Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson C J, Brescia R
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
JAMA. 2000 Dec 13;284(22):2907-11. doi: 10.1001/jama.284.22.2907.
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.
To assess the prevalence of desire for hastened death among terminally ill cancer patients and to identify factors corresponding to desire for hastened death. Design Prospective survey conducted in a 200-bed palliative care hospital in New York, NY.
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 permit analysis.
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.
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.
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.
理解为何一些绝症患者渴望速死已成为姑息治疗以及关于协助自杀合法化辩论中的一个重要问题。
评估绝症癌症患者中渴望速死的比例，并确定与渴望速死相关的因素。设计在纽约市一家拥有200张床位的姑息治疗医院进行的前瞻性调查。
1998年6月至1999年1月期间因临终护理入院的92名绝症癌症患者（60%为女性；70%为白人；平均年龄65.9岁），他们通过了认知筛查测试并提供了足够的数据以进行分析。
《对速死态度量表》（SAHD）的得分，这是一种自我报告量表，用于评估患有危及生命疾病的个体对速死的渴望。
根据SAHD，16名患者（17%）被归类为对速死有强烈渴望，89名患者中有15名（16%）符合当前重度抑郁发作的标准。对速死的渴望与抑郁症的临床诊断显著相关（P = 0.001），也与抑郁症状严重程度（P < 0.001）和绝望感（P < 0.001）的测量结果相关。在多变量分析中，抑郁症（P = 0.003）和绝望感（P < 0.001）对预测速死渴望提供了独立且独特的贡献，而社会支持（P = 0.05）和身体功能（P = 0.02）的贡献虽显著但较小。
绝症癌症患者中渴望速死并不罕见。抑郁症和绝望感是该人群中渴望速死的最强预测因素，并提供独立且独特的贡献。针对抑郁症、绝望感和社会支持的干预措施似乎是充分姑息治疗的重要方面，特别是与对速死的渴望相关时。
