The association of self-blame with treatment preferences in a multi-country cohort of advanced cancer patients from the APPROACH study.

Journal Article (Multicenter Study;Journal Article)


To understand the prevalence of behavioral and characterological self-blame and their associations with stated preferences for life-extension and the use of pain-relief medication in a multi-country cohort of advanced cancer patients.


The prevalence of self-blame and reasons participants attributed to their diagnosis was assessed in a sample of 968 advanced cancer patients enrolled in one of five sites from four Asian countries of the multi-country cross-sectional survey titled APRROACH. Ordered probit and Firth logistic regressions were used to determine associations between each type of self-blame and two treatment-related outcomes: participants' stated preference for life-extension and the use of pain-relief medication in the last 24 h.


Behavioral and characterological self-blame were reported by 41% and 49% of the participants respectively, with only 19% and 2% of participants providing a logically consistent reason for the two types of self-blame. We observed no statistically significant differences in stated preferences for life-extension for either type of self-blame and in the use of pain-relief medication for participants reporting behavioral self-blame. However, participants reporting characterological self-blame were 9.7% (95% CI, 2.0% to 17.3%; p = 0.014) more likely to report using pain-relief medication compared to participants not reporting characterological self-blame.


A substantial proportion of patients report self-blame and those reporting characterological self-blame appear more likely to use pain medication. Therefore, developing interventions aimed at reducing characterological self-blame might help patients receive only appropriate treatments as opposed to treatments pursued in response to feelings of self-blame.

Full Text

Duke Authors

Cited Authors

  • Doble, B; Lau, E; Malhotra, C; Ozdemir, S; Teo, I; Finkelstein, EA; APPROACH Study Group,

Published Date

  • December 2020

Published In

Volume / Issue

  • 139 /

Start / End Page

  • 110284 -

PubMed ID

  • 33152649

Electronic International Standard Serial Number (EISSN)

  • 1879-1360

International Standard Serial Number (ISSN)

  • 0022-3999

Digital Object Identifier (DOI)

  • 10.1016/j.jpsychores.2020.110284


  • eng