title: Does desire for hastened death change in terminally ill cancer patients?
abstract: Understanding why some terminally ill patients may seek a hastened death (a construct referred to as "desire for hastened death" or DHD) is critical to understanding how to optimize quality of life during an individual's final weeks, months or even years of life. Although a number of predictor variables have emerged in past DHD research, there is a dearth of longitudinal research on how DHD changes over time and what factors might explain such changes. This study examined DHD over time in a sample of terminally ill cancer patients admitted to a palliative care hospital. A random sample of 128 patients completed the Schedule of Attitudes toward Hastened Death (SAHD) at two time points approximately 2-4 weeks apart participated. Patients were categorized into one of four trajectories based on their SAHD scores at both time points: low (low DHD at T1 and T2), rising (low DHD at T1 and high DHD at T2), falling (high DHD at T1 and low DHD at T2) and high (high DHD at T1 and T2). Among patients who were low at T1, several variables distinguished between those who developed DHD and those who did not: physical symptom distress, depression symptom severity, hopelessness, spiritual well-being, baseline DHD, and a history of mental health treatment. However, these same medical and clinical variables did not distinguish between the falling and high trajectories. Overall, there appears to be a relatively high frequency of change in DHD, even in the last weeks of life. Interventions designed to target patients who are exhibiting subthreshold DHD and feelings of hopelessness may reduce the occurrence of DHD emerging in this population.
authors.affiliation: Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA. Electronic address: rosenfeld@fordham.edu.
authors.forename: Barry
authors.initials: B
authors.lastname: Rosenfeld
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Hayley
authors.initials: H
authors.lastname: Pessin
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Marziliano
authors.affiliation: Iona College, New Rochelle, NY, USA.
authors.forename: Colleen
authors.initials: C
authors.lastname: Jacobson
authors.affiliation: Independent Practice, NJ, USA.
authors.forename: Brooke
authors.initials: B
authors.lastname: Sorger
authors.affiliation: Independent Practice, NJ, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Abbey
authors.affiliation: Weill-Cornell Medical College, New York, NY, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Olden
authors.affiliation: Calvary Hospital, Bronx, NY, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Brescia
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Breitbart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D010166:Palliative Care; D019452:Terminally Ill / Q000523:psychology*; D013997:Time Factors
keywords: Cancer; Desire for hastened death; End of life; Palliative care; US
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