Wish to die and hasten death in palliative care: a cross-sectional study factor analysis.

OBJECTIVES: The wish to die (WTD) is a complex experience sometimes accompanied by intention to hasten death. The aim of this study is to identify the predictive factors for WTD and hastening death intention (HDI) in Spanish patients with advanced illness. METHODS: This is a subanalysis of a larger cross-sectional study conducted on patients experiencing advanced illness (N=201). Sociodemographic data and data related to symptom burden (Edmonton Symptom Assessment System-Revised), depressive and anxious symptoms (Hospital Anxiety and Depression Scale), demoralisation (Spanish version of the Demoralisation Scale), perceived loss of dignity (Patient Dignity Inventory) and WTD (Assessing Frequency and Extent of Desire to Die) were collected. The analysis used univariate and multivariate logistic regression. RESULTS: The prevalence of WTD in the sample was 18%, with 8 out of 36 patients reporting HDI. The independent factors predictive of WTD were (1) knowledge of approximate prognosis (OR=4.78; 95% CI 1.20 to 10.8; p=0.001); (2) symptom burden (OR=1.05; 95% CI 1.00 to 1.09; p=0.038); and (3) the Demoralisation Scale subsection 'lack of meaning and purpose in life' (OR=1.61; 95% CI 1.30 to 1.99; p=0.000). An independent predictive factor for HDI was the Demoralisation Scale subsection 'patients' distress and coping abilities' (OR=1.47; 95% CI 1.04 to 2.08; p=0.028), while having religious beliefs was a protective factor (OR=0.13; 95% CI0.17 to 0.97; p=0.047). CONCLUSIONS: Demoralisation was found to be the only common triggering factor for WTD and HDI, although experiences share certain features. Identification of the predictive factors for WTD and HDI may contribute to their prevention and management.

Cross-sectional survey of the wish to die among palliative patients in Spain: one phenomenon, different experiences.

OBJECTIVE: Cultural backgrounds and values have a decisive impact on the phenomenon of the wish to die (WTD), and examination of this in Mediterranean countries is in its early stages. The objectives of this study were to establish the prevalence of WTD and to characterise this phenomenon in our cultural context. METHODS: A cross-sectional study with consecutive advanced inpatients was conducted. Data about WTD (Assessing Frequency & Extent of Desire to Die (AFFED) interview) and anxiety and depression (Edmonton Symptom Assessment System-revised (ESAS-r)) were collected through two face-to-face clinical encounters. Data were analysed with descriptive statistics, χ2 and analysis of variance. RESULTS: 201 patients participated and 165 (82%) completed both interviews. Prevalence of WTD was 18% (36/201) in the first interview and 16% (26/165) in the second interview (p=0.25). After the first interview, no changes in depression (p=0.60) or anxiety (p=0.90) were detected. The AFFED shows different experiences within WTD: 11% of patients reported a sporadic experience, while 7% described a persistent experience. Thinking about hastening death (HD) appeared in 8 (22%) out of 36 patients with WTD: 5 (14%) out of 36 patients considered this hypothetically but would never take action, while 3 (8%) out of 36 patients had a more structured idea about HD. In this study, no relation was detected between HD and frequency of the appearance of WTD (p=0.12). CONCLUSIONS: One in five patients had WTD. Our findings suggest the existence of different experiences within the same phenomenon, defined according to frequency of appearance and intention to hasten death. A linguistically grounded model is proposed, differentiating the experiences of the 'wish' or 'desire' to die, with or without HD ideation.

Desactivar el desfibrilador automático implantable al final de la vida: la importancia de una comunicación proactiva / Deactivation of implantable defibrillators at the end of life: the importance of a proactive communication

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Essential elements of the relationship between the nurse and the person with advanced and terminal cancer: A meta-ethnography.

OBJECTIVE: The purpose of this study was to understand how the nurse-patient relationship is interpreted by nurses and patients with advanced and terminal cancer (ATC) and which aspects of this relationship are perceived to be the most valuable for patients. METHODS: A literature search was conducted using the Cumulative Index to Nursing and Allied Health (CINAHL), PubMed, and PsycINFO databases and was supported by reviewing reference lists. Nine articles were selected, and the quality of them was assessed using the Critical Appraisal Skills Program. A synthesis was performed following the seven-stage meta-ethnography described by Noblit and Hare. RESULTS: Four primary themes were derived from the synthesis: (a) being with and being for the person with ATC, (b) time is required for establishing the relationship, (c) the influence of the primary actors in the relationship: the nurse and the person with ATC, and (d) the effects of the relationship on both the nurse and the person with ATC. Finally, an explanatory model of the relationship between the nurse and the patient with ATC was developed, which shows that the relationship is an interpersonal process with several key elements including familiarity with one another, reciprocity, respect, and confidence. The nurses and patients with ATC perceive that their relationship is important and beneficial. The patients demand a helping and caring relationship focused on them as persons, not only as patients. CONCLUSIONS: Patients with ATC and nurses consider their relationship to be important and beneficial. An approach to caring focused on patients as persons should be fostered among health care professionals and students.

Insuficiencia cardíaca terminal ¿es posible morir bien? / End-stage heart failure: Is there a good way to die?

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Multicentre, double-blind, randomised placebo-controlled clinical trial on the efficacy of methylphenidate on depressive symptoms in advanced cancer patients.

INTRODUCTION: Methylphenidate is a psychostimulant that has been used to relieve depressive symptoms in advanced cancer patients. No studies compare its efficacy against placebo in this group of patients. OBJECTIVE: To explore the efficacy of methylphenidate compared with placebo in the relief of depressive symptoms in advanced cancer patients. MATERIAL AND METHODS: A multicentre, double-blind, randomised placebo-controlled clinical trial was undertaken comparing the efficacy of methylphenidate and placebo in depressive symptoms. Advanced stage cancer patients were eligible if they scored at least two points on the Two Question Screening Survey for depression. A reduction of at least two points on the Edmonton Symptom Assessment Scale for depression (0-10) was considered as a response. RESULTS: Sixty-nine patients were included (methylphenidate: n=31, placebo: n=38); median daily dose of methylphenidate was 25 mg. Fifty-eight patients (84%) who completed the first week of treatment were considered suitable for evaluation. In the intention to treat analysis, there were 14/31 (45%) responses with methylphenidate and 10/38 (26%) responses with placebo (difference: 19%; 95% CI: 4% to 39%; p=0.10). With the Hospital Anxiety and Depression Scale, 11/19 (58%) patients with methylphenidate and 10/24 (42%) with placebo improved from a score compatible with depression in the first 7 days (difference 16%; 95% CI 13% to 42%; p=0.29). The proportion of patients indicating adverse effects was similar for both cohorts (p=0.99). CONCLUSION: Compared with the placebo, methylphenidate demonstrated a positive trend in the incidence of response for depressive symptoms in advanced cancer patients.