An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

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. Findings: 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

An International Consensus Definition of the Wish to Hasten Death and Its Related Factors

Abstract Backgroun

An international consensus definition of thewish 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. Findings 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

Terminally ill elders speak out about their consideration to hasten death.

This study sought to gain a deeper understanding of the factors motivating terminally ill elders to consider a hastened death. This was accomplished by using theories and research on perceived personal control and social control to expand the motivating factors considered, and by asking terminally ill elders open-ended questions to uncover unknown motivating factors. Data were collected through face-to-face interviews with a purposive sample of 96 mentally competent, terminally ill elders, 50 years of age and older. Hospices, hospital-based inpatient palliative care programs and hospital-based outpatient clinics throughout Michigan provided referrals. Information was collected on previously studied variables (gender, education, religiosity, likelihood of clinical depression, and pain intensity) and new variables (indirect and direct social control, quality of social support, and perceived control over pain, fatigue and decision-making). The questionnaire incorporated quantitative and qualitative questions. Multivariate binomial logistic regression was conducted to determine which factors independently predicted whether elders were considering a hastened death. A content analysis approach was taken in analyzing the qualitative data to identify themes concerning motivating factors. Overall, 19% of respondents were considering hastening their death. Multivariate results revealed that respondents with a higher education were more likely to consider a hastened death, as were those experiencing poor social support or low perceived control over fatigue; gender, religiosity, likelihood of clinical depression, pain intensity, indirect and direct social control, and perceived control over pain and decision-making were not significant factors. Qualitative analyses revealed that instead of the two mind frames initially explored (considering hastening or not hastening death), six mind frames towards dying emerged: neither ready nor accepting death, not ready but accepting death, ready and accepting death, wishing death would come, considering a hastened death with no plan, and considering one with a plan. Key characteristics differentiating these mind frames and factors motivating their adoption by respondents were uncovered, such as religious beliefs, desire for control over dying and feeling useless. Study results provide important information for policy makers and practitioners working to improve the palliative care offered to terminally ill elders. These results also serve to inform theories on perceived control and social control.Ph.D.GerontologyHealth and Environmental SciencesIndividual and family studiesMedicineSocial SciencesSocial workUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/123695/2/3096193.pd