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Breitbart W, Rosenfeld B, Pessin H, et al. Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer. JAMA. 2000;284(22):2907–2911. doi:10.1001/jama.284.22.2907
Author Affiliations: Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY (Drs Breitbart and Kaim, Mss Pessin and Funesti-Esch, and Mr Nelson); Department of Psychology, Fordham University, Bronx, NY (Dr Rosenfeld and Ms Galietta); and the Palliative Care Institute, Calvary Hospital, Bronx, NY (Dr Brescia).
Context Understanding why some terminally ill patients desire a hastened death
has become an important issue in palliative care and the debate regarding
legalization of assisted suicide.
Objectives To assess the prevalence of desire for hastened death among terminally
ill cancer patients and to identify factors corresponding to desire for hastened
Design Prospective survey conducted in a 200-bed palliative care hospital in
New York, NY.
Patients Ninety-two terminally ill cancer patients (60% female; 70% white; mean
age, 65.9 years) admitted between June 1998 and January 1999 for end-of-life
care who passed a cognitive screening test and provided sufficient data to
Main Outcome Measure Scores on the Schedule of Attitudes Toward Hastened Death (SAHD), a
self-report measure assessing desire for hastened death among individuals
with life-threatening medical illness.
Results Sixteen patients (17%) were classified as having a high desire for hastened
death based on the SAHD and 15 (16%) of 89 patients met criteria for a current
major depressive episode. Desire for hastened death was significantly associated
with a clinical diagnosis of depression (P = .001)
as well as with measures of depressive symptom severity (P<.001) and hopelessness (P<.001). In
multivariate analyses, depression (P = .003) and
hopelessness (P<.001) provided independent and
unique contributions to the prediction of desire for hastened death, while
social support (P = .05) and physical functioning
(P = .02) added significant but smaller contributions.
Conclusions Desire for hastened death among terminally ill cancer patients is not
uncommon. Depression and hopelessness are the strongest predictors of desire
for hastened death in this population and provide independent and unique contributions.
Interventions addressing depression, hopelessness, and social support appear
to be important aspects of adequate palliative care, particularly as it relates
to desire for hastened death.
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