Assessment of the wish to hasten death in patients with advanced cancer: A comparison of 2 different approaches

Bellido-Pérez, Mercedes; Crespo, Iris; Wilson, Keith G.; Porta-Sales, Josep; Balaguer, Albert; Monforte-Royo, Cristina

doi:10.1002/pon.4689

Cited by 20 publications

(11 citation statements)

References 36 publications

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“…Further research could investigate the development and validation of a short form for the SAHD‐Senior because clinical uptake and usefulness improve significantly if a short form is available. Another open question concerning the SAHD is the cutoff value: in line with the traditional SAHD instrument we also used the value of 10 as a cutoff for the SAHD‐Senior, but this cutoff was criticized as arbitrary and needs further confirmation by qualitative studies or concurrent measurement with other tools that assess the wish to die …”

Section: Discussionmentioning

confidence: 99%

Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments

Dürst

Spencer

Büla

et al. 2020

J American Geriatrics Society

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OBJECTIVES The wish to die may be different in geriatric patients than in younger terminally ill patients. This study aimed to develop and validate instruments for assessing the wish to die in geriatric patients. DESIGN Cross‐sectional study. SETTING Geriatric rehabilitation unit of a university hospital. PARTICIPANTS Patients (N = 101) aged 65 years or older with a Mini‐Mental State Examination score of 20 or higher, admitted consecutively over a 5‐month period. MEASUREMENTS The Schedule of Attitudes Toward Hastened Death (SAHD) was adapted to the older population (SAHD‐Senior). A second tool was developed based on qualitative literature, the Categories of Attitudes Toward Death Occurrence (CADO). After cognitive pretesting, these instruments were validated in a sample of patients admitted to a geriatric rehabilitation unit. RESULTS The SAHD‐Senior showed good psychometric properties and a unifactorial structure. In the studied sample, 12.9% had a SAHD‐Senior score of 10 or higher, suggesting a significant wish to die. Associations were observed between high levels of the SAHD‐Senior and advanced age, high levels of depressive symptoms, lower quality of life, and lower cognitive function. The CADO allowed for passive death wishes to be distinguished from wishes to actively hasten death. According to the CADO, 14.9% of the sample had a wish to die. The two instruments showed a concordance rate of 90.1%. CONCLUSION The wish to die in older patients admitted to rehabilitation can be validly assessed with two novel instruments. The considerable proportion with a wish to die warrants investigation into concept, determinants, and management of the wish to die. J Am Geriatr Soc 68:1202–1209, 2020.

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Section: Discussionmentioning

confidence: 99%

Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments

Dürst

Spencer

Büla

et al. 2020

J American Geriatrics Society

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“…The patients in the case group showed greater perceived loss of dignity than those in the control group (43 (34-55) vs 32.5 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41), p < 0.001). Statistically significant differences were also found between the groups in the dimensions of psychological and existential distress (22 (18-29) vs 15 (13)(14)(15)(16)(17)(18)(19)(20), p < 0.001) and dependency (15 (12)(13)(14)(15)(16)(17)(18)(19)) vs 12 (10)(11)(12)(13)(14)(15)(16)(17), p < 0.001) on the PDI. No differences were found in the dimension of social support (see Table 3).…”

Section: Comparison Between the Case Group (Desire For Death Rating Smentioning

confidence: 86%

“…The sample included 153 adult patients with advanced cancer (defined according to the American Society of Clinical Oncology (ASCO)) 19 from a comprehensive cancer hospital. The sample was sub-selected from 300 participants who had taken part in two previous studies, 15,20 carried out between January 2016 and June 2017. Inclusion criteria were the following: (1) aged 18 or over, (2) judged by their physician or nurse to be clinically stable, (3) able to communicate with research personnel and (4) signed informed consent.…”

