Demoralisation and its associated factors among cancer patients in a university hospital / Chin Han Lim
Objective: To date, there is no literature on demoralisation in Malaysian patients with cancer. The primary objective of this study was to examine the relationship between demoralisation with positive emotion, depression, distress, sociodemographic, disease and treatment-related factors. The Demo...
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| Format: | Thesis |
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2018
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| Online Access: | http://studentsrepo.um.edu.my/11568/4/han_lim.pdf http://studentsrepo.um.edu.my/11568/ |
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| Summary: | Objective: To date, there is no literature on demoralisation in Malaysian patients with cancer.
The primary objective of this study was to examine the relationship between demoralisation
with positive emotion, depression, distress, sociodemographic, disease and treatment-related
factors. The Demoralisation Scale had also been translated and validated into Malay language
for the use of the Malaysian patients.
Method: This was a cross-sectional study conducted in Universiti Malaya Medical Centre
(UMMC), Kuala Lumpur, Malaysia with the approval from the Medical Ethics Committee
was obtained. One hundred and seventy-eight subjects were recruited from the oncology and
haematological ward, day-care clinics and follow-up clinics from January to December 2017
based on the inclusion and exclusion criteria. The convenient sampling method was
employed. After obtaining the informed consent from the subjects, the sociodemographic and
clinical data of the subjects were collected. The subjects filled both English and Malay
versions of the Demoralisation Scales, Centre for Epidemiologic Studies Depression (CESD)
Scale and Distress Thermometer. SPSS v24.0 was used as a method for statistical analysis.
Descriptive analysis, Spearman’s correlation, chi-square test and multiple logistic regression
were used to examine demoralisation and its associated factors. Principal component factor
analysis, internal consistency test, intra-class correlation and receiver operating characteristic
curve were used for the validation of DS-M.
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Results: The mean age of the subjects was 53.6± 16.51 years old (range 18-86). Sixty-four
percent of the patients were female. In terms of race, most of the subjects were Chinese
(42.1%), followed by Malays (39.9%) and others (18%). The commonest religion was Islam
(41%), followed by Buddhism (27.5%) and Christianity (15.2%). About two fifths of the
subjects had breast cancer, and twenty-four percent of the subjects were at the advanced stage
of various cancer.
The mean score for the Malay version of the Demoralisation Scale (DS-M) was 18.79 +
15.30. 37.6% of the cancer patients were demoralised based on DS-M score >23. In the group
with high demoralisation, 61.2% were depressed (x2=72.76, p<0.01), 52.2% had low positive
emotion (x2=41.34, p<0.01) and 68.7% were distressed (x2=40.45, p<0.01).
On the other hand, in the group with low demoralisation, 95.5% were not depressed
(x2=72.76, p<0.01), 91% had high positive emotion (x2=41.34, p<0.01) and 79.3% were not
distressed (x2=40.45, p<0.01). Demoralisation was correlated positively with depression
(r=.78, p<.01) and distress level (r=.64, p<0.01). Inverse relationship was found between
demoralisation and positive emotion (r=-.69, p<.01). No significant association was found
between demoralisation with sex ((x2=.09, p=.77), age (x2=.12, p=.74), race (x2=2.23, p=.14),
religion (x2=2.97, p=.09), marital status (x2=.01, p=.95), employment status (x2=1.98, p=.16)
and income (x2=1.93, p=.17). The association between demoralisation and the type of cancer
(x2=.02, p=.90), stage of cancer (x2=.09, p=.77), duration since diagnosis (x2=.04, p=.85),
mode of treatment (x2
=.41, p=.52), medical illness (x2
=1.12, p=.57) and psychiatric illness
(x2=2.21, p=.14) were not significant as well.
The principal component analysis of DS-M yielded four-factor structures. The Cronbach’s
alpha for the total scale was .95, and the subscales ranged between 0.81-0.92. The
Spearman’s correlation showed a good convergent validity between DS-M and Distress
Thermometer (r=.64, p<0.05) and divergent validity between DS-M and PERS (r=-.69,
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p<.01). The AUC was 0.92 (SE: 0.02, p < 0.01, 95% CI 0.88-0.97). The optimal sensitivity
and specificity for the DS-M were shown by the cut-off score of 23.
Conclusion: Demoralisation was highly prevalent in Malaysian cancer patients. Depression
and distress were significantly related to demoralisation. The lower level of positive emotion
was found in the patient suffering high demoralisation and vice versa. The state of
demoralisation among the cancer patients should receive more attention from the oncology
and mental health teams. The validated Malay version of the demoralisation scale can be used
on the Malaysians to screen for demoralisation and institute early intervention. |
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