{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T19:57:56Z","timestamp":1778702276611,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","issue":"11","license":[{"start":{"date-parts":[[2015,11,1]],"date-time":"2015-11-01T00:00:00Z","timestamp":1446336000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Palliative Medicine"],"published-print":{"date-parts":[[2015,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Demoralization is a syndrome of existential distress characterized by loss of meaning and purpose in life, hopelessness, and helplessness. Empirical data on its occurrence and associated factors in terminally ill patients is limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The study objective was to determine the frequency of demoralization and its association with individual and disease-related characteristics and to analyze the association between demoralization and the preference to discuss expected survival.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We recruited\n                      <jats:italic toggle=\"yes\">N<\/jats:italic>\n                      \u2009=\u200955 terminally ill cancer patients (54% women, mean age 67 years) within 48 hours after admission to a specialized palliative care inpatient ward (55% had a Karnofsky performance status of \u226450). Patients completed the Demoralization Scale (DS), the Generalized Anxiety Disorder Scale-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and a single-item question measuring preferences for discussion of expected survival with a physician.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      We found clinically significant demoralization present in 19% and moderate demoralization present in 10% of participants. Better educated patients reported a higher level of demoralization (d\u2009=\u20090.74,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.010). Patients with a preference to discuss expected survival reported higher levels in the \u201closs of meaning and purpose\u201d dimension of demoralization (d\u2009=\u20090.76,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.010) and higher levels of anxiety (d\u2009=\u20090.88,\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u2009.003) compared to those not wanting to discuss survival.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Demoralization is a significant dimension of distress in terminally ill cancer patients. In the end-of-life inpatient care setting, the preference to discuss expected survival with a physician can parallel existential distress and anxiety. Further elucidation of patients' underlying existential needs will inform interventions that sustain meaning and hope in face of a limited life expectancy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/jpm.2015.0112","type":"journal-article","created":{"date-parts":[[2015,8,19]],"date-time":"2015-08-19T11:20:21Z","timestamp":1439983221000},"page":"970-976","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":21,"title":["The Preference to Discuss Expected Survival Is Associated with Loss of Meaning and Purpose in Terminally Ill Cancer Patients"],"prefix":"10.1177","volume":"18","author":[{"given":"Sigrun","family":"Vehling","sequence":"first","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne","family":"Kamphausen","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Oechsle","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swantje","family":"Hroch","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carsten","family":"Bokemeyer","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anja","family":"Mehnert","sequence":"additional","affiliation":[{"name":"University Medical Center Hamburg-Eppendorf","place":["Germany"]},{"name":"University Medical Center Leipzig","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2015,11,1]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951511000745"},{"key":"e_1_3_3_3_2","first-page":"1","article-title":"Meaning and existential givens in the lives of cancer patients: A philosophical perspective on psycho-oncology","author":"Vos J","year":"2014","unstructured":"Vos J: Meaning and existential givens in the lives of cancer patients: A philosophical perspective on psycho-oncology. Palliat Support Care, 2014:1\u201316.","journal-title":"Palliat Support Care"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2012.3633"},{"key":"e_1_3_3_5_2","article-title":"A review of the construct of demoralization: History, definitions, and future directions for palliative care","author":"Robinson S","year":"2014","unstructured":"Robinson S, , Kissane DW, , Brooker J, , Burney S: A review of the construct of demoralization: History, definitions, and future directions for palliative care. Am J Hosp Palliat Care, 2014. [E-pub ahead of print.]","journal-title":"Am J Hosp Palliat Care"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0018301"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(97)00040-3"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440-1614.2002.01086.x"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/0010-440X(93)90016-W"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.4103\/0973-1075.25913"},{"key":"e_1_3_3_11_2","first-page":"96","article-title":"Demoralization, anhedonia and grief in patients with severe physical illness","volume":"4","author":"Clarke DM","year":"2005","unstructured":"Clarke DM, , Kissane DW, , Trauer T, , Smith GC: Demoralization, anhedonia and grief in patients with severe physical illness. World Psychiatry, 2005; 4:96\u2013105.","journal-title":"World Psychiatry"},{"key":"e_1_3_3_12_2","first-page":"1","article-title":"Demoralization: A systematic review on its clinical characterization","author":"Tecuta L","year":"2014","unstructured":"Tecuta L, , Tomba E, , Grandi S, , Fava GA: Demoralization: A systematic review on its clinical characterization. Psychol Med, 2014:1\u201319.","journal-title":"Psychol Med"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.07.008"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951509990253"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1177\/082585970402000402"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1044"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1708\/1292.14291"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.02.013"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1866"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0059417"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.04.095"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1080\/10810730902806786"},{"key":"e_1_3_3_23_2","first-page":"37","article-title":"Controversies in oncologist-patient communication: A nuanced approach to autonomy, culture, and paternalism","volume":"26","author":"Cherny NI","year":"2012","unstructured":"Cherny NI: Controversies in oncologist-patient communication: A nuanced approach to autonomy, culture, and paternalism. Oncology, 2012; 26:37\u201343,46.","journal-title":"Oncology"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.11.138"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0165-0327(03)00198-8"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.166.10.1092"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318160d093"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.psy.46.2.109"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0037167"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.57.2198"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216313507757"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2009.04.021"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2011.0249"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2006.9.1359"},{"key":"e_1_3_3_35_2","article-title":"Living with advanced cancer and an uncertain disease trajectory: An emerging patient population in palliative care?","author":"Lobb EA","year":"2013","unstructured":"Lobb EA, , Lacey J, , Kearsley J, et al.: Living with advanced cancer and an uncertain disease trajectory: An emerging patient population in palliative care?. BMJ Supp Pall Care, 2013. [E-pub ahead of print.]","journal-title":"BMJ Supp Pall Care"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2014.11.293"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2012.45.5865"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.5271"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70002-X"}],"container-title":["Journal of Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1089\/jpm.2015.0112","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jpm.2015.0112","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1089\/jpm.2015.0112","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T16:55:00Z","timestamp":1777654500000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1089\/jpm.2015.0112"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,11,1]]},"references-count":38,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2015,11,1]]}},"alternative-id":["10.1089\/jpm.2015.0112"],"URL":"https:\/\/doi.org\/10.1089\/jpm.2015.0112","relation":{},"ISSN":["1096-6218","1557-7740"],"issn-type":[{"value":"1096-6218","type":"print"},{"value":"1557-7740","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,11,1]]}}}