Exploring the occurrence and the risk factors of the desire for hastened death and depression in people with early-stage dementia in Greece.

OBJECTIVES: To assess the factors associated with desire for hastened death and depression in early-stage dementia as well as the association between them. Also, to explore the mediator and moderator role of age in the relationship between depression and desire for hasten death. METHODS: A prospective cross-sectional study including 100 patients diagnosed with early-stage dementia from a rehabilitation center between December 2018 and July 2019. Measurement tools used were the Mini-Mental State Examination, the Greek Montreal Cognitive Assessment, the Greek Schedule of Attitudes toward Hastened Death, and the Geriatric Depression Scale-15 item. Patients diagnosed with dementia as a result of Stroke history were excluded. RESULTS: Factors of multifactorial analysis significantly associated with desire for hastened death were as follows: age (p = 0.009), marital status (p = 0.001), and depression (p < 0.001). The factor significantly associated with depression was age (p = 0.001). Also, a mediation/moderation analysis has shown that depression and age are significant predictors of desire for hasten death. SIGNIFICANCE OF RESULTS: The desire for hastened death and depression in people diagnosed with early-stage dementia includes many components. Younger patients, men, higher educated patients, single, childless, and those with higher depression scores had higher desire for hastened death, while men and older patients had higher scores of desire for depression. Our study provides important information about the desire for hastened death and depression in early-stage dementia, their risk factors, and their association.

Psychometric Properties of the Greek Version of Demoralization Scale-II (DS-II) in Patients with Cancer.

Introduction: The concept of demoralization is used to describe situations of existential distress and self-perceived inability to effectively deal with stressors. The Demoralization Scale-II (DS-II) is a short and modified version of the original DS that measures the level of demoralization in patients. The purpose of this study is to evaluate the psychometric properties of the Greek version of the Greek Demoralisation Scale-II (DS-II GR) in the population of patients with cancer. Methods: The main tool used in this cross-sectional study is the DS-II GR translated and evaluated for its psychometric properties in a sample of 150 Greek patients with cancer. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA), convergent validity, known groups' validity, cut-off points, internal consistency reliability and test-retest reliability were done. Results: According to the CFA, a two-factor model emerged with a different conceptual content and grouping than the original. The correlation coefficients between DS-II GR and Hospital Anxiety and Depression Scale-Greek (HADS-GR) The internal consistency of DS-II GR for factor 1, factor 2, and total score were measured with Cronbach's alpha and calculated to be 0.906, 0.810, and 0.913. Conclusion: The Greek version of the demoralization scale is reliable and valid for assessing demoralization in Greek patients with cancer.

Hope and Distress Symptoms of Oncology Patients in a Palliative Care Setting.

Background Hope has a positive impact on health, playing a significant role in managing illness and its associated losses. In oncology patients, hope is crucial for effective adaptation to the disease, as well as a strategy for coping with physical and mental distress. It enhances disease management, psychological adaptation, and overall quality of life. However, due to the complexity of the effect of hope on patients, particularly those under palliative care, identifying its relationship with anxiety and depression remains a challenge. Methodology In this study, 130 cancer patients completed the Greek version of the Herth Hope Index (HHI-G) and the Hospital Anxiety and Depression Scale (HADS-GR). Results The HHI-G hope total score was strongly negatively correlated with HADS-anxiety (r = -0.491, p < 0.001) and HADS-depression (r = -0.626, p < 0.001). Patients with performance status, as defined by the Eastern Cooperative Oncology Group (ECOG), of 0-1 without radiotherapy had higher HHI-G hope total scores compared to those with ECOG status 2-3 (p = 0.002) and radiotherapy (p = 0.009). Multivariate regression analysis showed that patients who received radiotherapy had 2.49 points higher HHI-G hope scores compared to those who did not (explaining 3.6% of hope). An increase of 1 point in depression led to a 0.65-point decrease in the HHI-G hope score (explaining 40% of hope). Conclusions A deeper understanding of common psychological concerns and hope in patients with serious illnesses can improve their clinical care. Mental health care should focus on managing depression and anxiety, as well as other psychological symptoms, to enhance and maintain patients' hope.

