Quality of life and death anxiety among caregivers of patients with advanced cancer: the mediating effect of trait anxious personality and the moderating effect of social support.

Publisher: Springer International Country of Publication: Germany NLM ID: 9302957 Publication Model: Electronic Cited Medium: Internet ISSN: 1433-7339 (Electronic) Linking ISSN: 09414355 NLM ISO Abbreviation: Support Care Cancer Subsets: MEDLINE

Original Publication: Berlin : Springer International, c1993-

Quality of Life*/psychology ; Caregivers*/psychology ; Neoplasms*/psychology ; Social Support* ; Anxiety*/psychology ; Anxiety*/etiology ; Personality*; Humans ; Male ; Female ; Middle Aged ; Adult ; Aged ; Attitude to Death ; Surveys and Questionnaires

Purpose: To explore the mediating role of trait anxious personality in the association between quality of life (QoL) and death anxiety (DA), as well as to test the moderating effect of social support in the mediation model.
Methods: The Death Anxiety Scale, Quality of Life Scale, State-Trait Anxiety Scale, and Social Support Rating Scale were used to measure 588 family caregivers of advanced cancer patients. We then constructed a moderated mediation model.
Results: The presence of QoL was negatively associated with DA (β =  - 0.67, p < 0.01). Trait anxious personality partially mediated the relationship between QoL and DA (indirect effect β =  - 0.08, p < 0.01). Social support moderated both the antecedent and subsequent segments of the mediating paths of "QoL → trait anxious personality → DA" and the direct relationship between QoL and DA. Among caregivers with a low level of social support, the mediating effect coefficient of trait anxious personality was higher at 0.25 (95% confidence interval (CI): 0.059-0.182), in contrast to caregivers with a high level of social support, where the mediating effect coefficient of trait anxious personality was 0.11 (95% CI: 0.029-0.072).
Conclusion: QoL is directly associated with an increased risk of DA and indirectly related to DA by increasing the risk of trait anxious personality among caregivers. Social support can moderate the mediating effect of trait anxious personality and the relationship between QoL and DA. The intervention strategy for preventing DA among caregivers who have encountered QoL reduction should focus on reducing trait anxious personality and social support.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71:209–249. (PMID: 33538338)
Holm M, Årestedt K, Öhlen J, Alvariza A (2020) Variations in grief, anxiety, depression, and health among family caregivers before and after the death of a close person in the context of palliative home care. Death Stud 44:531–539. (PMID: 30907298)
Sharif Nia H, Lehto RH, Pahlevan Sharif S, Mashrouteh M, Goudarzian AH, Rahmatpour P, Torkmandi H, Yaghoobzadeh A (2021) A cross-cultural evaluation of the construct validity of Templer’s death anxiety scale: a systematic review. OMEGA J Death Dying 83:760–776.
Onyechi KCN, Onuigbo LN, Eseadi C, Ikechukwu-Ilomuanya AB, Nwaubani OO, Umoke PC, Agu FU, Otu MS, Utoh-Ofong AN (2016) Effects of rational-emotive hospice care therapy on problematic assumptions, death anxiety, and psychological distress in a sample of cancer patients and their family caregivers in Nigeria. Int J Environ Res Public Health 13:929. (PMID: 276570995036761)
Litzelman K, Green PA, Yabroff KR (2016) Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems. Support Care Cancer 24:763–771. (PMID: 26143040)
