Demoralization and dignity loss in breast cancer: A network analysis and computer simulation study

Objective Demoralization and loss of dignity frequently co-occur among individuals with cancer. However, their symptom-level associations remain poorly characterized. This study aimed to delineate the underlying pathways linking demoralization and dignity loss in breast cancer survivors and to identify potential symptom targets for intervention. Methods A total of 411 female breast cancer survivors were assessed using the Demoralization Scale II and the Patient Dignity Inventory. A Gaussian graphical model was used to identify central and bridge symptoms, while a Bayesian network model estimated the directional associations and potential causal pathways between demoralization and dignity-related symptoms. Computer-simulated intervention analyses were conducted to determine which symptom reduction would yield the greatest decrease in overall network activation. Results In the Gaussian network, illness uncertainty emerged as the most central symptom (strength = 1.20), and loss of life meaning as the principal bridge symptom (bridge strength = 0.30). The Bayesian network identified distress as an upstream node triggering downstream cascades from demoralization to dignity loss. Simulation analyses indicated that reducing distress led to the largest decrease in global network activation (from 5.3% to 1.9%). Conclusions This study elucidates the symptom-level mechanisms through which demoralization contributes to dignity loss in breast cancer survivors, highlighting loss of life meaning as a key bridging factor. Targeting distress may represent an effective intervention strategy to concurrently alleviate demoralization and preserve dignity.