Verbalized desire for death or euthanasia in advanced cancer patients receiving palliative care.
OBJECTIVE
We aimed to address the prevalence of desire-to-die statements (DDSs) among terminally ill cancer patients in an acute palliative care unit. We also intended to compare the underlying differences between those patients who make desire-to-die comments (DDCs) and those who make desire-for-euthanasia comments (EUCs).


METHODS
We conducted a one-year cross-sectional prospective study in all patients receiving palliative care who had made a DDC or EUC. At inclusion, we evaluated symptom intensity, anxiety and depression, and conducted a semistructured interview regarding the reasons for these comments.


RESULTS
Of the 701 patients attended to during the study period, 69 (9.8%; IC 95% 7.7-12.3) made a DDS: 51 (7.3%) a DDC, and 18 (2.5%) an EUC. Using Edmonton Symptom Assessment Scale (ESAS) DDC group showed higher percentage of moderate-severe symptoms (ESAS > 4) for well-being (91 vs. 25%; p = 0.001), depression (67 vs. 25%; p = 0.055), and anxiety (52 vs. 13%; p = 0.060) than EUC group. EUC patients also considered themselves less spiritual (44 vs. 84%; p = 0.034). The single most common reason for a DDS was pain or physical suffering, though most of the reasons given were nonphysical.


CONCLUSIONS
Almost 10% of the population receiving specific oncological palliative care made a DDC (7.3%) or EUC (2.5%). The worst well-being score was lower in the EUC group. The reasons for both a DDC and EUC were mainly nonphysical. We find that emotional and spiritual issues should be identified and effectively addressed when responding to a DDS in terminally ill cancer patients.
Palliative Care Unit, Oncology Department, Hospital de la Santa Creu i Sant Pau,Universitat Autònoma de Barcelona,Barcelona,Spain.
Ernest
E
Güell
Palliative Care Unit, Oncology Department, Hospital de la Santa Creu i Sant Pau,Universitat Autònoma de Barcelona,Barcelona,Spain.
Adelaida
A
Ramos
Palliative Care Unit, Oncology Department, Hospital de la Santa Creu i Sant Pau,Universitat Autònoma de Barcelona,Barcelona,Spain.
Tania
T
Zertuche
Palliative Care Unit, Oncology Department, Hospital de la Santa Creu i Sant Pau,Universitat Autònoma de Barcelona,Barcelona,Spain.
Antonio
A
Pascual
D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D005065:Euthanasia / Q000523:psychology*; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care; D011446:Prospective Studies; D019452:Terminally Ill / Q000523:psychology*
Palliative care