Choi JY, Chang YJ, Song HY, Jho HJ, Lee MK (2013) Factors that affect quality of dying and death in terminal cancer patients on inpatient palliative care units: perspectives of bereaved family caregivers. J Pain Symptom Manage 45:735–745. (PMID: 23102560)
Uslu-Sahan F, Terzioglu F, Koc G (2019) Hopelessness, death anxiety, and social support of hospitalized patients with gynecologic cancer and their caregivers. Cancer Nurs 42:373–380. (PMID: 29933308)
Alkan A, Köksoy EB, Karci E, Alkan A, Bruera E, Çay Şenler F (2020) Posttraumatic growth and death anxiety in caregivers of cancer patients: PHOENIX study. Turk J Med Sci 50:1364–1370. (PMID: 324906357491265)
Soleimani MA, Lehto RH, Negarandeh R, Bahrami N, Chan YH (2017) Death anxiety and quality of life in Iranian caregivers of patients with cancer. Cancer Nurs 40:E1–E10. (PMID: 26925995)
Sherman DW, Norman R, McSherry CB (2010) A comparison of death anxiety and quality of life of patients with advanced cancer or AIDS and their family caregivers. J Assoc Nurses AIDS Care 21:99–112. (PMID: 20006525)
Suzuki M (2012) Quality of life, uncertainty, and perceived involvement in decision making in patients with head and neck cancer. Number 6 39:541–548.
Furer P, Walker JR (2008) Death anxiety: a cognitive-behavioral approach. J Cogn Psychother 22(2):167–182.
Brown AJ, Shen MJ, Ramondetta LM, Bodurka DC, Giuntoli RL, Diaz-Montes T (2014) Does death anxiety affect end-of-life care discussions? Int J Gynecol Cancer: Off J Int Gynecol Cancer Soc 24(8):1521.
Sinoff, G (2017) Thanatophobia (death anxiety) in the elderly: the problem of the child’s inability to assess their own parent’s death anxiety state. Front Med 11.
Lee HJ, Jo KH (2006) A path model for death anxiety to suicidal ideation of the elderly. J Korean Gerontol Soc 26:717–731.
Egloff B, Hock M (2001) Interactive effects of state anxiety and trait anxiety on emotional Stroop interference. Pers Individ Dif 31:875–882.
Spielberger CD (1966) Theory and research on anxiety. Anxiety Behav 1:413–428.
Yıldız M, Bulut MB (2017) Relationship among death anxiety and personality traits[J]. Electron Turk Stud 12(13):659–676.
Özdemir S, Kahraman S (2021) Ertufan H (2021) Comparison of death anxiety, self-esteem, and personality traits of the people who live in Turkey and Denmark. Omega (Westport) 84(2):360–377. (PMID: 31726938)
Abdel-Khalek AM (2002) Death, anxiety, and depression: a comparison between Egyptian, Kuwaiti, and Lebanese undergraduates. OMEGA J Death Dying 45:277–287.
Bovero A, Cotardo F, Pierotti V, Gottardo F, Botto R, Opezzo M, Geminiani GC (2021) Personality traits and sense of dignity in end-of-life cancer patients: a cross-sectional study. Am J Hosp Palliat Care 38(1):39–46. (PMID: 33256475)
Uslu-Sahan F, Terzioglu F, Koc G (2019) Hopelessness, death anxiety, and social support of hospitalized patients with gynecologic cancer and their caregivers. Cancer Nurs 42(5):373–380. (PMID: 29933308)
Scheffold K, Philipp R, Koranyi S, Engelmann D, Schulz-Kindermann F, Härter M, Mehnert A (2018) Insecure attachment predicts depression and death anxiety in advanced cancer patients. Palliat Support Care 16(3):308–316. (PMID: 28502270)
Creswell KG, Cheng Y, Levine MD (2015) A test of the stress-buffering model of social support in smoking cessation: is the relationship between social support and time to relapse mediated by reduced withdrawal symptoms? Nicotine Tob Res 17:566–571. (PMID: 25257978)
Templer DI (1970) The construction and validation of a death anxiety scale. J Gen Psychol 82:165–177. (PMID: 4394812)
Soleimani MA, Bahrami N, Yaghoobzadeh A, Banihashemi H, Nia HS, Haghdoost AA (2016) Validity and reliability of the Persian version of Templer death anxiety scale in family caregivers of cancer patients. Iran J Nurs Midwif Res 21:284–290.
