The desire for death in Portuguese home-care palliative patients: Retrospective analysis of the prevalence and associated factors

Abstract

Objective Desire for death (DfD) is a complex and multifactorial dimension of end-of-life experience. We aimed to evaluate the prevalence of DfD and its associations, arising within the setting of a tertiary home-based palliative care (PC) unit. Method Retrospective analysis of all DfD entries registered in our anonymized database from October 2018 to April 2020. Results Of the 163 patients anonymously registered in our database, 122 met entry criteria; 52% were male, the average age was 69 years old; 85% had malignancies, with a mean performance status (PPS) of 56%. The prevalence of DfD was 20%. No statistical differences were observed between patients with and without DfD regarding sex, age, marital status, religion, social support, prior PC or psychological follow-up, type of diagnosis, presence of advanced directives/living will, time since diagnosis and PC team's follow-up time. Statistically significant associations were found between higher PPS scores and DfD (OR = 0.96; 95% confidence interval (CI) [0.93–0.99]); Edmonton Symptom Assessment Scale scores for drowsiness (OR = 4.05; 95% CI [1.42–11.57]), shortness of breath (OR = 3.35; 95% CI [1.09–10.31]), well-being (OR = 7.64; 95% CI [1.63–35.81]). DfD was associated with being depressed (OR = 19.24; 95% CI [3.09–+inf]); feeling anxious (OR = 11.11; 95% CI [2.51–49.29]); HADS anxiety subscale ≥11 (OR = 25.0; 95% CI [2.10–298.29]); will-to-live (OR = 39.53; 95% CI [4.85–321.96]). Patients feeling a burden were more likely to desire death (OR = 14.67; 95% CI [1.85–116.17]), as well as those who were not adapted to the disease (OR = 4.08; 95% CI [1.30–12.84]). In multivariate regression analyses predicting DfD, three independent factors emerged: higher PPS scores were associated with no DfD (aOR = 0.95; 95% CI [0.91–0.99]), while the sense of being a burden (aOR = 12.82; 95% CI [1.31–125.16]) and worse well-being (aOR = 7.72; 95% CI [1.26–47.38]) predicted DfD. Significance of results Prevalence of DfD was 20% and consistent with previous Portuguese evidence on DfD in PC inpatients. Both physical and psychosocial factors contribute to a stronger DfD.

Efficacy of Meaning-Centered Psychotherapy in adult patients with advanced cancer: A systematic review and meta-analysis

“…People faced with a diagnosis of advanced or late-stage cancer often experience existential-related distress, including hopelessness, demoralization, o desire for hastened death (1)(2)(3)(4) . Observational studies have found a prevalence of 13-18% of demoralization (5) , and up to 20.5% of desire for hastened death (6) during the late life stages of oncological patients. Authors such as David Kissane (7) and William Breitbart (4,8,9) have suggested that these experiences could represent a response to an existential crisis comprising a loss of meaning, values, and purpose in life.…”

Why People Think They Might Hasten Their Death When Faced With Irremediable Health Conditions Compared to Why They Actually Do so

“…It asks how strongly these physical, cognitive, emotional, and social factors influence people to want to hasten their death, rather than how these factors can lead to further treatment planning and the prolongation of life. While incorporating more psycho-social questions, the QLIS recognizes the inseparability and impact on each other of physical, emotional, cognitive, and social factors that lead to wanting to hasten one’s death rather than trying to measure primarily emotional impact alone (Julião et al, 2020; Rosenfeld et al, 2000).…”