Desire For Hastened Death Research Articles

The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients

The current study assessed the attitudes of the desire for hastened death in terminally ill cancer patients and whether these are determined by their physical and psychological symptoms. The final sample consisted of 106 terminally ill cancer patients attending a Palliative Care Unit, in University of Athens, Greece, between June and October 2004. Significant associations were found between the desire for hastened death (D.H.D.) and 'pain' (r=0.469, p<0.005), 'fatigue' (r=0.591, p<0.0005), 'loss of appetite' (r=0.622, p<0.0005) and 'feeling sad' (r=0.635, p<0.0005). Statistically significant associations were also found between Schedule of Attitudes towards Hastened Death (SAHD) scores, age (r=0.300, p=0.002) and ECOG (p<0.0005). Twenty-six percent of the patients reported high D.H.D. while 41% reported moderate desire. In the prediction of SHAD the contribution of 'pain' (p=0.011), 'lack of appetite' (p=0.012) and 'sadness' (p=0.011) is high (42% of variance). Further findings suggest that D.H.D. is significantly related to 'feeling sad', 'lack of appetite', 'pain' and 'fatigue' after controlling for age, gender and performance status according to ECOG in terminally ill cancer patients.

Desire for Hastened Death, Cancer Pain and Depression: Report of a Longitudinal Observational Study

Desire for hastened death (DHD) is reported in the literature as being common in patients with cancer pain. However, there is currently little evidence to suggest that improvement in pain results in improvement in DHD. Our objectives were to assess 1) the impact of improvements in cancer pain severity and pain's interference with daily functioning and depression on DHD, and 2) the role of factors such as social and spiritual well-being, educational level, and patient age in moderating the impact of pain and depression on DHD. This observational study included patient-rated and clinician-rated scales administered twice at 4-week intervals. We enrolled 131 newly-referred patients to the Pain and Palliative Care Service at Memorial Sloan-Kettering Cancer Center or newly-admitted patients to Calvary Hospital in New York. One hundred and sixteen patients completed the baseline measures and 64 patients completed both baseline and follow-up measures. The main outcome measures included the Brief Pain Inventory (BPI), Beck Depression Inventory (BDI), and the Desire for Hastened Death Scale (DHD). Sixty-six percent of patients had no DHD at baseline and 45% of patients had BDI scores of 14 or greater (‘mild’ depression). Only 40% of patients with moderate/severe depression were receiving antidepressants. BPI scores improved significantly from baseline to follow-up (6.36 vs. 4.86, P < 0.01). DHD scores increased significantly from baseline to follow-up (0.84 to 1.38, P = 0.03). All other measures including depression were stable. DHD scores were moderately correlated with depression ( r = 0.43), low social support ( r = 0.38), poor spiritual well-being ( r = −0.38), religious well being ( r = −0.25), pain interference ( r = 0.27), higher educational level ( F = 4.50, P = 0.02) and lower physical functioning (KPRS, r = −0.40), but were unrelated to sex, age, race, or marital status. In multivariate regression analyses, baseline DHD ( β = 0.30, P = 0.05) and change in depression ( β = 0.36, P = 0.02) were predictive of follow-up DHD. Improvement in pain interference was not predictive of follow-up DHD. The results suggest that improvement in depression moderated the severity of desire for hastened death in a population of patients with cancer pain. Depression was common in this population and was often untreated. Improvements in functional impairment due to pain did not moderate the severity of DHD in a setting of aggressive pain management. Strategies to preemptively screen for depression in the routine assessment of patients with cancer pain may be important to address DHD.

Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients

Objective This study evaluated the desire for hastened death (DHD) in cancer patients at varying stages of disease to determine its frequency and relationship to physical and psychological distress. Methods Two hundred twenty-four inpatients at Princess Margaret Hospital completed questionnaires assessing pain, physical symptoms, depression, hopelessness, and DHD. Results There was significant physical and psychological distress in this sample with a mean of nine physical symptoms reported by each subject. Seven percent reported moderate DHD on the Schedule of Attitudes Towards Hastened Death (SAHD) and 2% reported high DHD. Hopelessness and stage of disease were the only significant independent predictors of DHD and their interaction was associated with increased DHD. Hopelessness and, less so, depression both mediated the pathways between illness-related factors and DHD. Conclusions Findings suggest that DHD is significantly related to hopelessness and advancing disease. Assessment of this phenomenon prior to the end of life may provide opportunities for intervention.