Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.
Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand; National Institute of Geriatrics, Mexico City, Mexico.
J Pain Symptom Manage. 2020 Sep;60(3):539-548.e1. doi: 10.1016/j.jpainsymman.2020.04.003. Epub 2020 Apr 16.
The decision to request and proceed with euthanasia or physician-assisted dying is complex, and predictors of such decisions are heterogeneous with regard to physical health, psychological, and social factors. Local research is therefore needed.
To examine the interplay of demographic, clinical, and psychosocial factors routinely collected by a standardized clinical instrument, the interRAI Resident Assessment Instrument for Palliative Care (interRAI-PC), in people with a prognosis of less than 12 months who wanted to die.
All New Zealanders who had an interRAI-PC in 2018 were included. The outcome variable was the single item Wants to die now. Independent variables included biopsychosocial factors and health index scales generated by interRAI-PC. A binary logistic regression was used to determine the predictive factors of Wants to die now (yes vs. no).
There were 771 individuals included (mean age 76.0 years; SD 11.6; female 50.1%); 9.3% of whom reported yes to Wants to die now, 59.8% no, and for 30.9%, the assessor was unable to determine. The factors with the largest odds ratios (ORs) were awareness of terminal prognosis (OR 4.8; 95% CI 2.2-10.3), high level of depression (OR 4.6; 95% CI 1.7-12.6), not finding meaning in day-to-day life (OR 3.8; 95% CI 1.8-8.1), and pain (less than severe: OR 3.7; 95% CI 1.3-10.4 and severe to excruciating: OR 3.5; 95% CI 1.1-10.7).
Addressing the significant factors we identified should form part of a multidisciplinary assessment when terminally ill patients express a wish to die, to ensure their physical, psychological, and existential needs are adequately met.
请求并进行安乐死或医师协助自杀的决定是复杂的，并且这些决定的预测因素在身体健康、心理和社会因素方面存在差异。因此需要进行本地研究。
检查通过标准化临床工具 interRAI 姑息治疗居民评估工具（interRAI-PC）常规收集的人口统计学、临床和社会心理因素的相互作用，这些人预计寿命不足 12 个月但希望死亡。
纳入所有在 2018 年接受过 interRAI-PC 的新西兰人。因变量为现在就想死的单项。自变量包括 interRAI-PC 生成的生物心理社会因素和健康指数量表。使用二项逻辑回归确定现在就想死的预测因素（是与否）。
共纳入 771 人（平均年龄 76.0 岁；标准差 11.6；女性 50.1%）；9.3%的人报告现在就想死，59.8%的人报告不想死，30.9%的评估者无法确定。具有最大优势比（OR）的因素是意识到终末期预后（OR 4.8；95%置信区间 2.2-10.3）、高度抑郁（OR 4.6；95%置信区间 1.7-12.6）、日常生活中找不到意义（OR 3.8；95%置信区间 1.8-8.1）和疼痛（轻度以下：OR 3.7；95%置信区间 1.3-10.4 和严重至剧痛：OR 3.5；95%置信区间 1.1-10.7）。
当终末期患者表达想死的愿望时，应解决我们确定的重要因素，以确保他们的身体、心理和存在需求得到充分满足，这应成为多学科评估的一部分。
