Physical and psychological factors and the wish to hasten death in advanced cancer patients

Abstract

Background: Qualitative research suggests that the wish to hasten death (WTHD) in the advanced stages of disease is mainly related to overall suffering. This quantitative study explores the relationship between the WTHD and psychological and physical factors, including survival, in patients with advanced cancer.

Methods: Cross-sectional study of 101 advanced cancer patients admitted to an acute Palliative Care Unit (PCU) and followed-up for survival. Patients were assessed using the Schedule of Attitudes toward Hastened Death (SAHD). The Hospital Anxiety and Depression Scale (HADS), Eastern Cooperative Oncology Group Performance Status, and the Barthel Index were used to assess psychological and physical status. Survival prognosis was based on the Palliative Prognostic score.

Results: The Spanish adaptation of SAHD showed good psychometric properties (Cronbach's alpha 0.92; similar concurrent/discriminant validity to the original). The mean total score on SAHD was 4.9 (standard deviation [SD] = 5.3). SAHD scores were positively correlated with HADS-Total (r = 0.332, p < 0.01), HADS-Depression (r = 0.397, p < 0.01), Eastern Cooperative Oncology Group Performance Status (r = 0.276, p < 0.01), and Palliative Prognostic score (r = 0.248, p < 0.05) and negatively correlated with the Barthel Index (r = -0.324, p < 0.01). Women scored higher than men on SAHD (6.2, SD = 5.9 vs. 4.2, SD = 4.8, p < 0.01). No association was found between WTHD and survival (r = -0.12, p > 0.05).

Conclusions: Both psychological and physical impairment (as well as poorer prognosis) are associated with higher scores on SAHD, supporting the idea that WTHD emerges in response to overall suffering. Although we observed a direct relationship between physical status and survival, the latter was not related to any of the psychological factors or WTHD.

Keywords: cancer; end-of-life; oncology; palliative care; wish to hasten death.