCLUSIONS
  Findings suggest that distressed prostate cancer patients may benefit from additional support managing the emotional aspects of medical decisions and weighing immediate versus delayed outcomes.
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
authors.forename: James
authors.initials: J
authors.lastname: Gerhart
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Yasmin
authors.initials: Y
authors.lastname: Asvat
authors.affiliation: Department of Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Lattie
authors.affiliation: Department of Palliative Medicine, Rush University Medical Center, Chicago, IL, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: O'Mahony
authors.affiliation: Departments of Psychiatry and Family Medicine, University of Rochester, Rochester, NY, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Duberstein
authors.affiliation: Department of Psychology, Tulane University, New Orleans, LA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hoerger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D065786:Delay Discounting; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology*; D057240:Patient Preference / Q000706:statistics & numerical data*; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy; D013315:Stress, Psychological / Q000523:psychology*