BackgroundThere is a need for an in-depth approach to the meaning of the wish to hasten death (WTHD). This study aims to understand the experience of patients with serious or incurable illness who express such a wish.Methods and FindingsSystematic review and meta-ethnography of qualitative studies from the patient's perspective. Studies were identified through six databases (ISI, PubMed, PsycINFO, CINAHL, CUIDEN and the Cochrane Register of Controlled Trials), together with citation searches and consultation with experts. Finally, seven studies reporting the experiences of 155 patients were included. The seven-stage Noblit and Hare approach was applied, using reciprocal translation and line-of-argument synthesis. Six main themes emerged giving meaning to the WTHD: WTHD in response to physical/psychological/spiritual suffering, loss of self, fear of dying, the desire to live but not in this way, WTHD as a way of ending suffering, and WTHD as a kind of control over one's life (‘having an ace up one's sleeve just in case’). An explanatory model was developed which showed the WTHD to be a reactive phenomenon: a response to multidimensional suffering, rather than only one aspect of the despair that may accompany this suffering. According to this model the factors that lead to the emergence of WTHD are total suffering, loss of self and fear, which together produce an overwhelming emotional distress that generates the WTHD as a way out, i.e. to cease living in this way and to put an end to suffering while maintaining some control over the situation.ConclusionsThe expression of the WTHD in these patients is a response to overwhelming emotional distress and has different meanings, which do not necessarily imply a genuine wish to hasten one's death. These meanings, which have a causal relationship to the phenomenon, should be taken into account when drawing up care plans.

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BackgroundThe desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD.MethodsFollowing an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy.FindingsAll 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD.ConclusionsThis international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.

It is common for patients who are faced with physical or psychological suffering, particularly those in the advanced stages of a disease, to have some kind of wish to hasten death (WTHD). This paper reviews and summarises the current state of knowledge about the WTHD among people with end-stage disease, doing so from a clinical perspective and on the basis of published clinical research. Studies were identified through a search strategy applied to the main scientific databases.Clinical studies show that the WTHD has a multi-factor aetiology. The literature review suggests-perhaps in line with better management of physical pain-that psychological and spiritual aspects, including social factors, are the most important cause of such a wish. One of the difficulties facing clinical research is the lack of terminological and conceptual precision in defining the construct. Indeed, studies frequently blur the distinction between a generic wish to die, a WTDH (whether sporadic or persistent over time), the explicit expression of a wish to die, and a request for euthanasia or physician-assisted suicide.A notable contribution to knowledge in this field has been made by scales designed to evaluate the WTHD, although the problems of conceptual definition may once again limit the conclusions, which can be drawn from the results. Studies using qualitative methodology have also provided new information that can help in understanding such wishes.Further clinical research is needed to provide a complete understanding of this phenomenon and to foster the development of suitable care plans.

Adequate training of this kind would help to ensure that future nurses offer high-quality care to patients and their families, minimising the impact of death and preventing emotional fatigue.

The Collett-Lester Fear of Death Scale (CL-FODS) consists of 4 subscales: Death of Self, Dying of Self, Death of Others, and Dying of Others. The aim of this study was to develop a Spanish version of the CL-FODS and to explore its psychometric properties. The revised version of the scale was translated into Spanish from English. Then, the back translation technique was carried out. A sample of 281 Spanish nursing students and professionals responded to the Spanish CL-FODS, along with 2 instruments assessing death anxiety and general anxiety. Good internal consistency and satisfactory test-retest reliability of the 4 subscales of the Spanish CL-FODS were achieved. Its correlations with death anxiety were higher than that with general anxiety, supporting its discriminant validity. The principal component analysis forced to 4 components provided a distribution of loadings that is more coherent with the theoretical formulation of the 4 components than those obtained in previous studies. These results justify the use of the CL-FODS in Spanish-speaking health care professionals for the purpose of assessing attitudes toward death and dying in self and others.

Abstract. Background. Over the last 40 years the study of human attitudes toward death has attracted much scientific interest and a significant amount of research has been carried out in the English-speaking world. However, among Spanish-speaking researchers the subject has been practically ignored, as has the issue of related psychometric instruments. The aim of this study was to develop the Death Anxiety Inventory (DAI) and thus provide a valid and reliable assessment instrument for measuring death anxiety among Spanish-speaking subjects. Methods: This study examined the psychometric properties of the DAI. The DAI is a self-administered questionnaire of 20 items that can be used in either a dichotomous true/false format or on a six-point Likert scale. The properties of both scales were investigated by means of six empirical studies and several samples. Results: The scale has an α coefficient of internal consistency of 0.90 and test-retest correlation, at 4 weeks, of 0.94. The correlation with Templer's Death Anxiety Scale was 0.79. Factor analysis of the DAI identified five significant factors. Taken together these factors explained 54.60% of the total variance and were labeled as: (1) Externally generated death anxiety, (2) Meaning and acceptance of death, (3) Thoughts about death, (4) Life after death, and (5) Brevity of life. The English form of the DAI is also presented in the study in order to enable cross-cultural comparisons to be made. Conclusion: Results of this study suggest that the DAI has adequate psychometric properties that make it a valid and reliable instrument to assess death anxiety in Spanish-speaking individuals.

The aim of the present study was to provide evidence of validity of the Brief Resilient Coping Scale for use in Spanish young population. A total of 365 university students responded to the Spanish version of the BRCS as well as to other tools for measuring personal perceived competence, life satisfaction, depression, anxiety, negative and positive affect, and coping strategies. Confirmatory factor analysis confirmed the unidimensional structure of the scale. Internal consistency reliability and temporal stability through Cronbach's alpha and test-retest correlations, respectively, were comparable to those found in the initial validation of the tool. The BRCS showed positive and significant correlations with personal perceived competence, optimism, life satisfaction, positive affect (p < .01), and some coping strategies (p < .05). Significant negative correlations were observed with depression, anxiety and negative affect. (p < .01). Multiple regression analysis with stepwise method showed that positive affect, negative affect, optimism and problem solving explained 41.8% of the variance of the BRCS (p < .001). The Spanish adaptation of the BRCS in a young population is satisfactory and comparable to those of the original version and with the Spanish version adapted in an elderly population. This supports its validity as a tool for the assessment of resilient coping tendencies in young people who speak Spanish and offers researchers and professionals interested in this area of study a simple tool for assessing it.