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Prediction of end-of-life fears in COPD – hoping for the best but preparing for the worst

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Objective: The diagnosis of a life-threatening illness can trigger end-of-life fears. Early studies show that end-of-life fears play an important role in chronic obstructive pulmonary disease (COPD). However, predictors of these fears have not yet been identified. This study investigated the relevance of socio-demographic variables, illness severity, psychological distress and disease-specific anxieties as predictors of end-of-life fears in COPD.

Design: A total of 131 COPD patients participated at two time points. Regression and mediation analyses, as well as cross-lagged panel analyses were conducted.

Main outcome measures: The participants completed questionnaires assessing end-of-life fears (Multidimensional Orientation toward Dying and Death Inventory), psychological distress (Hospital Anxiety and Depression Scale), and disease-specific anxieties (COPD Anxiety Questionnaire). Pulmonary function and a 6-min walk test served as measures of illness severity.

Results: Illness severity was not predictive of end-of-life fears. However, gender and psychological distress explained incremental variance. When disease-specific anxieties were included as additional predictors, psychological distress was no longer significant. Cross-lagged panel analyses mostly supported these results. Moreover, disease-specific anxieties mediated the association between psychological distress and end-of-life fears.

Conclusion: Administration and intensity of end-of-life care (especially concerning end-of-life fears) in COPD patients should be based not only on illness severity, but rather on psychological distress and disease-specific anxieties.
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Keywords: chronic obstructive pulmonary disease; coping with chronic illnesses; disease-specific anxieties; end-of-life fears

Document Type: Research Article

Affiliations: 1: Department of Psychology, Division of Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany 2: Department of Psychology, Division of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Marburg, Germany 3: Department of Pneumology, Allergology, and Sleeping Medicine, Schoen Klinik Berchtesgadener Land, Marburg, Germany

Publication date: September 2, 2015

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