Emotional distress predicts palliative cancer care attitudes: The unique role of anger

Brenna Mossman, Laura M. Perry, James I. Gerhart, Laurie E. McLouth, Ashley B. Lewson, Michael Hoerger

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: Although palliative care can mitigate emotional distress, distressed patients may be less likely to engage in timely palliative care. This study aims to investigate the role of emotional distress in palliative care avoidance by examining the associations of anger, anxiety, and depression with palliative care attitudes. Methods: Patients (N = 454) with heterogeneous cancer diagnoses completed an online survey on emotional distress and palliative care attitudes. Emotional distress was measured using the Patient-Reported Outcomes Measurement Information System anger, anxiety, and depression scales. The Palliative Care Attitudes Scale was used to measure palliative care attitudes. Regression models tested the impact of a composite emotional distress score calculated from all three symptom measures, as well as individual anger, anxiety, and depression scores, on palliative care attitudes. All models controlled for relevant demographic and clinical covariates. Results: Regression results revealed that patients who were more emotionally distressed had less favorable attitudes toward palliative care (p < 0.001). In particular, patients who were angrier had less favorable attitudes toward palliative care (p = 0.013) while accounting for depression, anxiety, and covariates. Across analyses, women had more favorable attitudes toward palliative care than men, especially with regard to beliefs about palliative care effectiveness. Conclusions: Anger is a key element of emotional distress and may lead patients to be more reluctant toward timely utilization of palliative care. Although psycho-oncology studies routinely assess depression or anxiety, more attention to anger is warranted. More research is needed on how best to address anger and increase timely utilization of palliative cancer care.

Original languageEnglish
Pages (from-to)692-700
Number of pages9
Issue number5
StatePublished - May 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.


  • anger
  • anxiety
  • attitude
  • cancer
  • depression
  • emotions
  • oncology
  • palliative care
  • palliative medicine
  • psychological distress

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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