{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T12:02:02Z","timestamp":1761739322696,"version":"build-2065373602"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"unspecified","delay-in-days":301,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Pall Supp Care"],"published-print":{"date-parts":[[2025]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec id=\"S1478951525100813_sec1a\">\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Palliative care enhances life, but rural Australia faces significant inequities, and psychosocial distress, an important yet often overlooked aspect, is under-recognized in these settings. This study examines how psychosocial distress evolves in rural palliative patients using the Death and Dying Distress Scale (DADDS).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525100813_sec2b\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A longitudinal study was conducted with palliative care patients in rural hospitals on Australia\u2019s east coast. Distress levels were measured using DADDS at multiple timepoints. Mixed-effects models assessed distress trajectories, while survival analyses (Weibull model) examined whether average distress changes predicted survival duration. For comparability, DADDS scores in mixed-effects models were standardized (0\u2013100%), whereas survival analyses used raw total score changes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525100813_sec3c\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Adjusted mean total DADDS was 37.14 \u00b1 22.67, with highest distress in\n                      <jats:italic>fear of suffering and pain<\/jats:italic>\n                      (49.95 \u00b1 26.56) and lowest in\n                      <jats:italic>fear of sudden death<\/jats:italic>\n                      (30.26 \u00b1 30.24). Distress followed a U-shaped trajectory: peaking early (52.68), declining mid (29.85) and late stages (28.26), then rising near death (53.05) (EMMs). Statistically significant changes included declines from early to mid-stage (\u03b2 = \u221222.84, p = 0.007) and increases from late to near-death (\u03b2 = 24.79, p = 0.003). Distress increased most from late to near-death in fear of suffering and death (\u03b2 = 27.38, p = 0.006) and declined most from early to mid-stage in fear of dying (\u03b2 = 28.01, p = 0.007). Higher distress correlated with shorter survival; each one-point increase in distress linked to a 6.97% survival reduction (time ratio = 0.930, \u03b2 = \u22120.070, p &lt; 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S1478951525100813_sec4d\">\n                    <jats:title>Significance of results<\/jats:title>\n                    <jats:p>Psychosocial distress peaks in early palliative care and near death and is associated with reduced survival. Support should prioritize fears of suffering and pain during these stages, address fear of the dying process earlier, and remain attentive to persistent concerns such as loss of time and opportunity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1017\/s1478951525100813","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T05:49:27Z","timestamp":1761716967000},"update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":0,"title":["Psychosocial distress in rural palliative care: Preliminary longitudinal findings using the DADDS"],"prefix":"10.1017","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1888-871X","authenticated-orcid":false,"given":"Geena","family":"Bennett","sequence":"first","affiliation":[{"name":"University of Newcastle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-8647-5600","authenticated-orcid":false,"given":"Felicity","family":"Bates","sequence":"additional","affiliation":[{"name":"Senior Clinical Pharmacist, Mid North Coast Local Health District"},{"name":"College of Health, Medicine and Wellbeing, University of Newcastle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5525-6589","authenticated-orcid":false,"given":"Kerith","family":"Duncanson","sequence":"additional","affiliation":[{"name":"University of Newcastle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4030-7686","authenticated-orcid":false,"given":"Ian","family":"Heslop","sequence":"additional","affiliation":[{"name":"College of Health, Medicine and Wellbeing, University of Newcastle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3473-8009","authenticated-orcid":false,"given":"Jennifer","family":"Schneider","sequence":"additional","affiliation":[{"name":"University of Newcastle"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7080-0108","authenticated-orcid":false,"given":"Sarah","family":"Dineen-Griffin","sequence":"additional","affiliation":[{"name":"College of Health, Medicine and Wellbeing, University of Newcastle"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"S1478951525100813_ref16","unstructured":"NSW Health (n.d.) [region-blinded] Local Health District ([region-blinded] LHD). Sydney: NSW Health. Available at https:\/\/www.health.nsw.gov.au\/lhd\/Pages\/[region-blinded]lhd.aspx (accessed 20 March 2025 )."},{"key":"S1478951525100813_ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2007.11.010"},{"volume-title":"GPower* Ver 3.1.9.7","year":"2020","author":"Faul","key":"S1478951525100813_ref6"},{"volume-title":"R: A Language and Environment for Statistical Computing Ver 4.3.2","year":"2023","key":"S1478951525100813_ref18"},{"key":"S1478951525100813_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2022.08.002"},{"key":"S1478951525100813_ref21","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-024-01408-4"},{"key":"S1478951525100813_ref4","unstructured":"Australian Institute of Health and Welfare (AIHW) (2024) Palliative care services in Australia. Canberra: AIHW. Available at https:\/\/www.aihw.gov.au\/reports\/palliative-care-services\/palliative-care-services-in-australia\/contents\/overview (accessed 20 March 2025 )."},{"key":"S1478951525100813_ref24","doi-asserted-by":"publisher","DOI":"10.25259\/IJPC_381_20"},{"key":"S1478951525100813_ref20","unstructured":"SAS Institute Inc (2023) JMP\u00ae, Ver 17. Cary, NC: SAS Institute Inc."},{"key":"S1478951525100813_ref2","unstructured":"Australian Bureau of Statistics (ABS) (2021) 2021 Census QuickStats: Mid North Coast. Canberra: ABS. Available at https:\/\/www.abs.gov.au\/census\/find-census-data\/quickstats\/2021\/108 (accessed 20 March 2025 )."},{"key":"S1478951525100813_ref14","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313507757"},{"key":"S1478951525100813_ref17","unstructured":"Parliament of New South Wales (Parliament of NSW) (2022). Health outcomes and access to health and hospital services in rural, regional, and remote New South Wales. Sydney: Parliament of NSW. Available at https:\/\/www.parliament.nsw.gov.au\/lcdocs\/inquiries\/2615\/Report%20no%2057%20-%20PC%202%20-%20Health%20outcomes%20and%20access%20to%20services.pdf (accessed 20 March 2025 )."},{"key":"S1478951525100813_ref27","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2016-001287"},{"key":"S1478951525100813_ref1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4843"},{"key":"S1478951525100813_ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-021-06727-3"},{"key":"S1478951525100813_ref26","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4872"},{"key":"S1478951525100813_ref3","unstructured":"Australian Government Department of Health and Aged Care (Department of Health and Aged Care) (2024) Modified Monash Model. Canberra: Australian Government Department of Health and Aged Care. 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Published by Cambridge University Press.","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}],"article-number":"e194"}}