The incidence of suicide among patients with cancer in the United States is twice that of the general population. Studies demonstrate that demoralization, defined as lowered morale and perceived incapacity to cope, is strongly and independently related to suicidal ideation among cancer patients. Nancy Gilbert, MSN, RN, OCN and colleagues performed a retrospective analysis to determine the prevalence of suicidal ideation in cancer patients. Ms. Gilbert, nurse manager in the Psychiatric Oncology Center at MD Anderson Cancer Center, spoke with i3 Health about her research findings and implications for nursing practice.
Can you tell us the scope of the problem you investigated and your approach?
Nancy Gilbert, MSN, RN, OCN: I studied the demoralization syndrome as it relates to suicidal ideation in adult ambulatory cancer patients. It was a retrospective analysis of psychological skills relating to patients using the Demoralization Scale-II and the patient health questionnaire 9. We looked at two specific questions that related to suicidality.
What were your findings?
Ms. Gilbert: We had 922 patients: average age 53, white females, in committed relationships. Out of the 922 patients, 14% of the patients completing the Patient Health Questionnaire endorsed suicidal thoughts: "Thoughts that you would be better off dead or of hurting yourself in some way." Of the patients who completed the Demoralization Scale-II, 17% endorsed suicidality: "I would rather not be alive."
Although the majority of patients did not have suicidal thoughts, 14% and 17% are still significant numbers, so the intent of this research was to highlight demoralization so that nurses can assess high-risk patients and refer them out to appropriate mental health services.
What are the key takeaways of your presentation?
Ms. Gilbert: The key take home message is that nurses should be familiar with demoralization syndrome and recognize it in their patients. They can do that using the literature, but they can also use the scales. I included the actual scales on the poster so that nurses can see the content and be aware that these are topics that patients bring up when caring for them. They need to be alert, assess a bit further, and then discuss it with the patient's care team.
About Ms. Gilbert
Nancy R. Gilbert, MSN, RN, OCN, is the nurse manager in the Psychiatric Oncology Center at MD Anderson Cancer Center. She has been an oncology nurse for 23 years and has previously presented at ONS Congress.
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