{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T18:57:32Z","timestamp":1790449052845,"version":"4.1.0"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T00:00:00Z","timestamp":1781049600000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Demoralization is common in palliative psycho\u2010oncology settings. Although its relationship with other psycho\u2010existential conditions has been scrutinized, its co\u2010occurrence with adjustment disorder, as measured by the\n                      <jats:italic>Adjustment Disorder New Module\u201020<\/jats:italic>\n                      (ADNM\u201020), remains unexamined.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Estimate frequency and co\u2010occurrence of demoralization and adjustment disorder symptom domains among palliative outpatients and examine sociodemographic and psycho\u2010existential factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A single\u2010site, cross\u2010sectional survey at an academic cancer center used self\u2010reported web\u2010based screening questionnaires. Analyses included descriptive statistics, association tests, and hierarchical logistic regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Moderate\u2010to\u2010severe demoralization symptoms occurred in 43.3% (90% CI: 36.9\u201349.7) of the 164 outpatients. Among these, co\u2010occurrence with high\u2010risk adjustment disorder symptoms reached 77.6% (90% CI: 69.5\u201385.8) versus 54.9% (90% CI: 45.2\u201364.6) for moderate\u2010to\u2010severe depression symptoms (\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.001). High\u2010risk adjustment disorder was also frequent (44.1%, 90% CI: 34.4\u201353.8.3) and, along with moderate\u2010to\u2010severe depression (OR 7.23 and 8.67,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0&lt;\u00a00.01), was independently associated with moderate\u2010to\u2010severe demoralization.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Approximately half of oncology outpatients screened positive for demoralization or adjustment disorder, with substantial co\u2010occurrence reflecting their conceptually defined shared disruption of adaptive capacities. Demoralization demonstrates incomplete overlap at the symptom\u2010domain level and appears to capture a distinct existential dimension of distress. This pattern supports consideration of routine screening and further empirical evaluation of its potential diagnostic positioning. Clinician\u2010administered longitudinal studies incorporating item\u2010level analyses are warranted to clarify temporal relationships, refine discriminant validity, and further evaluate demoralization as a distinct diagnostic entity. Such work may enhance recognition of existential suffering and inform targeted integrative interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70522","type":"journal-article","created":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T04:38:01Z","timestamp":1781152681000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Demoralization and Associated Factors in Palliative Oncology Outpatients: A Cross\u2010Sectional Study"],"prefix":"10.1002","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2386-1749","authenticated-orcid":false,"given":"Michael","family":"Ljuslin","sequence":"first","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Supportive Oncology Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"},{"name":"Division of Palliative Medicine, Department of Rehabilitation and Geriatrics Geneva University Hospitals  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Boston Massachusetts USA"},{"name":"Department of Supportive Oncology Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kate","family":"Lally","sequence":"additional","affiliation":[{"name":"Harvard Medical School  Boston Massachusetts USA"},{"name":"Department of Supportive Oncology Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"},{"name":"Department of Medicine, Division of Palliative Medicine Brigham and Women's Hospital  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emanuele","family":"Mazzola","sequence":"additional","affiliation":[{"name":"Department of Supportive Oncology Dana\u2010Farber Cancer Institute  Boston Massachusetts USA"},{"name":"Department of Data Science Dana\u2010Farber Cancer Institute  Boston Massachusetts 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