Desire for Hastened Death Amongst Veterans Facing Terminal Illness (SA520)

Abstract

1.Define the desire for hastened death, in contrast to suicidal ideation or post-traumatic-stress syndrome (PTSD).2.Recognize this symptom in select veterans (or other patients) in order to provide support and interdisciplinary management.3.Recognize and understand this complex syndrome and apply interdisciplinary techniques to manage this symptom. Some patients with advanced illness express a desire for hastened death (DHD), which typically involves mental health interventions. However, these patients may benefit from a palliative care team approach in management to mitigate suffering and improve outcomes.•DHD is a wish for death to occur prior to natural death. It is expressed in the context of progressive disease as a response to symptoms of physical and psychological suffering. Typically, it does not involve active suicidal ideation or requests for assisted suicide.•Depression in palliative care patients is not uncommon when faced with advanced or terminal illness. However, select patients present with obtrusive thoughts and a desire for hastened death, which may be mistaken for active suicidal ideation. Because this is a relatively less studied presentation, there exist few published approaches to management of these seriously ill patients.•DHD may be distinguished from suicidal ideation as it understandably occurs in the context of progressive disease rather than underlying psychiatric illness. Palliative care team interventions are effective to relieve symptoms of DHD in contrast to suicidal ideation, which is managed by psychiatric and psychological interventions. Barriers to assess and respond to DHD with both provider and patient factors will be discussed. Possible risk factors will be explored in the setting of DHD. In a small study in the palliative care clinic setting, 21 veterans who presented for routine palliative care consultations because of the nature of their illness were found to have DHD. We will discuss the assessments, findings, and clinical interventions provided, as well as the enhanced clinical outcomes in these veterans, as well as recommendations for other palliative care teams. Limitations of this study include the small sample size, but it provides valuable insight and understanding of DHD that may lead to improved clinical outcomes and potential future research.