Obliged to fight? Patient moral processes in the face of poor prognosis cancer.

Objective: Theoretical work suggests that moral psychological processes-those pertaining to the interests or welfare of others-are a key driver of overtreatment at the end of life. We examined patient moral processes and their associations with distress and treatment decision-making.

Method: During structured interviews with 116 patients with advanced cancer and a poor prognosis, Likert scale items were used to operationalize (a) moral emotions: feeling shame and guilt about cancer getting worse, (b) moral motives for cancer treatment: perceiving an obligation to family for continuing potentially nonbeneficial treatments, and (c) moral performance: putting up the appearance of feeling better than how one is really feeling (5-point response scale, not at all to a great deal). Several distress and end-of-life decision-making variables were also assessed.

Results: Most patients reported moral motives for cancer treatments and engaging in moral performance (35%-88% responded "a little" or higher for each of the 10 items). The mean moral motives score was associated with a higher likelihood of choosing life-extending care over comfort care (t = -3.16, p = .002) and a lower likelihood of having an advance care planning discussion (t = 3.19, p = .002). Moral performance was associated with worse distress regarding prognosis (r_s = .32, p = .001), worse psychological symptoms (r_s = -.26, p = .004), and less peaceful acceptance of cancer (r_s = -.25, p = .006).

Conclusions: For patients with advanced cancer, moral processes are prevalent and influential on how they behave and make treatment decisions. Attention must be paid to how these moral processes can result in more intensive treatments than warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).