Depressive symptoms, fear of emotional expression, and less favorable attitudes toward palliative care

Many patients with cancer are reluctant to consider palliative care services due to fears and misconceptions regarding the goals of palliative care. Depressive symptoms also predict less preferential attitudes toward palliative care. Individuals often respond to stressful events including serious illness and depression with defensiveness, withdrawal, and avoidance of otherwise supportive relationships, particularly if they fear that others will judge their emotional reactions. Thus, patients experiencing depressive symptoms may be reluctant to consider palliative care because they fear the consequences of accepting their vulnerable emotions and expressing them to others—potentially because they have been previously criticized for expressing their emotions. Depression is a heterogeneous disorder. Loss of interest, low mood, difficulty concentrating, and pessimistic beliefs may make it difficult for some patients to accurately assess the potential benefits of palliative care, while physiological symptoms such as fatigue, sleep, and psychomotor disturbances may create barriers to adjusting routines. Patients who inhibit their emotions tend to experience higher levels of distress and, for reasons poorly understood, tend to have poorer cancer outcomes. Patients with depression may adopt a decision-making style that prioritizes the short-term relief of avoiding emotional distress over the possible long-term benefits of addressing their palliative care needs. Another possibility is that fears of expressing emotion could also lead these patients to avoid upsetting healthcare consultations, and procedures such as palliative care that may enhance emotional and physical well-being, if not subtle increases in survival 5,6 This study investigated the potential role that fear of emotional expression may play in shaping preferences for palliative care. Understanding these fears could potentially help to enhance palliative care utilization in at-risk and acutely distressed patients. A mediation model was computed to test the hypothesis that the association of depression with less preferential attitudes toward palliative care would be mediated by fears of emotional expression.