W. Breitbart et al., Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer, J AM MED A, 284(22), 2000, pp. 2907-2911
Citations number
29
Categorie Soggetti
General & Internal Medicine","Medical Research General Topics
Context Understanding why some terminally ill patients desire a hastened de
ath has become an important issue in palliative care and the debate regardi
ng legalization of assisted suicide.
Objectives To assess the prevalence of desire for hastened death among term
inally ill cancer patients and to identify factors corresponding to desire
for hastened death. Design Prospective survey conducted in a 200-bed pallia
tive care hospital in New York, NY.
Patients Ninety-two terminally ill cancer patients (60% female; 70% white;
mean age, 65.9 years) admitted between June 1998 and January 1999 for end-o
f-life care who passed a cognitive screening test and provided sufficient d
ata to permit analysis.
Main Outcome Measure Scores on the Schedule of Attitudes Toward Hastened De
ath (SAHD), a self-report measure assessing desire for hastened death among
individuals with life-threatening medical illness.
Results Sixteen patients (17%) were classified as having a high desire for
hastened death based on the SAHD and 15 (16%) of 89 patients met criteria f
or a current major depressive episode. Desire for hastened death was signif
icantly associated with a clinical diagnosis of depression (P =.001) as wel
l as with measures of depressive symptom severity (P<.001) and hopelessness
(P<.001), In multivariate analyses, depression (P=.003) and hopelessness (
P<.001) provided independent and unique contributions to the prediction of
desire for hastened death, while social support (P=.05) and physical functi
oning (P=.02) added significant but smaller contributions.
Conclusions Desire for hastened death among terminally ill cancer patients
is not uncommon. Depression and hopelessness are the strongest predictors o
f desire for hastened death in this population and provide independent and
unique contributions. Interventions addressing depression, hopelessness, an
d social support appear to be important aspects of adequate palliative care
, particularly as it relates to desire for hastened death.