Rodin Gary, Zimmermann Camilla, Rydall Anne, Jones Jennifer, Shepherd Frances A, Moore Malcolm, Fruh Martin, Donner Allan, Gagliese Lucia
Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Canada.
J Pain Symptom Manage. 2007 Jun;33(6):661-75. doi: 10.1016/j.jpainsymman.2006.09.034.
A substantial minority of patients in palliative care settings report a high desire for hastened death (DHD), in association with physical and emotional distress, low social support, and impaired spiritual well being. To clarify to what extent DHD emerges in association with suffering prior to the end of life, we determined its prevalence and correlates in ambulatory patients with metastatic cancer, the majority of whom had an expected survival of >6 months. We hypothesized that DHD in this sample would be directly linked to physical and psychological distress, and inversely related to perceived social support, self-esteem, and spiritual well being. Three hundred twenty-six outpatients completed the Schedule of Attitudes Toward Hastened Death (SAHD), Brief Pain Inventory, Memorial Symptom Assessment Scale, Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Medical Outcomes Study Social Support Survey, FACIT-Spiritual Well-Being Scale, Rosenberg Self-Esteem Scale, and Karnofsky Performance Status. Over 50% of participants reported pain, >20% reported elevated levels of depression (BDI-II> or =15) and hopelessness (BHS> or =8), but <2% had a high DHD (SAHD> or =10). DHD was correlated positively with hopelessness, depression, and physical distress, and negatively with physical functioning, spiritual well being, social support, and self-esteem; it was not associated with treatment status or proximity to death. Over 34% of the variance in predicting SAHD scores was accounted for by hopelessness, depression, and functional status. The relative absence of a strong DHD in this sample suggests that the will to live tends to be preserved in cancer patients prior to the end of life, in spite of significant emotional and physical suffering.
在姑息治疗环境中，相当一部分患者表示强烈渴望加速死亡（DHD），这与身体和情绪困扰、社会支持不足以及精神健康受损有关。为了弄清楚DHD在生命结束前与痛苦相关的程度，我们确定了其在转移性癌症门诊患者中的患病率及相关因素，这些患者中的大多数预期生存期超过6个月。我们假设该样本中的DHD将与身体和心理困扰直接相关，而与感知到的社会支持、自尊和精神健康呈负相关。326名门诊患者完成了加速死亡态度量表（SAHD）、简明疼痛问卷、纪念症状评估量表、贝克抑郁量表第二版（BDI-II）、贝克绝望量表（BHS）、医学结局研究社会支持调查、FACIT精神健康量表、罗森伯格自尊量表和卡氏功能状态量表。超过50%的参与者报告有疼痛，超过20%报告抑郁（BDI-II≥15）和绝望（BHS≥8）水平升高，但不到2%的人有高DHD（SAHD≥10）。DHD与绝望、抑郁和身体困扰呈正相关，与身体功能、精神健康、社会支持和自尊呈负相关；它与治疗状态或接近死亡无关。在预测SAHD评分的方差中，超过34%由绝望、抑郁和功能状态所解释。该样本中相对缺乏强烈的DHD表明，尽管存在明显的情绪和身体痛苦，但癌症患者在生命结束前往往仍有求生欲望。
