The growing interest in the psychological distress in patients with cancer has been the major reason for the conduction of this study. The aims were to assess the relationship of hopelessness, anxiety, distress, and preparatory grief, as well as their predictive power to hopelessness. Ninety-four patients with advanced cancer completed the study at a palliative care unit in Athens, Greece. Beck Hopelessness Scale, the Greek version of the Hospital Anxiety and Depression (HAD) scale, and the Preparatory Grief in Advanced Cancer Patients scale were administered. Information concerning patients' treatment was acquired from the medical records, whereas physicians recorded their clinical condition. Hopelessness correlated significantly with preparatory grief (r = .630, P < .0005), anxiety (r = .539, P < .0005), depression (r = .642, P < .0005), HAD-Total (r = .686, P < .0005), and age (r = −.212, P = .040). Multiple regression analyses showed that preparatory grief (P < .0005), depression (P < .0005), and age (P = .003) were predictors of hopelessness, explaining 58.8% of total variance. In this patient sample, depression, preparatory grief, and patients' age were predictors of hopelessness.
Results
Descriptive Results
All three scales (i.e., BHS, PGAC, and HAD) are normally distributed, as examined using the Kolmogorov–Smirnov test of normality. The Cronbach's alpha values of the study instruments were the following: BHS: .959, HAD-A: .820, HAD-D: .750, and PGAC: .857. The mean age of the participants was 57.65 years (SD = 14.0, range = 24–85). Of the 94 patients, 53 were female (56.4%). Gastrointestinal and urogenital cancers were diagnosed in 31.9% and 23.4%, respectively. A significant proportion (51.1%) had a poor performance status, and 60.6% had undergone chemotherapy ( Table 1). Mean ± SD hopelessness score ( Table 2) was 9.93 ± 7.38. Moderate hopelessness was experienced by 20.2% of the patients, whereas 35.1% had severe hopelessness (data not shown in table). Patients' mean ± SD anxiety and depression scores were 9.85 ± 4.71 and 8.95 ± 3.57, respectively. Possible anxiety and depression were observed in 36.2% and 31.9% of the participants, respectively ( Table 3).
Table 2.
Descriptive Statistics of Assessed Measurements
M SD Minimum Maximum
Hopelessness (BHS) 9.93 7.38 0.00 20.00
Grief total (PGAC-total) 42.49 13.97 14 76
Anxiety (HAD-A) 9.85 4.71 0.00 21.00
Depression (HAD-D) 8.95 3.57 3.00 17.00
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Table 3.
Categorization of the Assessed Measurements
n %
Hopelessness (BHS) 33 35.1
No
Mild 9 9.6
Moderate 19 20.2
Severe 33 35.1
Anxiety (HAD-A)
No 21 22.3
Possible 34 36.2
Probable 27 28.7
Severe 12 12.8
Depression (HAD-D)
No 29 30.9
Possible 30 31.9
Probable 32 34.0
Severe 3 3.2
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Univariate Analysis
Significant correlations were found between hopelessness and the measurements of preparatory grief (r = .630, P < .0005), anxiety (r = .539, P < .0005), depression (r = .642, P < .0005), and the HAD-T scale (r = .686, P < .005). From the sociodemographic characteristics, the only correlation observed was between hopelessness and age (r = −.212, P = .040) ( Table 4). No significant correlations were observed between hopelessness and patients' clinical characteristics ( Table 5).
Table 4.
Correlation Between Hopelessness (BHS), Preparatory Grief (PGAC-total), Anxiety (HAD-A), Depression (HAD-D), HAD-T, Age, and Education
BHS
Grief total (PGAC-total)
r .630
P <.0005
Anxiety (HAD-A)
r .539
P <.0005
Depression (HAD-D)
r .642
P <.0005
HAD-T
r .686
P <.0005
Age
r .212
P .040
Education
r −.115
P .280
Note. Significant correlations are in bold.
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Table 5.
Comparison Between BHS and Patients' Sociodemographic and Clinical Categorical Characteristics
BHS
M SD P
Gender .653
Male 10.32 6.40
Female 9.62 6.41
Metastasis .488
No 10.18 5.84
Yes 8.83 5.01
Chemotherapy .972
No 9.89 6.53
Yes 9.95 6.34
Radiotherapy .253
No 10.58 6.33
Yes 8.76 6.43
ECOG .485
0–1 10.76 7.11
2–3 9.13 6.58
Cancer location .549
Gastrointestinal 10.57 7.13
Lung 9.50 7.01
Urogenital 9.91 7.50
Breast 9.00 7.22
Other 9.80 7.85
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Multiple Regression
Multiple regression analysis (stepwise method) was conducted to evaluate the unique contribution of the variables found to have statistically significant associations with hopelessness (preparatory grief, anxiety, depression, and age). The results are shown in Table 6. For the prediction of hopelessness, the model (F = 3.90, P < .0005) explained 58.8% of the variance. Increased total grief (P < .0005), high depressive symptoms (P < .0005), and younger age (P = .003) were significant predictors of hopelessness. On the other hand, none of the clinical characteristics were predictors of hopelessness. All assessed variables (BHS, PGAC, and HAD) had VIF <2.0, condition index <10.0, and eigenvalues >50%.
Table 6.
Multiple Regression Analysis (Stepwise Method) of Hopelessness (BHS), with Preparatory Grief (PGAC), Depression (HAD-D), and Age
Dependent: BHS B SE P
Constant −13.920 2.770 <.0005
PGAC-total 0.907 0.164 <.0005
Depression (HAD-D) 0.223 0.042 <.0005
Age 0.108 0.036 .003
Note. R2 = .588, F(3, 90) = 42.76, P < .0005, and SE of the estimate = 4.82.
