The role of perceived dignity and control in the wish to hasten death among advanced cancer patients: A mediation model

Abstract

Objective: The objective of the study is to test a model in which perceived loss of dignity and control are proposed, along with symptoms of depression and functional impairment, as risk factors for the wish to hasten death (WTHD) in advanced cancer patients.Methods: This was a cross-sectional study of 193 patients in an oncology unit. Outcome measures included perceived control, performance status, symptoms of depression, perceived dignity, and the WTHD. Structural equation modeling was performed. Results: Structural equation modeling showed that perceived loss of control (−0.402) and functional impairment (−0.21) were risk factors for perceived loss of dignity. Loss of control (−0.385) and functional impairment (−0.283) were also risk factors for symptoms of depression. Perceived loss of dignity and symptoms of depression were the most proximal determinants of the WTHD, on which they had a direct, positive, and significant effect (0.246 and 0.209, respectively). Therefore, both symptoms of depression and perceived loss of dignity independently predicted the WTHD and mediated the effects of perceived loss of control and functional impairment on this wish. Conclusions: The hypothesized model provides evidence for the impact of the four aforementioned factors on the WTHD. Our results suggest that personalized care plans which are able to enhance the sense of dignity and control among advanced cancer patients could help to reduce the likelihood or intensity of a WTHD. KEYWORDS cancer, control, depression, desire to die, dignity, functional status, mediation model, oncology, self-efficacy, wish to hasten death 1 | BACKGROUND Patients with advanced disease sometimes express a wish to hasten death (WTHD), which can be understood as a response to suffering of multifactorial origin. 1,2 Research on the factors associated with a WTHD in these patients has highlighted the importance of considering factors related to different domains: physical, psychological, and existential/spiritual. 2,3 Qualitative studies suggest that the expression of a WTHD can have several different meanings and functions. 2 Accordingly, it has been argued that the WTHD should not be seen an explicit request to die. 4Patients who express a WTHD often allude to a loss of dignity. [5][6][7] This was highlighted in a meta-ethnography which found that a perceived loss of dignity was a central feature of the loss of self that patients experienced in the context of a life-threatening condition.Research on the WTHD and perceived loss of dignity has also Cristina Monforte-Royo and Iris Crespo contributed equally to this work. /journal/pon highlighted the importance of a sense of control over their circumstances and the dying process. 8,9 In addition, various studies have found that for some people, a perceived loss of dignity and of autonomy are key reasons why they wish to hasten death, especially in countries where euthanasia or assisted suicide are decriminalized. 10,11 Despite extensive literature on the WTHD and physical impairment, 12,13 depression, ...

The meaning of dignity patient question and changes in the approach to this issue of cancer patients during home hospice care

“…Thus the vast majority of patients (77-92%) confirm the need for posing that question, which indicates that recognising and respecting their dignity is very significant for them. The loss of dignity is one of the frequently mentioned factors contributing to the desire to accelerate one's own death [13,14]. On the basis of the results obtained, it can be concluded that care for preserving and strengthening the sense of dignity of the patient should be considered as important as treatment of somatic symptoms.…”

“…Tak, więc zdecydowana większość pacjentów (77-92%) potwierdza potrzebę stosowania pytania, co wskazuje jak ważne jest, aby ich godność była dostrzeżona i respektowana. Utrata godności jest jednym z często wymienianych czynników przyczyniających się do pragnienia przyspieszenia własnej śmierci [13,14]. Na podstawie uzyskanych wyników można stwierdzić, że dbałość o zachowanie i wzmacnianie poczucia godności pacjenta, należy uznać za równie istotne, jak leczenie objawów somatycznych.…”

Characteristics of patients with cancer who die by suicide: Coronial case series in an Australian state

“…Useful discussion points include the patient's experience of pain and other negative effects of cancer and its treatment; past psychiatric illness; engagement with right to death groups; and planning regarding suicide method. Such conversations conducted with sensitivity have been shown to reduce distress and highlight important personal concerns . Moreover, they can strengthen the patient‐oncologist relationship, which has been shown to be more helpful in reducing suicidal ideation than engaging mental health services …”

“…Such conversations conducted with sensitivity have been shown to reduce distress and highlight important personal concerns. 18,19 Moreover, they can strengthen the patient-oncologist relationship, which has been shown to be more helpful in reducing suicidal ideation than engaging mental health services. 20 Furthermore, understanding the individual's cancer experience as it relates to thoughts of suicide is of potential utility in providing targeted care.…”

Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences

“…The AFFED guide was also used in another study, showing that WTHD was significantly associated with perceptions of dignity and control. 24 In our setting, the exploration of reasons for the WTD is thus recent and limited to the studies cited from Catalonia. The present study was designed to determine the prevalence of the WTD in a Spanish population with patients from different regions, to go deeper into the characteristics of this phenomenon (frequency and extension) and the implications of examining it by means of a clinical interview (stability and repercussion on their emotional status).…”