The clinical evaluation of the wish to hasten death is not upsetting for advanced cancer patients: A cross-sectional study

Abstract

Background: An important concern of healthcare professionals when exploring the wish to hasten death with patients is the risk of causing them some type of distress. Aim: To assess the opinion of hospitalized patients with advanced cancer about the proactive assessment of the wish to hasten death. Design: Descriptive, cross-sectional study. Setting/participants: We assessed 193 advanced cancer patients admitted to an oncology ward for the wish to hasten death using a semi-structured clinical interview. After the assessment the participants were surveyed to determine whether they found the interview upsetting and, if so to what extent, and also their opinion regarding the assessment’s importance. Results: The wish to hasten death was reported by 46 (23.8%) patients. The majority of patients (94.8%) did not find talking about the wish to hasten death to be upsetting, regardless of whether they presented it or not. The majority of patients (79.3%) considered that it was either quite or extremely important for the clinician to proactively assess the wish to hasten death and discuss this topic, regardless of whether they experienced it. Conclusions: In this study, most of the advanced cancer patients did not find the assessment of wish to hasten death to be upsetting, and a substantial proportion of patients in this study believe that it is important to routinely evaluate it in this setting. These findings suggest that healthcare professionals can explore the wish to hasten death proactively in routine clinical practice without fear of upsetting patients.

The Desire to Die in Palliative Care: A sequential mixed methods study to develop a semi-structured clinical guideline

“…Current studies confirm that asking about suicidality causes no harm but may reduce experienced burden and distress. 31 Based on preliminary studies 20,32 these findings can likely be extrapolated to PC. Currently, our clinical guideline is only available for HPs attending the related multi-professional training program.…”

“…A recent descriptive study employed an ad hoc semi-structured clinical interview for proactive assessment of a wish to hasten death among advanced cancer patients. 32 Participants did not experience this as distressing, but considered it important regardless of whether they were personally affected. The patients we interviewed indicated that they appreciated the initiation of DD conversations by HPs.…”

“…Although patients do not object to enquiries about potential DD, even when they do not personally have one, 32 the impact is likely to depend on how and when such conversations take place. Various guidelines have been developed for the improvement of HP-patient-communication in PC settings, e.g.…”

The Desire to Die in Palliative Care: A sequential mixed methods study to develop a semi-structured clinical aproach

“…Current studies confirm that asking about suicidality causes no harm but may reduce experienced burden and distress. 34 Based on preliminary studies 23,35 these findings can likely be extrapolated to palliative care. Currently, our clinical approach is only available for health professionals attending the related multi-professional training program.…”

How should palliative care respond to increasing legislation for assisted dying?

“…If they do, then they may fail to provide 'safe and compassionate care for the dying person'. 5 The paper by Porta-Sales et al 13 in this edition raises whether we should facilitate patients to discuss if they have considered hastening their death. When this was initiated through a semi-structured interview, they found that 98% of their participants reported no distress in talking about and exploring whether they considered hastening their death.…”