Susan Burney

A Systematic Review of the Demoralization Syndrome in Individuals With Progressive Disease and Cancer: A Decade of Research

CONTEXT Demoralization can be understood as a condition that results from existential conflict. It presents with symptoms of hopelessness and helplessness caused by a loss of purpose and meaning in life. It is a significant mental health concern given there can be an associated desire for hastened death. OBJECTIVES The aim of this systematic review was to synthesize the recent empirical evidence on demoralization in patients with progressive disease or cancer, including prevalence rates; the relationships between demoralization and sociodemographic, disease- and treatment-related, and psychological factors; and the psychometric properties of demoralization measures. METHODS A comprehensive literature search using key words and subject headings was performed following PRISMA guidelines with nine electronic bibliographic databases, resulting in 25 studies (33 articles) with a total of 4545 participants reviewed. Full articles underwent methodological quality assessment, and correlational information was synthesized according to the strength of evidence. RESULTS The findings suggest that demoralization is prevalent in patients with progressive disease or cancer and clinically significant in 13%-18%. A range of factors were consistently associated with demoralization: poorly controlled physical symptoms, inadequately treated depression and anxiety, reduced social functioning, unemployment, and single status. The Demoralization Scale has demonstrated good psychometric properties across five studies. CONCLUSION Overall, this systematic review was limited by the extent of variability in the characteristics of studies. Patients who are single, isolated or jobless, have poorly controlled physical symptoms, or have inadequately treated anxiety and depressive disorders are at increased risk for demoralization. Clinical recognition of demoralization can trigger more focused interventions.

Home-based palliative care: a systematic literature review of the self-reported unmet needs of patients and carers

Background: There have been many studies on the unmet needs of palliative care patients and carers from the perspective of bereaved caregivers. However, the unmet needs of palliative care patients and carers from the perspective of current patients and their carers have received little research attention. Aim: As home-based services have become one of the main delivery models of palliative care, the aim of this review was to describe, evaluate and summarise the literature on the unmet needs of palliative home care patients and carers. Design: The systematic review of qualitative and quantitative studies was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources: PubMed, CINAHL, Embase, MEDLINE, PsycINFO, AMED and CareSearch were searched to find empirical studies on the self-reported unmet needs of palliative home care patients and carers. Results: Nine qualitative studies, three quantitative studies and three mixed-design studies were identified. The most frequently reported unmet need was effective communication with health-care professionals, the lack of which negatively impacted on the care received by patients and carers. Physical care needs were met, which indicates that the examined palliative home care services were delivering satisfactory care in this domain, but lacking in other areas. Conclusions: The focus therefore should be on improving other aspects of patient care, including communication by health professionals to prevent or reduce suffering in areas such as psychosocial domains. Valid and reliable quantitative measures of unmet needs in palliative care are needed to examine this area more rigorously.

Correlates of post-traumatic stress symptoms and growth in cancer patients: a systematic review and meta-analysis

The aim of this study is to examine the relationships among demographic, medical, and psychosocial factors and post‐traumatic stress symptoms (PTSS) and post‐traumatic growth (PTG) in oncology populations.

Anxiety in the management of localised prostate cancer by active surveillance.

To describe a range of anxieties in men on active surveillance (AS) for prostate cancer and determine which of these anxieties predicted health‐related quality of life (HRQL).

A Review of the Construct of Demoralization History, Definitions, and Future Directions for Palliative Care

Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.

The role of rumination in affective distress in people with a chronic physical illness: A review of the literature and theoretical formulation

The role of maladaptive cognitive content among individuals with chronic physical illness has been acknowledged in cognitive models. Rumination has been documented as a key predictor of depression, and to a lesser extent of anxiety, in non-clinical samples. This paper provides a preliminary discussion of the potential role of rumination as a causal and maintaining factor for emotional distress in the setting of chronic physical illness. Although a number of methodological limitations exist, the current research on rumination may provide a useful framework for the extension of existing cognitive models in chronic illness.

Factors associated with adherence to physical activity guidelines in patients with prostate cancer

This study aimed to estimate the proportion of patients with prostate cancer (PCa) meeting the National Physical Activity Guidelines of Australia (NPAGA) and determine sociodemographic and medical factors associated with meeting these guidelines. Secondary aims included examining physical activity (PA) levels by treatment type and domain (leisure, work, transport and domestic) and establishing a predictive model of the likelihood that men with PCa would meet NPAGA.

Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy

To evaluate the effects of androgen deprivation therapy (ADT) on depression, anxiety and quality of life (QoL) in patients with prostate cancer (PCa) and to examine the relationship between meeting the National Physical Activity Guidelines of Australia (NPAGA) and the presence and severity of both psychological sequelae and physical side effects associated with ADT. A secondary purpose was to examine the predictors of depression, anxiety and QoL in patients with PCa.

The Relationship of Knowledge, Health Value and Health Self-efficacy with Men’s Intentions to Receive the Human Papillomavirus (HPV) Vaccine

The aim of the present study was to determine whether it was possible to predict Human Papillomavirus (HPV) vaccination intentions an Australian male sample. One hundred and twenty one males aged 18 to 26 (M = 22.3, SD = 2.06), completed an online survey assessing HPV-related knowledge, health beliefs and health self-efficacy. HPV knowledge and health self-efficacy were significant independent predictors of vaccine acceptance. A moderating effect was found between HPV knowledge and health self-efficacy. It was concluded that the results of previous research into the predictors of HPV vaccination intentions can largely be applied to an Australian male population.

The impact of physical activity on psychosocial outcomes in men receiving androgen deprivation therapy for prostate cancer: a systematic review.

OBJECTIVE Depression, anxiety, and cognitive dysfunction are common complaints in men with prostate cancer (PCa) receiving androgen deprivation therapy (ADT). Consequently, the quality of life (QoL) of these men is negatively impacted. This systematic review evaluated the effectiveness of physical activity (PA) as an intervention to improve depression and anxiety symptoms, cognitive function, and QoL in patients receiving ADT for PCa. METHODS Inclusion criteria and search strategy were defined and documented in a protocol registered with the International Prospective Register of Systematic Reviews (Registration # CRD42012002666). Due to the limited number of studies examining these outcomes in this patient group, no limitations were placed on study designs included. A systematic search of Ovid MEDLINE, PsycINFO, EMBASE, Informit, Scopus, Cochrane Library, and CINAHL databases identified 7 relevant peer-reviewed studies: 4 clinical PA interventions, 2 pilot studies, and 1 cross-sectional survey. Data extraction and risk of bias assessment tools developed by the Cochrane Collaboration were used to evaluate evidence. RESULTS Existing data suggest that PA improved QoL in men with PCa receiving ADT. The existing evidence, however, is not sufficiently robust to determine the adequacy of PA as an intervention to improve depression, anxiety, and cognitive function outcomes in this patient group. CONCLUSIONS Despite the lack of studies conducted, preliminary findings support the utility of PA for improving QoL in men undergoing ADT for PCa. A clear gap in the current literature was identified, confirming the need for further clinical trials in which depression, anxiety, and cognitive function are evaluated.