Detrimental social interactions predict loss of dignity among patients with cancer

• Published in: Supportive care in cancer Vol. 24; no. 6; pp. 2751 - 2758
• Main Authors: Philipp, R., Mehnert, A., Lehmann, C., Oechsle, K., Bokemeyer, C., Krüll, A., Vehling, S.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2016; Springer; Springer Nature B.V
• Subjects: Adult; Aged; Analysis; Anxiety; Anxiety - etiology; Anxiety - psychology; Cancer; Cancer patients; Depression - etiology; Depression - psychology; Female; Follow-Up Studies; Humans; Interpersonal Relations; Male; Measuring instruments; Medical research; Medicine; Medicine & Public Health; Mental depression; Middle Aged; Neoplasms - complications; Neoplasms - psychology; Nursing; Nursing Research; Oncology; Original Article; Pain Medicine; Rehabilitation Medicine; Social aspects; Social interaction; Social Support; Depression; Anxiety; Loss of dignity; Social support; Cancer
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-016-3090-9

Purpose
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.
Methods
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.
Results
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.
Conclusion
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.