A concept map of death-related anxieties in patients with advanced cancer

Vehling, Sigrun; Malfitano, Carmine; Shnall, Joanna; Watt, Sarah; Panday, Tania; Chiu, Aubrey; Rydall, Anne; Zimmermann, Camilla; Hales, Sarah; Rodin, Gary; Lo, Christopher

doi:10.1136/bmjspcare-2016-001287

Cited by 35 publications

(27 citation statements)

References 38 publications

(10 reference statements)

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“…Finally, 1 study explored anxiety related to death in patients suffering from cancer [39], disclosing that the most central concern related to death is “running out of time.” The authors also identified nodes that act as a bridge between 2 death-related anxiety clusters (i.e., 1 related to practical fears regarding the process of dying, and the other to existential concerns). These findings suggest that psychology interventions should be aimed at targeting those central symptoms to alleviate anxiety related to death.…”

Section: Resultsmentioning

confidence: 99%

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

Contreras

Nieto

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et al. 2019

Psychother Psychosom

288

214

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Background: Network analysis (NA) is an analytical tool that allows one to explore the map of connections and eventual dynamic influences among symptoms and other elements of mental disorders. In recent years, the use of NA in psychopathology has rapidly grown, which calls for a systematic and critical analysis of its clinical utility. Methods: Following PRISMA guidelines, a systematic review of published empirical studies applying NA in psychopathology, between 2010 and 2017, was conducted. We included the literature published in PubMed and PsycINFO using as keywords any combination of “network analysis” with the terms “anxiety,” “affective disorders,” “depression,” “schizophrenia,” “psychosis,” “personality disorders,” “substance abuse” and “psychopathology.” Results: The review showed that NA has been applied in a plethora of mental disorders in adults (i.e., 13 studies on anxiety disorders; 19 on mood disorders; 7 on psychosis; 1 on substance abuse; 1 on borderline personality disorder; 18 on the association of symptoms between disorders), and 6 on childhood and adolescence. Conclusions: A critical examination of the results of each study suggests that NA helps to identify, in an innovative way, important aspects of psychopathology like the centrality of the symptoms in a given disorder as well as the mutual dynamics among symptoms. Yet, despite these promising results, the clinical utility of NA is still uncertain as there are important limitations on the analytic procedures (e.g., reliability of indices), the type of data included (e.g., typically restricted to secondary analysis of already published data), and ultimately, the psychometric and clinical validity of the results.

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Section: Resultsmentioning

confidence: 99%

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

Contreras

Nieto

Valiente

et al. 2019

Psychother Psychosom

288

214

View full text Add to dashboard Cite

show abstract

“…Its conceptual closeness to death anxiety is supported by a recent integrative model identifying threat of loss and death, ongoing uncertainty and limited control, and continual reminders of cancer as relevant sources of anxiety for all patients with cancer . Advanced cancer brings fear of the process of dying, its consequences for close others, regret about not having reached important goals and being a burden, well exemplified by studies using the Death and Dying Distress Scale (DADDS) and the Patient Dignity Inventory (PDI) . Similar fears may underlie the fear of recurrence in cancer survivors.…”

Section: How Does Existential Distress Arise?mentioning

confidence: 99%

Existential distress in cancer: Alleviating suffering from fundamental loss and change

2018

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A severe life threatening illness can challenge fundamental expectations about security, interrelatedness with others, justness, controllability, certainty, and hope for a long and fruitful life. That distress and suffering but also growth and mastery may arise from confrontation with an existentially threatening stressor is a longstanding idea. But only recently have researchers studied existential distress more rigorously and begun to identify its distinct impact on health care outcomes.Operationalizations of existential distress have included fear of cancer recurrence, death anxiety, demoralization, hopelessness, dignity-related distress, and the desire for hastened death. These focus in varying emphasis on fear of death, concern about autonomy, suffering, or being a burden to others; a sense of profound loneliness, pointlessness or hopelessness; grief, regret, or embitterment about what has been missed in life; and shame if dignity is lost or expectations about coping are not met.We provide an overview of conceptual issues, diagnostic approaches, and treatments to alleviate existential distress. Although the two meta-analyses featured in this special issue indicate the progress that has been made, many questions remain unresolved. We suggest how the field may move forward through defining a threshold for clinically significant existential distress, investigating its comorbidity with other psychiatric conditions, and inquiring into adjustment processes and mechanisms underlying change in existential interventions. We hope that this special issue may inspire progress in this promising area of research to improve recognition and management of a central psychological state in cancer care. KEYWORDScancer, death anxiety, demoralization, existential distress, existential suffering, existential therapy, fear of cancer recurrence, hopelessness, sense of dignity

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“…Since desire to die may be a potential way to cope with advanced disease at some point during the disease trajectory [33], exploring it and allowing its emotional expression in conversation may be beneficial to all patients. A desire to die can be expressed in different ways and proactively addressing it may help to clarify reasons more openly and at an earlier stage.…”

Section: Discussionmentioning

confidence: 99%

The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach

et al. 2020

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Background: Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress. Methods: Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria. Results: 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die". Conclusions: We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeuticallybased on evidence, patients' views and consensus among professional experts. Trial registration: The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

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A concept map of death-related anxieties in patients with advanced cancer

Cited by 35 publications

References 38 publications

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

The Study of Psychopathology from the Network Analysis Perspective: A Systematic Review

Existential distress in cancer: Alleviating suffering from fundamental loss and change

The desire to die in palliative care: a sequential mixed methods study to develop a semi-structured clinical approach

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