Assessment of the wish to hasten death in patients with advanced disease: A systematic review of measurement instruments

Abstract

Background: Patients with advanced conditions may present a wish to hasten death. Assessing this wish is complex due to the nature of the phenomenon and the difficulty of conceptualising it.

Aim: To identify and analyse existing instruments for assessing the wish to hasten death and to rate their reported psychometric properties.

Design: Systematic review based on PRISMA guidelines. The COnsensus-based Standards for the selection of health Measurement INstruments checklist was used to evaluate the methodological quality of validation studies and the measurement properties of the instrument described.

Data sources: The CINAHL, PsycINFO, Pubmed and Web of Science databases were searched from inception to November 2015.

Results: A total of 50 articles involving assessment of the wish to hasten death were included. Eight concerned instrument validation and were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments criteria. They reported data for between two and seven measurement properties, with ratings between fair and excellent. Of the seven instruments identified, the Desire for Death Rating Scale or the Schedule of Attitudes toward Hastened Death feature in 48 of the 50 articles. The Schedule of Attitudes toward Hastened Death is the most widely used and is the instrument whose psychometric properties have been most often analysed. Versions of the Schedule of Attitudes toward Hastened Death are available in five languages other than the original English.

Conclusion: This systematic review has analysed existing instruments for assessing the wish to hasten death. It has also explored the methodological quality of studies that have examined the measurement properties of these instruments and offers ratings of the reported properties. These results will be useful to clinicians and researchers with an interest in a phenomenon of considerable relevance to advanced patients.

Keywords: Wish to hasten death; advanced illness; assessment instrument; desire to die; palliative care; psychometric properties; systematic review; tool.

Figure 1.

PRISMA flow diagram for study selection. *Reasons for exclusion: (a) language of the publication (n = 1), (b) not peer-reviewed journal (n = 8), (c) the study did not include any WTHD measurement (n = 36), (d) the study is focused on the paediatric population (n = 1), (e) the target population is not advanced disease or palliative care (n = 3) and (f) measurement of the WTHD was based on the report of informants such as relatives or health professionals (n = 1).