Center of Bioethics - Faculty of Medicine of the University of Lisbon, Lisboa, Portugal; Center for Evidence Based Medicine - Faculty of Medicine of the University of Lisbon, Lisboa, Portugal; Department of Palliative Medicine - IIHSCJ - Casa de Saúde da Idanha, Belas, Portugal.
Psychosomatics. 2013 Sep-Oct;54(5):451-7. doi: 10.1016/j.psym.2013.01.006. Epub 2013 Mar 7.
Desire for death (DFD) within the context of palliative care has become a prominent medical issue and remains the subject of much controversy.
Cross-sectional study designed to assess the prevalence and associated demographic, physical, psychiatric, and psychosocial factors for DFD in patients with advanced disease.
Seventy-five terminally ill patients were included in the analyses in a 28-month period. The prevalence of DFD was 20% (95% CI [11.7-30.8]). No statistical differences were observed between patients with and without DFD with respect to sex, age, race, education, religion, type of family, medical diagnosis, and medication. There were associations between DFD and being married/cohabitating (OR = 4.0; 95% CI [1.21-13.29]) and being socially isolated (OR = 0.3; 95% CI [0.06-0.98]). Significant positive correlations were found between moderate to severe Edmonton Symptom Assessment Scale (ESAS) scores and DFD for tiredness (OR = 10.1; 95% CI [1.57 ± inf]) and drowsiness (OR = 6.0; 95% CI [1.77-20.37]). DFD was also correlated with depression (DSM-IV criteria: OR = 5.5; 95% CI [1.56-19.47]; Hospital and Anxiety Depression Scale (HADS) depression subscale ≥11: OR = 8.6; 95% CI [1.33 ± inf]). In exact multivariate regression analyses predicting DFD, three independent factors emerged: marital status (OR = 5.3; 95% CI [1.16-29.89]); HADS depression sub-scale score ≥11 (OR = 8.3; 95% CI [1.11 ± inf]); drowsiness (OR = 5.8; 95% CI [1.29-32.85]).
Prevalence of DFD was high in this sample of patients. Identifying factors associated with DFD could help provide medical and social interventions capable of diminishing suffering in terminal ill patients.
在姑息治疗背景下，对死亡的渴望（DFD）已成为一个突出的医学问题，并且仍然是许多争议的主题。
本研究采用横断面设计，旨在评估晚期疾病患者 DFD 的流行率以及与人口统计学、身体、精神和心理社会因素相关的情况。
在 28 个月的时间里，共纳入了 75 名终末期患者进行分析。DFD 的患病率为 20%（95%CI[11.7-30.8]）。在有无 DFD 的患者之间，在性别、年龄、种族、教育、宗教、家庭类型、医学诊断和药物治疗方面未观察到统计学差异。DFD 与已婚/同居（OR=4.0；95%CI[1.21-13.29]）和社交孤立（OR=0.3；95%CI[0.06-0.98]）有关。在中度至重度 Edmonton 症状评估量表（ESAS）评分与 DFD 之间发现了显著的正相关关系，用于疲倦（OR=10.1；95%CI[1.57+inf]）和嗜睡（OR=6.0；95%CI[1.77-20.37]）。DFD 还与抑郁（DSM-IV 标准：OR=5.5；95%CI[1.56-19.47]；医院和焦虑抑郁量表（HADS）抑郁分量表≥11：OR=8.6；95%CI[1.33+inf]）相关。在预测 DFD 的精确多元回归分析中，出现了三个独立的因素：婚姻状况（OR=5.3；95%CI[1.16-29.89]）；HADS 抑郁分量表评分≥11（OR=8.3；95%CI[1.11+inf]）；嗜睡（OR=5.8；95%CI[1.29-32.85]）。
在本患者样本中，DFD 的患病率较高。确定与 DFD 相关的因素可能有助于提供能够减轻终末期患者痛苦的医疗和社会干预措施。
