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. 2018 Feb 20;17(1):30.
doi: 10.1186/s12904-018-0279-3.

The DEsire to DIe in Palliative care: Optimization of Management (DEDIPOM) - a study protocol

Kerstin Kremeike  1 , Maren Galushko  2 , Gerrit Frerich  2 , Vanessa Romotzky  2 , Stefanie Hamacher  3 , Gary Rodin  4   5   6 , Holger Pfaff  7 , Raymond Voltz  2   8   9   10
Affiliations

The DEsire to DIe in Palliative care: Optimization of Management (DEDIPOM) - a study protocol

Kerstin Kremeike et al. BMC Palliat Care. .

Abstract

Background: A desire to die (DD) is frequent in palliative care (PC). However, uncertainty remains as to the appropriate therapeutic response. (Proactive) discussion of DD is not usually part of standard care. To support health practitioners' (HPs) reactions to a patient's DD, a training program has been developed, piloted and evaluated. Within this framework, a first draft of a semi-structured clinical interview schedule with prompts (CISP) has been developed, including recommendations for action to support HPs' self-confidence. The aim of this study is the further development of the CISP to support routine exploration of death and dying distress and proactive addressing of a DD.

Methods: This observatory, prospective health services study comprises a three step study design: 1. Revision of the CISP and consensus finding based on semi-structured interviews with patients and a Delphi process with (inter-)national experts, patient representatives and relatives; 2. Increasing confidence in HPs through a 2 day-training program using the consented CISP; 3. A formative quantitative evaluation of conversations between HPs and patients (300 palliative patients at three time points) and a qualitative evaluation based on interview triads of patients, relatives and HPs. The evaluation of conversations will include patient-oriented outcomes, including perceived relationships with HPs and death and dying distress. We will also consider aspects of social inequality and gender.

Discussion: The intervention can provide a framework for open discussion of DD and a basis for enhancing a trustful HP-patient relationship in which such difficult topics can be addressed. The benefits of this study will include (a) the creation of the first consented semi-structured approach to identify and address DD and to respond therapeutically, (b) the multi-professional enhancement of confidence in dealing with patients' DD and an intervention that can flexibly be integrated into other training and education programs and (c) an evaluation of effects of this intervention on patients, relatives and HPs, with attention to social inequality and gender.

Trial registration: The study is registered in the German Clinical Trials Register ( DRKS00012988 ; registration date: 27.9.2017) and in the Health Services Research Database ( VfD_DEDIPOM_17_003889 ; registration date: 14.9.2017).

Keywords: Assisted dying; Communication; Desire to die; General and specialized palliative care; Multi-professional; Relationship; Suicidal ideation; Suicide; Training; Wish towards hastening death.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval for this study was obtained from the Ethics Committee of the University of Cologne (#17–265; 4th September 2017). All study information and patient consent forms are approved by the Ethics committee.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Training course evaluation
Fig. 3
Fig. 3
Timeline of the quantitative evaluation of conversations on DD between palliative care patients and health practitioners
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References

    1. Chochinov H, Wilson K, Enns M. Desire for death in the terminally ill. Am J. Psychiatry. 1995;152:1185–1191. doi: 10.1176/ajp.152.8.1185. - DOI - PubMed
    1. Rodin G, Zimmermann C, Rydall A, Jones J, Shepherd FA, Moore M, Fruh M, Donner A, Gagliese L. The desire for hastened death in patients with metastatic cancer. J Pain Symptom Manage. 2007;33:661–675. doi: 10.1016/j.jpainsymman.2006.09.034. - DOI - PubMed
    1. Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients. Psycho-Oncology. 2006;15:355–360. doi: 10.1002/pon.972. - DOI - PubMed
    1. Kelly B, Burnett P, Pelusi D, Badger S, Varghese F, Robertson M. Factors associated with the wish to hasten death: a study of patients with terminal illness. Psycholical Med. 2003;33:75–81. - PubMed
    1. Hudson PL, Schofield P, Kelly B, Hudson R, O'Connor M, Kristjanson LJ, Ashby M, Aranda S. Responding to desire to die statements from patients with advanced disease: recommendations for health professionals. Pall Med. 2006;20:703–710. doi: 10.1177/0269216306071814. - DOI - PubMed

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