title: Detrimental social interactions predict loss of dignity among patients with cancer.
abstract: This prospective study aimed to determine the extent to which cancer patients experience loss of dignity during primary cancer care (baseline) and at 3-month follow-up and the contribution of positive social support and detrimental social interactions on loss of dignity at follow-up.
  
  
  
  At baseline, we enrolled N = 270 cancer patients (advanced cancer 57 %) undergoing oncological treatment. At follow-up, n = 178 patients (72 %) participated. Patients completed the following questionnaires: sense of dignity item (SDI), physical problem list of the NCCN Distress Thermometer, Illness-Specific Social Support Scale (SSUK), Patient Health Questionnaire (PHQ-9), and Generalized Anxiety Disorder Questionnaire (GAD-7). We conducted ordinal regression analyses controlling for age, gender, tumor stage, number of physical symptoms, depression, and anxiety.
  
  
  
  At baseline, 18 % of the patients experienced moderate to extreme loss of dignity (follow-up 23 %, p = 0.27). Detrimental interactions significantly predicted loss of dignity (OR = 1.42, 95 % CI 1.06-1.90) in a model including positive support (OR = 1.10, 95 % CI 0.82-1.49), depression (OR = 1.55, 95 % CI 0.96-2.51), and anxiety (OR = 1.20, 95 % CI 0.83-1.74). Items in relation to detrimental interactions with significant others such as "made you feel like you couldn't take care of yourself" (r = 0.29, p < 0.001) and "felt uncomfortable in illness conversations" (r = 0.24, p = 0.002) showed the highest associations with perceived loss of dignity.
  
  
  
  Loss of dignity was a frequent problem in our mixed cancer patient sample. Detrimental interactions that weaken the sense of dignity may result from discrepancies with patients' needs for autonomy and security. Tailoring social support to attachment-related patient needs may help to conserve patients' sense of dignity.
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52-W26, 20246, Hamburg, Germany. r.philipp@uke.de.
authors.forename: R
authors.initials: R
authors.lastname: Philipp
authors.affiliation: Department of Medical Psychology and Medical Sociology, Division of Psychosocial Oncology, University Medical Center Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Mehnert
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52-W26, 20246, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Lehmann
authors.affiliation: Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52-O24, 20246, Hamburg, Germany.|University Cancer Center Hamburg (UCCH)-Hubertus Wald Tumor Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52-O24, 20246, Hamburg, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Oechsle
authors.affiliation: Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Martinistr. 52-O24, 20246, Hamburg, Germany.|University Cancer Center Hamburg (UCCH)-Hubertus Wald Tumor Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52-O24, 20246, Hamburg, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Bokemeyer
authors.affiliation: University Cancer Center Hamburg (UCCH)-Hubertus Wald Tumor Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52-O24, 20246, Hamburg, Germany.|Department of Radiotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52-O26, 20246, Hamburg, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Krüll
authors.affiliation: Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52-W26, 20246, Hamburg, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Vehling
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000209:etiology / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000523:psychology*; D012944:Social Support
keywords: Anxiety; Cancer; Depression; Loss of dignity; Social support
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