Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-20T01:19:53.889Z Has data issue: false hasContentIssue false
  • English
  • Français

Complexity of desire for hastened death in terminally ill cancer patients: A cluster analysis

Published online by Cambridge University Press:  01 March 2021

Yutaka Hatano Open the ORCID record for Yutaka Hatano [Opens in a new window] ,
Tatsuya Morita ,
Masanori Mori ,
Isseki Maeda ,
Shunsuke Oyamada ,
Akemi Shirado Naito ,
Kiyofumi Oya ,
Akihiro Sakashita Open the ORCID record for Akihiro Sakashita [Opens in a new window] ,
Satoko Ito  and
Yusuke Hiratsuka Open the ORCID record for Yusuke Hiratsuka [Opens in a new window]
...Show all authors
Yutaka Hatano*
Affiliation:
Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
Tatsuya Morita
Affiliation:
Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
Masanori Mori
Affiliation:
Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
Isseki Maeda
Affiliation:
Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
Shunsuke Oyamada
Affiliation:
Department of Biostatistics, JORTC Data Center, Tokyo, Japan
Akemi Shirado Naito
Affiliation:
Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
Kiyofumi Oya
Affiliation:
Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
Akihiro Sakashita
Affiliation:
Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
Satoko Ito
Affiliation:
Hospice, The Japan Baptist Hospital, Kyoto, Japan
Yusuke Hiratsuka
Affiliation:
Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
Satoru Tsuneto
Affiliation:
Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
*
Author for correspondence: Yutaka Hatano, Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups.

Methods

Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD.

Results

Data from 971 patients, whose Richmond Agitation–Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16–20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): “physical distress,” cluster 2 (21%, 37/173): “dependent and burdensome,” cluster 3 (19%, 33/173): “hopelessness,” cluster 4 (17%, 30/173): “profound fatigue,” and cluster 5 (7%, 12/173): “extensive existential suffering.”

Conclusions

A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.

