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A recent study suggests that palliative care programs must adequately address depression and hopelessness in terminally ill patients in order to reduce this desire for hastened death. The desire for hastened death has taken on added importance in palliative care as the debate regarding legalization of assisted suicide continues to mount.
Researchers conducted a prospective study of 92 terminally ill patients in a 200-bed palliative care hospital in New York City admitted between June 1998 and January 1999 for end-of-life care. Patients passed a cognitive screening test and provided sufficient data to permit analysis.
Patients completed the 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. Findings include:
• Seventeen percent of patients were classified as having a high desire for hastened death based on the SAHD and 16% of patients met criteria for a current major depressive episode.
• Desire for hastened death was significantly associated with a clinical diagnosis of depression and hopelessness.
• In multivariate analyses, depression and hopelessness provided independent and unique contributions to the prediction of desire for hastened death.
• Social support and physical functioning added significant but small contributions to predicting desire for hastened death.
Researchers suggest that interventions which address depression, hopelessness, and social support be standard aspects of all palliative care, particularly as it relates to desire for hastened death.
[See: 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.]