Intentions in wishes to die: analysis and a typology – A report of 30 qualitative case studies of terminally ill cancer patients in palliative care

Ohnsorge, Kathrin; Gudat, Heike; Rehmann‐Sutter, Christoph

doi:10.1002/pon.3524

Cited by 71 publications

(75 citation statements)

References 37 publications

(37 reference statements)

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“…Descriptions of the philosophical concepts underlying this approach have also been given elsewhere [28,32]. This approach is conceived of as being as open as possible to the participants’ subjective views and experiences and refrains from judging a patient’s views.…”

Section: Methodsmentioning

confidence: 99%

What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care

2014

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BackgroundDespite research efforts over recent decades to deepen our understanding of why some terminally ill patients express a wish to die (WTD), there is broad consensus that we need more detailed knowledge about the factors that might influence such a wish. The objective of this study is to explore the different possible motivations and explanations of patients who express or experience a WTD.MethodsThirty terminally ill cancer patients, their caregivers and relatives; from a hospice, a palliative care ward in the oncology department of a general hospital, and an ambulatory palliative care service; 116 semi-structured qualitative interviews analysed using a complementary grounded theory and interpretive phenomenological analysis approach.ResultsThree dimensions were found to be crucial for understanding and analysing WTD statements: intentions, motivations and social interactions. This article analyses the motivations of WTD statements. Motivations can further be differentiated into (1) reasons, (2) meanings and (3) functions. Reasons are the factors that patients understand as causing them to have or accounting for having a WTD. These reasons can be ordered along the bio-psycho-socio-spiritual model. Meanings describe the broader explanatory frameworks, which explain what this wish means to a patient. Meanings are larger narratives that reflect personal values and moral understandings and cannot be reduced to reasons. Functions describe the effects of the WTD on patients themselves or on others, conscious or unconscious, that might be part of the motivation for a WTD. Nine typical ‘meanings’ were identified in the study, including “to let death put an end to severe suffering”, “to move on to another reality”, and – more frequently– “to spare others from the burden of oneself”.ConclusionsThe distinction between reasons, meanings and functions allows for a more detailed understanding of the motivation for the WTD statements of cancer patients in palliative care situations. Better understanding is crucial to support patients and their relatives in end-of-life care and decision making. More research is required to investigate the types of motivations for WTD statements, also among non-cancer patients.

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Section: Methodsmentioning

confidence: 99%

What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care

2014

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“…Only recently has a Swiss report described the intentions and motivations of a wish to die in patients with terminal cancer. 26,27 However, the authors included patients with and without a wish to die, and there is no information how many patients of the study sample did explicitly request hastened death. The authors describe a wide range of nine different intentions (ranging from the will to live to acting toward dying) and a similar range of motivations, including different reasons, meanings, and functions of the wish to die, including being an example to other on how to die, spare others the burden of oneself, re-establishing agency, or manipulation.…”

Section: Discussionmentioning

confidence: 99%

The desire to hasten death: Using Grounded Theory for a better understanding “When perception of time tends to be a slippery slope”

et al. 2015

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Background: Some patients with advanced and progressive diseases express a desire to hasten death. Aim: This study evaluated the motivations of patients expressing such a desire in a country with prohibitive legislation on euthanasia and physician-assisted suicide. Design: A modified form of Grounded Theory was used. Setting/participants: Patients from the departments of palliative medicine in three hospitals in Germany were recruited when they had made a statement or request to hasten death. Participants were interviewed face to face. Recruitment was stopped with 12 participants because of data saturation. Results: Thematic analysis revealed three main motivational themes: self-determination, agony, and time. Expectations toward health professionals, attitudes toward death, and secureness related to the end of life were additional main themes emerging from the analysis. Conclusions:The desire to hasten death may be used as an extreme coping strategy to maintain control against anticipated agony. Patients expected health professionals to listen to and respect their experiences. Emerging hypotheses included the following: (a) patients try to balance life time and anticipated agony, and the perception of time is distressing in this balancing act; (b) anticipated images of agony and suffering in the dying process occur frequently and are experienced by patients as intrusive; (c) patients expressing a desire to hasten death are in need of more information about the dying process; and (d) patients wanted their caregivers to listen to and respect their wish to hasten death, and they did not expect the caregivers to understand this as an order to actually hasten their death.

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“…After all, WTD is a complex subjective and social phenomenon, a process rather than a mental state, in which it is important to explore not only the reasons or triggering factors, which can be treated, but also how a WTD makes sense for the patients [25]. Caregivers have a great responsibility because the WTD can be inluenced by conversations about them.…”

Section: Discussion Of Albert's Casementioning

confidence: 99%

Reflection on Palliative Sedation for Existential Distress. It is Possible to Tolerate the Incomprehensible?

Endrizzi¹,

Palella²,

Ghelleri³

et al. 2017

Highlights on Several Underestimated Topics in Palliative Care

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The diiculty of making decisions in end of life is the subject of these relections through two clinical cases. We considered the question of palliative sedation for existential distress through a phenomenological approach, focusing the relationship between a patient's clinical history and the reactions of the care team to the existential distress of the patients. We chose to introduce a concept, dynamic projective identiications, which is a powerful mechanism for communication between human beings. The hypothesis is that projective identiication works as a powerful mechanism of emotional contagion between people facing death, families, and their health workers. In the cases, however, the use of this therapeutic tool is not oriented to provide psychotherapeutic methods of supporting dying patients but to sustain the awareness of the care team in the decisionmaking process. The psychological pressure on the care team may lead physicians to act considering "what you already know". Being aware of these mechanisms can help physicians to understand the phenomena that are happening. Even if palliative sedation is the best therapy, the care team must clarify the meaning of the projective identiication and enter them into the low of communication with the patients and their families.

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Intentions in wishes to die: analysis and a typology – A report of 30 qualitative case studies of terminally ill cancer patients in palliative care

Cited by 71 publications

References 37 publications

What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care

What a wish to die can mean: reasons, meanings and functions of wishes to die, reported from 30 qualitative case studies of terminally ill cancer patients in palliative care

The desire to hasten death: Using Grounded Theory for a better understanding “When perception of time tends to be a slippery slope”

Reflection on Palliative Sedation for Existential Distress. It is Possible to Tolerate the Incomprehensible?

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