Section: Study Samplementioning

confidence: 99%

Health-related quality of life in patients with advanced cancer who express a wish to hasten death: A comparative study

et al. 2020

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Background: Some evidence suggests the wish to hasten death is related to poor health-related quality of life. Deficits in perceived dignity and self-efficacy are risk factors for wish to hasten death that also impact health-related quality of life. Aim: To compare perceived health-related quality of life, dignity and self-efficacy in patients with advanced cancer who either do (case group) or do not (control group) express a wish to hasten death. Cases and controls were matched on sociodemographic and functional characteristics. Design: A comparative cross-sectional study. Participants: A total of 153 adult patients with advanced cancer were assessed for wish to hasten death using the Desire for Death Rating Scale. Scores ⩾1 indicate some degree of wish to hasten death (case group, n = 51), and score = 0 implies no wish to hasten death (control group, n = 102). Assessments included health-related quality of life using the European Organization for Research and Treatment of Cancer Quality-of-Life Core 15-Item Palliative Questionnaire, perceived loss of dignity using the Patient Dignity Inventory and self-efficacy using the General Self-Efficacy Scale. Results: Patients with a wish to hasten death had worse emotional functioning ( p < 0.001), greater perceived loss of dignity ( p < 0.001) and lower self-efficacy ( p = 0.001). There was no difference in most physical symptoms. Perceived overall health-related quality of life was significantly worse for those with a clinically relevant wish to hasten death ( p = 0.023) and marginally worse for the case group than the control group ( p = 0.052). Conclusion: Patients with wish to hasten death showed lower perceived dignity, self-efficacy and emotional quality of life than patients without wish to hasten death without necessarily perceiving worse physical symptoms.

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“…One review of qualitative studies answered question 1) on the desire to die phenomenon and partly question 3) on caring for patients with a desire to die (22). Three reviews helped answering question 2) on screening, assessment, and proactive addressing of desire to die (23)(24)(25). The search for RCTs identified 766 electronic references, out of them four RCTs were included (26)(27)(28)(29).…”

Section: Consensus (Ec)mentioning

confidence: 99%

“…In some cases, a patient-centered, respectful, and open conversation can be accompanied by the use of validated instruments (GoR 0/ LoE 3) (23). To report and rate the psychometric properties of available assessment instruments for desire to die, Bellido-Perez et al (in 2017) conducted a systematic review of 50 studies that yielded seven tools (23). Among those, the Schedule of Attitudes Towards Hastened Death (SAHD) mainly used for research purposes, and the Desire for Death Rating Scale (DDRS) for clinicians, are the most widely used.…”

Section: Screening and Assessmentmentioning

confidence: 99%

‘Desire to Die’ in palliative care patients—legal framework and recommendations of the national evidence-based guideline on palliative care in Germany

et al. 2021

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Background: Desire to die, understood as a broad phenomenon, is common in patients receiving palliative care. Euthanasia ("termination of life on request", §216 German Criminal Code) is currently forbidden in Germany, the legal restrictions with regard to assisted suicide ("assistance of suicide with intent of repeated conduct", §217 German Criminal Code) has recently been repealed by the national Federal Constitutional Court. This dynamically changing legal situation adds to health professionals reported uncertainty in dealing appropriately with a desire to die. Methods: As part of the new extended version of the German Palliative Care Guideline for Patients with Incurable Cancer, evidence and consensus-based statements and recommendations on desire to die were developed by an interdisciplinary and multi-professional working group. The best available evidence was identified through systematic literature searches and by asking experts for further known quantitative as well as qualitative literature. Included publications were assessed as recommended by the Scottish Intercollegiate Guidelines Network (SIGN). Due to the limited availability of high-quality empirical publications related to desire to die, close attention was paid to national clinical expertise to develop recommendations. Consensus for these recommendations was reached at a conference of the guideline group consisting of elected representatives from 61 professional societies and patient associations. Each recommendation was approved by at least 75% of those present. Results: The expert panel developed and agreed on 21 statements and recommendations on desire to die and related phenomena. A descriptive definition was agreed upon of desire to die as a complex phenomenon with individual causes, manifestations, and consequences. The potential background of desire to die, its meanings, functions and possible interventions are described. The guideline recommends proactively addressing and exploring a potential desire to die as the intervention that should be considered before all others, because evidence from studies on suicidality found no negative effect when asking study participants about suicidality. Conclusions: The guideline informs health professionals working within the German statutory framework, how to care for and communicate with patients who are receiving palliative care and who express a desire to die.

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Assessment of the wish to hasten death in patients with advanced cancer: A comparison of 2 different approaches

Cited by 20 publications

References 36 publications

Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments

Wish to Die in Older Patients: Development and Validation of Two Assessment Instruments

Health-related quality of life in patients with advanced cancer who express a wish to hasten death: A comparative study

‘Desire to Die’ in palliative care patients—legal framework and recommendations of the national evidence-based guideline on palliative care in Germany

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