Understanding factors influencing demoralization among cancer patients based on the bio-psycho-social model: A systematic review.

ABSTRACT

OBJECTIVE: Demoralization is a prevalent psychological problem among cancer patients and reflects a sense of subjective incompetence. This systematic review aims to identify factors influencing demoralization among cancer patients. METHODS: Eleven databases were systematically searched from database inception to 31 December 2020. Google Scholar and relevant reference lists were supplementarily searched. Studies reporting demoralization measured by Demoralization Scale and its influencing factors among cancer patients were included. A qualitative synthesis was conducted owing to the heterogeneity of the study outcome. RESULTS: A total of 49 studies involving 10,712 participants were included in this review. The results showed substantial effect size variation, but the psychological factors showed the strongest magnitude of association. Among the biological factors, the number of physical symptoms (mean r values [rs] 0.331) was associated with increased demoralization. Among the psychological factors, negative psychological factors include hopelessness (mean rs 0.633), desire for death (mean rs 0.620), dignity-related distress (mean rs 0.595), depression (mean rs 0.593), anxiety (mean rs 0.589), psychological distress (mean rs 0.465), and suicidal ideation (mean rs 0.460) were related to increased demoralization; whereas positive psychological factors including hope (mean rs -0.565), attachment security (mean rs -0.530), and sense of coherence (mean rs -0.453) were related to decreased demoralization. Among the social factors, social support (mean rs -0.330) was negatively related to demoralization, and the demographic factors were still controversial. Quality of life was considered to be at the intersection of biopsychosocial factors and negatively associated with demoralization (mean rs -0.599). CONCLUSIONS: Demoralization is a consequence of the interaction of physical, psychological, and social factors among cancer patients. Factors with a significant effect should not be overlooked when designing an intervention to reduce demoralization. It is necessary to distinguish demoralization from other negative psychological states and further explore positive psychological factors influencing demoralization among cancer patients.