Research On The Degree Of Dignity Lose And Related Influence Factors For Advanced Cancer Patients

Objective: WHO laid special emphasis on the development and reinforcement of comprehensive national cancer control programmes,which include prevention,early detection,improved treatment and palliative care.As for palliative care,symptom control,patient support,improve the quality of life and many other aspects were particularly mentioned.Dignity is the philosophical foundation of palliative care and an essential component of individual psychological and physical health.There are already evidences that demonstrate quality of life of most cancer patients is seriously decreased,with varying degrees of dignity loss.Therefore,maintaining the dignity of cancer patients is an essential part of palliative care.Currently,the researches on the dignity of cancer patients mainly focus on the end stage of disease,exploring the sense of dignity and dignity therapy in the world.The degree of dignity lose in cancer patients can be deepened with the progression of the disease,and even become a main reason for patients giving up treatment.Therefore,could an early intervention for maintaining the patient's sense of dignity be delivered before the disease is terminal and the sense of dignity is damaged severely,so that their quality of life could be improved and they could die with dignity?This study is designed for exploring early targeted intervention before severe damage occurring on dignity,as well as enhancing the sense of dignity,improving quality of life and optimizing the holistic management of cancer.Sense of dignity was evaluated through questionnaires.Influencing factors and correlation with dignity lose was explored based on existing domestic and foreign research.Method:1 In this cross-sectional study,202 patients with advanced cancer wererecruited.They were treated in the Fourth Hospital of Hebei Medical University from December 1st,2016 to January 31 st,2017,and were pathologically diagnosed as malignant tumor.Informed consent has been signed by all the patients.2 Information and relevant risk factors affecting the dignity of patients with advanced cancer were collected and analyzed.Patient Dignity Inventory,the Chinese-language version of M.D.Anderson Symptom Inventory,the National Comprehensive Cancer Network Distress Thermometer,Hospital Anxiety and Depression Scale and Quality-of-Life Questionnaire-Core were applied.3 Statistical analysis: SPSS 21.0 software is used for all data analysis.According to PDI score,the degree of dignity was assessed and grouped.Associated factors were compared by Kruskal-Wallis H rank test.Multivariate logistic regression was used to analyze the independent influencing factors of dignity lose.Spearman's rank correlation was used to analyze the correlation between dignity lose and related influence factors as well as QLQ-C30 areas.All data were analyzed by bilateral test,setting the test level ? = 0.05,with P<0.05 as statistically significant.Results:1 The overall degree of dignity lose in advanced cancer patientsA total of 202 patients with advanced cancer were enrolled in this study,with 155 patients(76.73%)with mild dignity lose,37 patients(18.32%)with moderate dignity lose and 10 patients(4.95%)with severe dignity lose.So there were 23.27% of cancer patients with significant loss of dignity.Each patient had an average of 4.5 dignity-related issues,among which the 4 most common questions in the dignity-related score ? 3 were "Physically distressing symptoms(e.g.pain,short of breath,nausea,vomiting,etc.)"(36.63%),"Worried about future"(30.69%)"Feeling no longer who I was"(29.21%)"Feeling depressed"(27.23%).In the 5 dimensions of PDI,the most vulnerable one was symptom distress dimension,followed by the dimension of existential distress and dependency.2 The factors of the sense of dignity and correlation analysisThe incidence of distress in 202 patients was 50%.35.6% of patients had anxiety(HAD-A>7),of which 15.3% met the anxiety criteria(HAD-A?11).33.6% of patients had depression(HAD-D> 7 points),of which 16.8% of patients met the depression diagnostic criteria(HAD-D?11 points).The MDASI-C Symptom Rating Scale had the highest score for fatigue,followed by poor appetite,sleep disturbances,distress,dry mouth,and pain,etc.The factor that were most significantly impact on life was work(including housework),followed by fun in life and walking.The average number of moderate to severe symptoms every patient has was 5.24.Univariate analysis demonstrated that age,tumor metastasis,KPS score were the influencing factors of dignity(P=0.015,P=0.001,P<0.001).There was a significant correlation between age,tumor metastasis,KPS score and degree of dignity loss(correlation coefficient r=-0.195,P=0.005;r=0.235,P=0.001;r=0.478,P<0.001).Distress was also an influencing factors of dignity(P<0.001)and had a significant correlation between distress and the sense of dignity(r=0.37,P<0.001).Degree of anxiety and depression was the influencing factor of dignity and had a significant correlation with dignity level(r=0.538,P<0.001)The correlation coefficient of anxiety and depression was respectively r=0.538(P<0.001),r = 0.485(P <0.001).Pain,fatigue,nausea,vomiting and other symptoms and its interference on the life had a significant impact on the sense of dignity(P <0.001),which had a significant correlation with dignity as well(P<0.001).Multivariate logistic regression analysis showed that age,KPS score,anxiety,symptom burden and its disturbance on life were independent factors of dignity lose.3 Relationship between the level of dignity and quality of lifeThere was a significant correlation between the level of dignity and quality of life.The level of dignity was most relevant to emotional function in the function subscale(r =-0.67,P <0.001)and fatigue in the symptom subscale(r = 0.571,P<0.001).Conclusion:1 The degree of dignity lose in advanced cancer patients is mainly mild to moderate.In the 5 dimensions of PDI,the symptom distress dimension is most vulnerable,followed by the dimension of existential distress and dependency.2 Factors that affect the dignity of advanced cancer patients are age,tumor metastasis,KPS scores,distress,anxiety,depression,symptoms burden(e.g.pain,fatigue and so on)and its interference on life.Among them,age,KPS score,anxiety,symptom burden and its interference on life are the dignity independent influencing factors.3 Quality of life tends to decrease along with loss of dignity in advanced cancer patients.Results of this study could offer a guidance on early targeted intervention for maintaining the sense of dignity and improving the quality of life in advanced cancer patients.