Herth Hope Index: A Psychometric Evaluation Study within a Sample of Greek Patients with Cancer.

OBJECTIVES: This study aims to develop the Greek version of the Herth Hope Index (HHI) and assess its psychometric properties to a palliative care patient sample, using a cross-sectional design. MATERIALS AND METHODS: The HHI was translated into Greek (HHI-Gr) using the 'forward-backward' procedure. It was administered to 130 eligible cancer patients, while for the stability of patients' responses, 40 of these patients completed the HHI-Gr 3 days later. Along with the HHI-Gr, patients also completed the Hospital Anxiety and Depression Scale (HADS) and the Beck Hopelessness Scale (BHS). The HHI-Gr internal consistency reliability (Cronbach's a), stability (intraclass correlation coefficient [ICC]), factor structure (factor analysis) and convergent validity (correlation with the HADS and the BHS questionnaires) were examined using the Eastern Cooperative Oncology Group (ECOG) performance status. RESULTS: The HHI-Gr yielded a one-factor model and a Cronbach alpha (0.860) with excellent internal consistency reliability and stability ICC (>0.90). Satisfactory convergent validity was supported by the correlation analysis between the HHI-Gr and BHS (r = 0.718, P < 0.001). Overall test-retest reliability was satisfactory with a range between 0.77 and 0.96 (P < 0.001). CONCLUSION: These results demonstrate that the HHI-Gr is an instrument with satisfactory psychometric properties and is a valid research tool for the measurement of the levels of hope among Greek oncology patients.

The Experience of Living With Breast Cancer and the Assessment of Needs and Expectations.

Living with a chronic disease constitutes a biographical reversal characterized by change and loss. The aims of this study are to conceptualize the meaning of breast cancer, of its burden, to explore the patient's needs and expectations while being admitted to a palliative care unit, and to evaluate the fulfillment of those expectations. Two semistructured interviews were conducted, audio taped, transcribed verbatim, and subjected to the qualitative method of Interpretative Phenomenological Analysis. The first interview was conducted at the first visit of the patient to the palliative care unit, and the second after 2 weeks of receiving palliative care services. Qualitative findings indicated that the meaning of cancer can be interpreted as a transition of fading away. The transition began with redefining cancer from "my difficult moment" to "fortunately to its final destination"; struggling with the paradox of "the will to see the development of yourself and your child" and "wishing to die" while being able to "adapt" to "a balanced" day to day leaving and preparing for death. The need for interdisciplinarity is expressed.

Complementary Therapies for Patients with Cancer: Reflexology and Relaxation in Integrative Palliative Care. A Randomized Controlled Comparative Study.

Objectives: Comparison of the effects of reflexology and relaxation on pain, anxiety, and depression, and quality of life (QoL) of patients with cancer. Design: A stratified random sample was selected, using an experimental design. Location: An outpatient Palliative Care Unit in Attica, Greece. Subjects: 88 patients suffering with cancer. Interventions: The sample was randomly divided into two equal groups, a reflexology and a relaxation group. The number of interventions for both groups was six 30-min weekly sessions. Outcome measures: The Greek Brief Pain Inventory (G-BPI) was used to measure pain, the Greek Hospital Anxiety and Depression Scale for screening anxiety and depression, and finally the Short Form Health Survey was used to measure QoL. Measurements of the above tools were taken three times in both groups as follows: preintervention, at fourth and at sixth week of intervention. Results: Anxiety and depression for both groups exhibited a statistically significant decrease during the observation period (p < 0.001, η2 > 0.25) but at the sixth week, there was a more significant decrease in the reflexology group compared with the relaxation group (p = 0.062, η2 = 0.044 vs. p = 0.005, η2 = 0.096 for anxiety), (p = 0.006, η2 = 0.094 vs. p = 0.001, η2 = 0.138 for depression). QoL physical and mental component measurements were significantly greater for the reflexology group (p < 0.001, η2 = 0.168 and p = 0.017, η2 = 0.071, respectively). The baseline-to-sixth week G-BPI measurements were markedly decreased for the reflexology group (p = 0.207, η2 = 0.020). Conclusions: Both interventions, relaxation and reflexology, seemed to be effective in decreasing anxiety and depression in patients with cancer. However, reflexology was found to be more effective in improving QoL (physical component) and to have a greater effect on pain management than relaxation.

