title: An International Consensus Definition of the Wish to Hasten Death and Its Related Factors.
abstract: BACKGROUND
  The desire for hastened death or wish to hasten death (WTHD) that is experienced by some patients with advanced illness is a complex phenomenon for which no widely accepted definition exists. This lack of a common conceptualization hinders understanding and cooperation between clinicians and researchers. The aim of this study was to develop an internationally agreed definition of the WTHD.
  
  
  METHODS
  Following an exhaustive literature review, a modified nominal group process and an international, modified Delphi process were carried out. The nominal group served to produce a preliminary definition that was then subjected to a Delphi process in which 24 experts from 19 institutions from Europe, Canada and the USA participated. Delphi responses and comments were analysed using a pre-established strategy.
  
  
  RESULTS
  All 24 experts completed the three rounds of the Delphi process, and all the proposed statements achieved at least 79% agreement. Key concepts in the final definition include the WTHD as a reaction to suffering, the fact that such a wish is not always expressed spontaneously, and the need to distinguish the WTHD from the acceptance of impending death or from a wish to die naturally, although preferably soon. The proposed definition also makes reference to possible factors related to the WTHD.
  
  
  CONCLUSIONS
  This international consensus definition of the WTHD should make it easier for clinicians and researchers to share their knowledge. This would foster an improved understanding of the phenomenon and help in developing strategies for early therapeutic intervention.
authors.affiliation: School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: Albert
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authors.lastname: Balaguer
authors.affiliation: Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Monforte-Royo
authors.affiliation: School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.|Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Porta-Sales
authors.affiliation: Unidad de Cuidados Paliativos, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Alberto
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authors.lastname: Alonso-Babarro
authors.affiliation: Institute of Health Research Aragon, Cátedra de Profesionalismo y Ética Clínica, Universidad de Zaragoza, Zaragoza, Spain.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Altisent
authors.affiliation: Escola Universitària d'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Amor
authors.initials: A
authors.lastname: Aradilla-Herrero
authors.affiliation: Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
authors.forename: Mercedes
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authors.lastname: Bellido-Pérez
authors.affiliation: Memorial Sloan-Kettering Cancer Center, New York, NY, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Breitbart
authors.affiliation: ATLANTES Research Program, Institute for Culture and Society and Palliative Medicine Department, Clinica Universidad de Navarra, University of Navarra, Navarra, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
authors.affiliation: Complejo Hospitalario Infanta Cristina, Badajoz, Spain.
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Cuervo
authors.affiliation: End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Luc
authors.initials: L
authors.lastname: Deliens
authors.affiliation: Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.
authors.forename: Gerrit
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authors.lastname: Frerich
authors.affiliation: Catholic University of Leuven, Leuven, Belgium.
authors.forename: Chris
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authors.lastname: Gastmans
authors.affiliation: Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Lichtenfeld
authors.affiliation: Faculty of Psychology, Stress and Research Group, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
authors.forename: Joaquín T
authors.initials: JT
authors.lastname: Limonero
authors.affiliation: Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Maier
authors.affiliation: Department of Philosophy and Religious Studies, Faculty of Humanities, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Lars Johan
authors.initials: LJ
authors.lastname: Materstvedt
authors.affiliation: Palliative Care Supportive Team, Hospital Universitario Arnau de Vilanova, Lleida, Institut Català de la Salut, IRB, Lleida, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Nabal
authors.affiliation: Department of Supportive Care, Princess Margaret Cancer Centre, Department of Psychiatry and Global Institute Psychosocial, Palliative and End-Life Care (GIPPEC), University of Toronto, Ontario, Canada.
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.affiliation: Department of Psychology, Fordham University, Bronx, New York, United States of America.
authors.forename: Barry
authors.initials: B
authors.lastname: Rosenfeld
authors.affiliation: School of Social Work, University of Wisconsin-Madison, Wisconsin, United States of America.
authors.forename: Tracy
authors.initials: T
authors.lastname: Schroepfer
authors.affiliation: Escola Universitària d'Infermeria Gimbernat, Autonomous University of Barcelona, Barcelona, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Tomás-Sábado
authors.affiliation: Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Trelis
authors.affiliation: School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.|Palliative Care Service, Institut Català d'Oncologia, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.
authors.forename: Christian
authors.initials: C
authors.lastname: Villavicencio-Chávez
authors.affiliation: Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany.
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mesh_terms: D001293:Attitude to Death; D032921:Consensus; D003697:Delphi Technique; D003863:Depression; D005060:Europe; D006801:Humans; D038622:Internationality; D009656:North America; D010166:Palliative Care; D057240:Patient Preference; D010361:Patients / Q000523:psychology*; D010865:Pilot Projects; D013315:Stress, Psychological / Q000523:psychology; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D013727:Terminal Care; D019452:Terminally Ill / Q000523:psychology