Fear of Palliative Care: Roles of Age and Depression Severity.

Abstract

<b><i>Background:</i></b> Palliative care is underutilized due in part to fear and misunderstanding, and depression might explain variation in fear of palliative care. <b><i>Objective:</i></b> Informed by the socioemotional selectivity theory, we hypothesized that older adults with cancer would be less depressed than younger adults, and subsequently less fearful of utilizing palliative care. <b><i>Setting/Subjects:</i></b> Patients predominately located in the United States with heterogeneous cancer diagnoses (<i>n</i> = 1095) completed the Patient-Reported Outcomes Information System (PROMIS) Depression scale and rated their fear of palliative care using the Palliative Care Attitudes Scale (PCAS). We examined the hypothesized intercorrelations, followed by a bootstrapped analysis of indirect effects in the PROCESS macro for SPSS. <b><i>Results:</i></b> Participants ranged from 26 to 93 years old (mean [M] = 60.40, standard deviation = 11.45). The most common diagnoses were prostate (34.1%), breast (23.3%), colorectal (17.5%), skin (15.3%), and lung (13.5%) cancer. As hypothesized, older participants had lower depression severity (<i>r</i> = -0.20, <i>p</i> < 0.001) and were less fearful of palliative care (<i>r</i> = -0.11, <i>p</i> < 0.001). Participants who were more depressed were more fearful of palliative care (<i>r</i> = 0.21, <i>p</i> < 0.001). An indirect effect (<i>β</i> = -0.04, standard error = .01, 95% confidence interval: -0.06 to -0.02) suggested that depression severity may account for up to 40% of age-associated differences in fear of palliative care. <b><i>Conclusions:</i></b> Findings indicate that older adults with cancer are more likely to favor palliative care, with depression symptom severity accounting for age-related differences. Targeted interventions among younger patients with depressive symptoms may be helpful to reduce fear and misunderstanding and increase utilization of palliative care.