Validation of the German version of the Schedule of Attitudes Toward Hastened Death (SAHD-D) with patients in palliative care.
OBJECTIVE
Reliable and validated instruments are needed in order to study the desire for hastened death (DHD). As there is no instrument in the German language to measure DHD, our aim was to validate a German version of the Schedule of Attitudes Toward Hastened Death (SAHD-D).


METHODS
The SAHD was translated following guidelines promulgated by the European Organization for Research and Treatment of Cancer (EORTC). In eligible patients (clinical situation adequate, MMSE ≥21), the following instruments were employed: a symptom checklist (HOPE), the HADS-D (Hospital Anxiety and Depression Scale), the EORTC-QLQ-PAL15, and the SAHD-D, as well as an external estimation of DHD provided by the attending physician. A high level of DHD was defined as the mean plus one standard deviation (SD).


RESULTS
Of the 869 patients assessed, 92 were eligible for inclusion (66% females, mean age of 64.5 years). The SAHD-D total score ranged from 0 to 18, with a mean of 5 and a standard deviation (SD) of 3.7. A high level of DHD was found in 20% (n = 19). For discriminant validity, significant correlations were found between the SAHD-D and depression (r rho = 0.472), anxiety (r rho = 0.224), and clinical state (r rho = 0.178). For criterion validity, the external estimate of DHD showed a low significant correlation with patient score (r rho = 0.290). Factor analysis of the SAHD-D identified two factors.


CONCLUSIONS
Validation of the SAHD-D illustrated good discriminant validity, confirming that a desire to hasten death is a construct separate from depression, anxiety, or physical state. The unidimensionality of the SAHD could not be reproduced. Our findings support the multifactorial interdependencies on DHD and suggest that the SAHD-D should be refined by considering actual wishes, general attitudes, and options of patients.
Department of Palliative Medicine,University Hospital of Cologne,Cologne,Germany.
Maren
M
Galushko
Department of Palliative Medicine,University Hospital of Cologne,Cologne,Germany.
Julia
http://orcid.org/0000-0003-3135-2693
J
Strupp
Department of Palliative Medicine,University Hospital of Cologne,Cologne,Germany.
Johanna
J
Walisko-Waniek
Institute for Medical Statistics and Epidemiology,University Hospital of Cologne,Cologne,Germany.
Moritz
M
Hahn
German Hospital Institute,Düsseldorf, Düsseldorf,Germany.
Sabine
S
Löffert
Center for Health Services Research,University of Cologne,Cologne,Germany.
Nicole
N
Ernstmann
Center for Health Services Research,University of Cologne,Cologne,Germany.
Holger
H
Pfaff
Department of Palliative Medicine,University Hospital of Bonn,Bonn,Germany.
Lukas
L
Radbruch
Department of Palliative Medicine,University Hospital of Göttingen,Göttingen,Germany.
Friedemann
F
Nauck
Department of Palliative Medicine,University Hospital of Cologne,Cologne,Germany.
Christoph
C
Ostgathe
Department of Palliative Medicine,University Hospital of Cologne,Cologne,Germany.
Raymond
R
Voltz
D001293:Attitude to Death; D005065:Euthanasia / Q000523:psychology*; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D010166:Palliative Care / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000592:standards*; D017236:Suicide, Assisted / Q000523:psychology*; D011795:Surveys and Questionnaires
Desire for hastened death; Palliative care; SAHD; Validation