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

Abstract

ObjectiveCultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context.MethodsA cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die (AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment System-revised (ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, χ2 and analysis of variance.Results201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12).ConclusionsOne in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the ‘wish’ or ‘desire’ to die, with or without HD ideation.

Wish to die and hasten death in palliative care: a cross-sectional study factor analysis

“…More than 64% of the patients were from different regions. 1 Patients who met the following criteria were included: (1) with advanced illness (progressive and irreversible disease); (2) expecting death in a maximum period of 1 year according to the referring physician (negative answer to a 'surprise question'); (3) awareness of the life-limiting nature of the disease; (4) ability to conduct a fluent conversation in Spanish; and (5) with cognitive capacity.…”

“…2 Thus, this study follows a recent terminological analysis of the issue, referring to the global phenomenon that includes both sporadic or persistent experiences of WTD and explicitly noting when patients expressed HDI, both as real plans and as passing thoughts. 1 Research has associated the experience of WTD with different factors, 4 namely physical (ie, pain, dyspnoea, tiredness), 2 3 psychoemotional (ie, depression, anxiety), 2 6-9 existential spiritual (ie, existential suffering, perceived loss of dignity) 2 8 and social (ie, feeling that one is a burden). 9 Health professionals often shy away from exploring and discussing WTD with patients.…”

“…The wish to die (WTD) is common in patients with advanced illness. [1][2][3] Between 11% and 55% of patients have sporadic WTD, [1][2][3] while 3%-20% have more persistent thoughts. [1][2][3] The scientific literature has described different experiences of WTD, 4 referring to them with varying terminologies such as 'desire to die' or 'wish to hasten death', with no differentiation or consideration of the term's nuances.…”

“…[1][2][3] Between 11% and 55% of patients have sporadic WTD, [1][2][3] while 3%-20% have more persistent thoughts. [1][2][3] The scientific literature has described different experiences of WTD, 4 referring to them with varying terminologies such as 'desire to die' or 'wish to hasten death', with no differentiation or consideration of the term's nuances. 1 4 A terminological consensus process concluded that the phenomenon should be called 'wish to hasten death'.…”

The state of transience, and its influence on the wish to die of advanced disease patients: insights from a qualitative phenomenological study

“…The experience of the wish to die (WTD) in patients with advanced disease is a phenomenon that has been studied worldwide. This is not surprising considering that 11% and 55% patients present it occasionally [ 1 – 3 ], while in 8-17% of the cases these feelings or thoughts are more persistent [ 1 , 4 , 5 ]. Furthermore, between 4 and 11% of seriously ill patients experiencing such phenomenon present real or hypothetical intention to hasten death [ 1 , 6 ].…”