Depression as a Mediator or Moderator Between Preparatory Grief and Sense of Dignity in Patients With Advanced Cancer.

The objectives of the study were to evaluate the relationship between depression, preparatory grief, and loss of dignity in patients with advanced cancer and whether depression has a mediator and/or a mediator role between preparatory grief and dignity. The participants were 120 patients with advanced cancer who completed the Greek version of the Patient Dignity Inventory, the Greek Hospital Anxiety and Depression Scale, and the Preparatory Grief in Advanced Cancer Patients questionnaire. Depression was highly correlated with preparatory grief and loss of dignity. Additionally, strong relationship was found between preparatory grief and loss of dignity. Mediation analyses revealed that preparatory grief influenced loss of dignity as well as indirectly by its effect on depression. However, there was not any affect of depression as moderator. The effect of depression on preparatory grief in patients with advanced cancer and dignity emphasizing the need for further research to confirm the current relationship as well as the need for treatment of depression.

Advanced Cancer Patients' Perceptions of Dignity: The Impact of Psychologically Distressing Symptoms and Preparatory Grief.

PURPOSE: The present study assesses the relationship between patient dignity in advanced cancer and the following variables: psychological distress, preparatory grief, and sociodemographic and clinical characteristics. METHODS: The sample consisted of 120 patients with advanced cancer. The self-administered questionnaires were as follows: the Preparatory Grief in Advanced Cancer Patients (PGAC), the Patient Dignity Inventory-Greek (PDI-Gr), the Greek Schedule for Attitudes toward Hastened Death (G-SAHD), and the Greek version of the Hospital Anxiety and Depression Scale (G-HADS). RESULTS: Moderate to strong statistically significant correlations were found between the 4 subscales of PDI-Gr (psychological distress, body image and role identity, self-esteem, and social support) with G-HADS, G-SAHD, and PGAC ( P < .005), while physical distress and dependency was moderately correlated with depression. Multifactorial analyses showed that preparatory grief, depression, and age influenced psychological distress, while preparatory grief, depression, and performance status influenced body image and role identity. CONCLUSIONS: Preparatory grief, psychological distress, and physical symptoms had significant associations with perceptions of dignity among patients with advanced cancer. Clinicians should assess and attend to dignity-distressing factors in the care of patients with advanced cancer.

Psychometric Properties of the Greek Version of the Patient Dignity Inventory in Advanced Cancer Patients.

CONTEXT: The patient dignity inventory (PDI) is an instrument to measure dignity distressing aspects at the end of life. OBJECTIVES: The aims of the present study were the translation of the PDI in Greek language as well as to measure its psychometric aspects in a palliative care unit. METHODS: A back-translation method was obtained at the Greek version. One hundred twenty advanced cancer patients completed the Greek version of the PDI, the Greek hospital anxiety and depression scale, the Greek schedule of attitudes toward hastened death (SAHD-Gr), and the Greek 12-item short form health survey. RESULTS: Confirmatory factor analysis failed to fit to the original instrument's structure and exploratory factor analysis was conducted revealing five factors ("Psychological Distress," "Body Image and Role Identity," "Self-Esteem," "Physical Distress and Dependency," and "Social Support"). The psychometric analysis of the PDI-Gr demonstrated a good concurrent validity, and the instrument discriminated well between subgroups of patients regarding age differences. Cronbach α were between 0.71 and 0.9 showing a good internal consistency. CONCLUSION: The Greek version of the PDI showed good psychometric properties in advanced cancer patients, supported the usefulness of the instrument assessing the sense of dignity distressing aspects of the terminally ill cancer patients.