Valentina Tesio

Terminally ill cancer patients often experience demoralization and loss of dignity, which undermines their spiritual wellbeing, which could, however, be supported by the presence of other factors such as self-transcendence and religious coping strategies. To assess self-transcendence and religious coping strategies and how they influence spirituality, we studied 141 end-stage cancer patients (64.3% male; mean age 68.6 ± 14.6) with a Karnofsky Performance Status ≤ 50 and a life expectancy ≤ 4 months using the Self-Transcendence Scale, the Demoralization Scale, the Functional Assessment of Chronic Illness Therapy—Spiritual Wellbeing (FACIT-Sp-12), the Brief Religious COPE, and the Patient Dignity Inventory. To understand the effects of these variables on spirituality, hierarchical multiple regression was performed on FACIT-Sp-12. The final model predicted 67% of the variance in spiritual wellbeing. Demoralization was the strongest influencing factor (β = −0.727, p < 0.001), followed by self-transcendence (β = 0.256, p < 0.001), and positive religious coping (β = 0.148, p < 0.05). This study suggests that self-transcendence and positive religious coping may be protective factors for spirituality in terminal cancer patients. These factors should be considered in treatment to promote spiritual wellbeing and improve patients’ quality of life at the end of life.

Objective To examine the relationship between demoralization and health‐related quality of life (HRQoL) in a sample of end‐of‐life cancer patients with a life expectancy of 4 months or less undergoing palliative care, controlling for sociodemographic, clinical, and psychological variables. Methods Sociodemographic, clinical, and psychological data from 170 end‐of‐life cancer patients were collected using the following scales: Edmonton Symptom Assessment System for palliative care patients' symptoms; Patient Health Questionnaire‐9 (PHQ‐9) for depressive symptoms; Functional Assessment of Cancer Therapy Scale ‐ General Measure (FACT‐G) for HRQoL; Functional Assessment of Chronic Illness Therapy ‐ Spiritual Well‐Being for spirituality (FACIT‐Sp); Demoralization Scale ‐ Italian Version (DS‐IT) for demoralization. Results The DS‐IT showed that 51.8% of cancer patients were severely demoralized. In addition, 36.5% of the sample had clinically significant depressive symptoms and QoL was severely impaired (FACT‐G). The result of regression analysis showed that demoralization (especially “Disheartenment” and “Sense of failure”) was the strongest contributor for HRQoL, followed by ESAS_Lack of Well‐Being and depression (PHQ‐9), with the final model explaining 66% of the variance of the FACT‐G. Conclusions The results highlight a very high prevalence of severe demoralization in end‐of life cancer patients. Moreover, demoralization was not only associated with patients' HRQoL, but it was also the most important contributing factor. This finding underscores the need to identify preventive or therapeutic psychological interventions that focus on preventing existential distress, and thus improve the QoL of dying patients in their last days of life.