Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China

Hui Liu; Xiaocheng Liu; Zhili Liu; Yao Wang; Ruiling Feng; Ruihua Zheng; Rongzhi Xie; Hongmei Tao; Yanchun Wu; Xiaomin Li; Wenjuan Ying; Xiaoying Wu

doi:10.1016/j.apjon.2022.100134

Death anxiety and its relationship with family function and meaning in life in patients with advanced cancer-A cross-sectional survey in China

Asia Pac J Oncol Nurs. 2022 Aug 26;9(10):100134. doi: 10.1016/j.apjon.2022.100134. eCollection 2022 Oct.

Authors

Hui Liu¹, Xiaocheng Liu², Zhili Liu³, Yao Wang⁴, Ruiling Feng⁴, Ruihua Zheng³, Rongzhi Xie⁵, Hongmei Tao⁵, Yanchun Wu³, Xiaomin Li⁴, Wenjuan Ying³, Xiaoying Wu⁶

Affiliations

¹ Nursing Department, Cancer Hospital of Shantou University Medical College, Shantou, China.
² Nursing Department, Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China.
³ Nursing Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.
⁴ Shantou University Medical College, Shantou, China.
⁵ Nursing Department, The Fifth Affiliated Hospital of Sun-Yat-Sen University, Zhuhai, China.
⁶ Nursing Department, Shantou Central Hospital, Shantou, China.

Abstract

Objective: This study explores the factors influencing death anxiety in patients with advanced cancer, and to investigate the role of family function on death anxiety, and the correlation between meaning in life and death anxiety.

Methods: Patients with advanced cancer who were hospitalized in three institutions from November 2020 to May 2021 were recruited in this cross-sectional study. The Chinese version of the Death and Dying Distress Scale, Meaning in Life Scale For Advanced Cancer Patients and Family APGAR Index were used to assess death anxiety, meaning in life and family function. Pain symptoms were evaluated by the Numeric Rating Scale. Karnofsky Performance Status, patients' socio-demographic and clinical variables were also recorded. Statistical analyses were performed using IBM SPSS Statistics for Windows (version 26.0). Multivariate regression analysis was performed to examine the correlations of social-demographic and clinical variables with family function and death anxiety.

Results: Three hundred and twenty-eight patients with advanced cancer were included in this study. The results showed that 12.2% of patients experienced moderate to severe death anxiety. Meaning in Life Scale For Advanced Cancer Patients (acceptance of death, controlling one's life), types of institution (oncology department of tertiary hospitals), self-perceived economic burden (extreme), Karnofsky Performance Status score, age, and medical insurance status (self-paid, inter-provincial medical insurance) were identified as associated factors of death anxiety (R ² = 0.335, F = 20.072, P < 0.001). Patients with good family function scores had significantly low level of death anxiety in univariate analysis (F = 5.892, P = 0.003). Multivariate analysis revealed no significant association between family function and death anxiety.

Conclusions: Our results demonstrated that the oncology department of a tertiary hospital, extremely high of self-perceived economic burden, self-pay, and inter-provincial medical insurance might be associated with higher death anxiety in patients with advanced cancer. Lower level death anxiety was associated with higher level acceptance of death, a greater sense of life control, better physical performance, and older age. Further confirmation about the association between family function and death anxiety in patients with advanced cancer is warranted in the future.

Keywords: Advanced cancer; Death anxiety; Family function; Meaning in life.