Advances in the Understanding of Demoralization in Oncology and Palliative Care

Abstract

Over the last decade, psychosocially-oriented assessment methods, rather than nosological psychiatric systems, have been used in oncology and palliative care to detect clinically relevant dimensions with prognostic and therapeutic implications. Demoralization has emerged as one of the most important constructs, a clinical syndrome distinct from other psychiatric disorders (e.g., major depression, dysthymia, adjustment disorders, post-traumatic stress disorder [PTSD]). A number of recent studies have shown that demoralization in cancer patients is related to confrontation with existential stressors that impair the sense of mastery and competence of the individual throughout the illness and across all disease stages. Clinically, demoralization is characterized by feelings of subjective incompetence in dealing with stress, a sense of failure to meet the expectations of others, a sense of being trapped, accompanied with feelings of impotence, isolation, and despair, hopelessness or loss of meaning and purpose in life. Demoralization has a remarkable role in negatively influencing a patients’ quality of life, coping styles, and dignity and in increasing the risk for suicidal ideation. This article presents and discusses the most recent emerging issues related to demoralization in oncology and palliative care in terms of prevalence, diagnostic boundaries, and consequences to clinical practice. Important tools for the assessment of demoralization are also summarized and implications for future research are discussed.