Yang H, Han L, Guo H (2012) Study on the cross-cultural adjustment and application of the Death Anxiety Scale. Chin J Pract Nurs. 53–57.
Whoqol Group (1995) The World Health Organization quality of life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 41:1403–1409.
Sjolander C, Rolander B, Järhult J, Mårtensson J, Ahlstrom G (2012) Health-related quality of life in family members of patients with an advanced cancer diagnosis: a one-year prospective study. Health Qual Life Outcomes 10:89. (PMID: 228464523489687)
Xiao S (1994) Theoretical basis and research application of social support rating scale. J Clin Psychiatry 4(2):98.
Li L, Zhu X, Yang C, Hu T, Zhao X, Li C, Wu M, Qiao G, Yang F (2021) Social support and coping style of tongqi in China: a cross-sectional study. Arch Psychiatr Nurs 35:317–322. (PMID: 33966799)
Spielberger RL Gorsuch, Lushene RE (1970) State-trait anxiety inventory. palo Alto. Consulting Psychologists Press.
Hayes AF (2018) Introduction to mediation, moderation, and conditional process analysis: a regression-based approach, 2nd edn. Guilford Press.
Lau BHP, Wong DFK, Fung YL, Zhou J, Chan CLW, Chow AYM (2018) Facing death alone or together? Investigating the interdependence of death anxiety, dysfunctional attitudes, and quality of life in patient–caregiver dyads confronting lung cancer. Psychooncology 27:2045–2051. (PMID: 29785836)
Lyon ME, Jacobs S, Briggs L, Cheng YI, Wang J (2014) A longitudinal, randomized, controlled trial of advance care planning for teens with cancer: anxiety, depression, quality of life, advance directives, spirituality. J Adolesc Health 54:710–717. (PMID: 24411819)
Clak DA, Beck AT (1999) Scientific foundations of cognitive theory and therapy of depression. John Wiley & Sons, New York.
Bibi A, Khalid MA (2020) Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan. Death Stud 44:787–792. (PMID: 31094668)
Götze H, Brähler E, Gansera L, Polze N, Köhler N (2014) Psychological distress and quality of life of palliative cancer patients and their caring relatives during home care. Support Care Cancer 22:2775–2782. (PMID: 24811216)
Burnette D, Duci V, Dhembo E (2017) Psychological distress, social support, and quality of life among cancer caregivers in Albania. Psychooncology 26:779–786. (PMID: 26810582)
Doka KJ (2015) Hannelore wass: death education—an enduring legacy. Death Stud 39(9):545–548. (PMID: 26280195)
Wang T, Cheung K, Cheng H (2024) Death education interventions for people with advanced diseases and/or their family caregivers: a scoping review. Palliat Med 38(4):423–446. (PMID: 38634233)
Kuru Alıcı N, Zorba Bahceli P, Emiroğlu ON (2018) The preliminary effects of laughter therapy on loneliness and death anxiety among older adults living in nursing homes: a nonrandomised pilot study. Int J Older People Nurs 13(4):e12206. (PMID: 30004172)
Eseadi C (2019) Rational-emotive behavioral intervention helped patients with cancer and their caregivers to manage psychological distress and anxiety symptoms. World Journal of Clinical Oncology 10(2):62. (PMID: 308153726390117)
Zhang JX, Peng JX, Gao P, Huang H, Cao Y, Zheng L, Miao D (2019) Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator. BMC Geriatr 19(1):308. (PMID: 317185616852934)

N2022Y05 the Young Talents Training Foundation in Nursing of Sun Yat-sen University, China

Keywords: Caregivers; Death anxiety; Moderated mediation model; Quality of life; Social support; Trait anxious personality

Date Created: 20240701 Date Completed: 20240701 Latest Revision: 20240715

20240715

10.1007/s00520-024-08653-6

38949725