Τετάρτη 28 Φεβρουαρίου 2018

Assessment of the wish to hasten death in patients with advanced cancer: a comparison of two different approaches

Abstract

Introduction

The Desire for Death Rating Scale (DDRS) and the short form of the Schedule of Attitudes toward Hastened Death (SAHD-5) are different approaches to assessing the wish to hasten death (WTHD). Both have clinical threshold scores for identifying individuals with a meaningfully elevated WTHD. However, the agreement between the two measures, and patient opinions about assessment of the WTHD, are unknown.

Objectives

To compare the DDRS and SAHD-5 and to analyse patient opinions about assessment of the WTHD.

Methods: The WTHD was assessed in 107 patients with advanced cancer using both the DDRS and SAHD-5. Patients were subsequently asked their opinion about this assessment.

Results

Correlation between scores on the SAHD-5 and the DDRS was moderate, Spearman rho=.67 (p<.01). The SAHD-5 identified 13 patients (12.1%) at risk of the WTHD, and the DDRS identified 6 patients (5.6%) with a moderate-high WTHD (p>.05). Concordance between the DDRS and SAHD-5 in identifying individuals with an elevated WTHD was poor when using recommended cut-off scores, κ=.37 (p<.01), but could be improved by using different thresholds. Only 4 patients (3.8%) regarded the assessment questions as bothersome, and 90.6% considered it important that healthcare professionals inquire about the WTHD.

Conclusions

The SAHD-5 and DDRS appear to be appropriate methods for assessing the WTHD and could provide complementary information in clinical practice: the SAHD-5 to screen for risk of the WTHD and the DDRS as a clinical interview to explore it in greater detail. Assessment of the WTHD is well accepted by palliative care cancer patients.



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