Keywords

Cluster analysisDesire for hastened deathMulticentre observational studyReasons of desire for deathTerminally ill cancer patients
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 6 , December 2021 , pp. 646 - 655
Check for updates
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Akazawa, T, Akechi, T, Morita, T, et al. (2010) Self-perceived burden in terminally ill cancer patients: A categorization of care strategies based on bereaved family members’ perspectives. Journal of Pain and Symptom Management 40, 224–234.CrossRefGoogle ScholarPubMed
Anderson, F, Downing, GM, Hill, J, et al. (1996) Palliative performance scale (PPS): A new tool. Journal of Palliative Care 12, 5–11.CrossRefGoogle ScholarPubMed
Balaguer, A, Monforte-Royo, C, Porta-Sales, J, et al. (2016) An international consensus definition of the wish to hasten death and its related factors. PLoS ONE 11, e0146184.CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld, BD and Passik, SD (1996) Interest in physician-assisted suicide among ambulatory HIV-infected patients. The American Journal of Psychiatry 153, 238–242. doi:10.1176/ajp.153.2.238Google ScholarPubMed
Breitbart, W, Rosenfeld, B, Pessin, H, et al. (2000) Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 284, 2907–2911.CrossRefGoogle ScholarPubMed
Chochinov, HM, Wilson, KG, Enns, M, et al. (1995) Desire for death in the terminally ill. The American Journal of Psychiatry 152, 1185–1191.Google ScholarPubMed
Chochinov, HM, Wilson, KG, Enns, M, et al. (1998) Depression, Hopelessness, and suicidal ideation in the terminally ill. Psychosomatics 39, 366–370.CrossRefGoogle ScholarPubMed
Eisen, MB, Spellman, PT, Brown, PO, et al. (1998) Cluster analysis and display of genome-wide expression patterns. Proceedings of the National Academy of Sciences of the United States of America 95, 14863–14868.CrossRefGoogle ScholarPubMed
Ganzini, L, Harvath, TA, Jackson, A, et al. (2002) Experiences of Oregon nurses and social workers with hospice patients who requested assistance with suicide. New England Journal of Medicine 347, 582–588.CrossRefGoogle ScholarPubMed
Ganzini, L, Goy, ER and Dobscha, SK (2008) Prevalence of depression and anxiety in patients requesting physicians’ aid in dying: Cross sectional survey. BMJ 337, a1682.CrossRefGoogle ScholarPubMed
Gilbert, P and Allan, S (1998) The role of defeat and entrapment (arrested flight) in depression: An exploration of an evolutionary view. Psychological Medicine 28, 585–598.CrossRefGoogle ScholarPubMed
Gomes, B, Higginson, IJ, Calanzani, N, et al. (2012) Preferences for place of death if faced with advanced cancer: A population survey in England, Flanders, Germany, Italy, the Netherlands, Portugal and Spain. Annals of Oncology 23, 2006–2015.CrossRefGoogle ScholarPubMed
Hodkinson, HM (1972) Evaluation of a mental test score for assessment of mental impairment in the elderly. Age Ageing 1, 233–238.CrossRefGoogle ScholarPubMed
Imai, K, Morita, T, Mori, M, et al. (2016) Development and linguistic validation of the Japanese version of the modified Richmond Agitation–Sedation Scale. Palliative Care Research 11, 331–336 (in Japanese).CrossRefGoogle Scholar
Li, XM, Xiao, WH, Yang, P, et al. (2017) Psychological distress and cancer pain: Results from a controlled cross-sectional survey in China. Scientific Reports 7, 39397.CrossRefGoogle ScholarPubMed
Lochner, C, Keuthen, NJ, Curley, EE, et al. (2019) Comorbidity in trichotillomania (hair-pulling disorder): A cluster analytical approach. Brain and Behavior 9, e01456.CrossRefGoogle ScholarPubMed
Logan, J, Hall, J and Karch, D (2011) Suicide categories by patterns of known risk factors: A latent class analysis. Archives of General Psychiatry 68, 935–941.CrossRefGoogle ScholarPubMed
Maltoni, M, Scarpi, E, Rosati, M, et al. (2012) Palliative sedation in end-of-life care and survival: A systematic review. Journal of Clinical Oncology 30, 1378–1383.CrossRefGoogle ScholarPubMed
McClain, CS, Rosenfeld, B and Breitbart, W (2003) Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 361, 1603–1607.CrossRefGoogle ScholarPubMed
McKenzie, E, Zhang, L, Chan, S, et al. (2020) Symptom correlates of dyspnea in advanced cancer patients using the Edmonton Symptom Assessment System. Supportive Care in Cancer 28, 87–98.CrossRefGoogle ScholarPubMed
McMillan, SC, Tofthagen, C and Morgan, MA (2008) Relationships among pain, sleep disturbances, and depressive symptoms in outpatients from a comprehensive cancer center. Oncology Nursing Forum 35, 603–611.CrossRefGoogle ScholarPubMed
Morita, T, Sakaguchi, Y, Hirai, K, et al. (2004) Desire for death and requests to hasten death of Japanese terminally ill cancer patients receiving specialized inpatient palliative care. Journal of Pain and Symptom Management 27, 44–52.CrossRefGoogle ScholarPubMed
Mystakidou, K, Parpa, E, Katsouda, E, et al. (2006) The role of physical and psychological symptoms in desire for death: A study of terminally ill cancer patients. Psycho-Oncology 15, 355–360.CrossRefGoogle ScholarPubMed
Oken, MM, Creech, RH, Tormey, DC, et al. (1982) Toxicity and response criteria of the Eastern Cooperative Oncology Group. American Journal of Clinical Oncology 5, 649–655.CrossRefGoogle ScholarPubMed
O'Mahony, S, Goulet, J, Kornblith, A, et al. (2005) Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study. Journal of Pain and Symptom Management 29, 446–457.CrossRefGoogle ScholarPubMed
Parpa, E, Tsilika, E, Galanos, A, et al. (2019) Depression as mediator and or moderator on the relationship between hopelessness and patients’ desire for hastened death. Supportive Care in Cancer 27, 4353–4358.CrossRefGoogle ScholarPubMed
Peixoto da Silva, S, Santos, JMO, Costa E Silva, MP, et al. (2020) Cancer cachexia and its pathophysiology: Links with sarcopenia, anorexia and asthenia. Journal of Cachexia, Sarcopenia and Muscle 11, 619–635.CrossRefGoogle ScholarPubMed
Robinson, S, Kissane, DW, Brooker, J, et al. (2017) The relationship between poor quality of life and desire to hasten death: A multiple mediation model examining the contributions of depression, demoralization, loss of control, and low self-worth. Journal of Pain and Symptom Management 53(2), 243–249.CrossRefGoogle ScholarPubMed
Rodin, G, Zimmermann, C, Rydall, A, et al. (2007) The desire for hastened death in patients with metastatic cancer. Journal of Pain and Symptom Management 33, 661–675.CrossRefGoogle ScholarPubMed
Rosenfeld, B, Breitbart, W, Stein, K, et al. (1999) Measuring desire for death among patients with HIV/AIDS: The schedule of attitudes toward hastened death. American Journal of Psychiatry 156, 94–100.CrossRefGoogle ScholarPubMed
Sakurai, H, Miyashita, M, Imai, K, et al. (2019) Validation of the integrated palliative care outcome scale (IPOS) - Japanese version. Japanese Journal of Clinical Oncology 49, 257–262.CrossRefGoogle ScholarPubMed
Suarez-Almazor, ME, Newman, C, Hanson, J, et al. (2002) Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival. Journal of Clinical Oncology 20, 2134–2141.CrossRefGoogle ScholarPubMed
Vehling, S, Kissane, DW, Lo, C, et al. (2017) The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer 123(17), 3394–3401.CrossRefGoogle ScholarPubMed
Villavicencio-Chávez, C, Monforte-Royo, C, Tomás-Sábado, J, et al. (2014) Physical and psychological factors and the wish to hasten death in advanced cancer patients. Psycho-Oncology 23, 1125–1132.CrossRefGoogle ScholarPubMed
Wilson, KG, Chochinov, HM, McPherson, CJ, et al. (2007) Desire for euthanasia or physician-assisted suicide in palliative cancer care. Health Psychology 26, 314–323.CrossRefGoogle ScholarPubMed
Wilson, KG, Dalgleish, TL, Chochinov, HM, et al. (2016) Mental disorders and the desire for death in patients receiving palliative care for cancer. BMJ Supportive & Palliative Care 6, 170–177.CrossRefGoogle ScholarPubMed
Yao, CA, Hu, WY, Lai, YF, et al. (2007) Does dying at home influence the good death of terminal cancer patients? Journal of Pain and Symptom Management 34, 497–504.CrossRefGoogle ScholarPubMed
Supplementary material: File

Hatano et al. supplementary material

Figures S1-S2

Download Hatano et al. supplementary material(File)
File 706.8 KB