Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
Institute of Medical Statistics and Computational Biology, Faculty of Medicine, University of Cologne, Cologne, Germany.
Palliat Med. 2024 Oct;38(9):1042-1053. doi: 10.1177/02692163241269689. Epub 2024 Aug 16.
Patients with serious illness frequently report (temporary) wishes to hasten death. Even until the end-of-life, many patients also harbor a will to live. Although both phenomena are negatively correlated according to some studies, they can also co-exist. Knowledge about the complex relationship between the seemingly opposing wish to hasten death and will to live is limited, but crucial for delivering adequate care and understanding potential requests for assisted dying.
To study the correlation of and explore the relationship between wish to hasten death and will to live over 6 weeks.
Observatory, prospective cohort study following a mixed methods design. Analysis of quantitative (Schedules of Attitudes Toward Hastened Death, a visual numerical scale and (additional) validated questionnaires) and qualitative (semi-structured interviews) data with illustrative case descriptions.
SETTING/PARTICIPANTS: Patients receiving palliative care with heterogenous underlying diseases from various care settings, before and after an open conversation on a possible desire to die.
In = 85 patients, wish to hasten death and will to live were strongly negatively correlated at three time points (baseline: (65) = -0.647, ⩽ 0.001; after 1 week: (55) = -0.457, ⩽ 0.001 and after 4-6 weeks: (43) = -0.727, ⩽ 0.001). However, visual assessment of scatterplots revealed a small, but substantial number of outliers. When focusing on these outlier patients, they showed clinically relevant changes between baseline and 6 weeks with the wish to hasten death changing in = 9 (15% of = 60) and the will to live changing in = 11 (18.6% of = 59). Interview data of three outlier cases illustrates unusual trajectories and possible factors which may influence them.
As they can co-exist in different possible combinations, a high wish to hasten death does not necessarily imply a low will to live and vice versa. Patients receiving palliative care can hold such seemingly opposing positions in mind as a form of coping when confronted with an existential threat of serious illness. Therefore, health professionals are encouraged to proactively engage patients in conversation about both phenomena.
许多重病患者会报告（暂时）希望加速死亡。即使在生命末期，许多患者仍怀有生存意愿。尽管一些研究表明这两种现象呈负相关，但它们也可能同时存在。目前对于加速死亡意愿和生存意愿之间看似对立的关系的了解有限，但这对于提供适当的护理和理解潜在的协助自杀请求至关重要。
研究并探讨在 6 周内加速死亡意愿和生存意愿之间的相关性。
采用混合方法设计的观察性前瞻性队列研究。对定量数据（加速死亡态度量表、视觉数字量表和（额外）验证过的问卷）和定性数据（半结构化访谈）进行分析，并结合案例描述进行说明。
地点/参与者：来自不同护理环境的接受姑息治疗的、患有各种基础疾病的患者，在进行有关死亡意愿的公开对话之前和之后。
在 85 名患者中，加速死亡意愿和生存意愿在三个时间点呈强烈负相关（基线：（65）= -0.647，p<0.001；1 周后：（55）= -0.457，p<0.001；4-6 周后：（43）= -0.727，p<0.001）。然而，散点图的视觉评估显示，有一小部分但数量相当多的离群值。当关注这些离群值患者时，他们在基线和 6 周时的意愿有明显变化，其中 9 名（15%的 60 名）患者加速死亡意愿发生变化，11 名（18.6%的 59 名）患者生存意愿发生变化。三个离群值案例的访谈数据说明了不同的异常轨迹和可能影响这些轨迹的因素。
由于它们可以以不同的组合同时存在，因此高加速死亡意愿不一定意味着低生存意愿，反之亦然。接受姑息治疗的患者在面对严重疾病带来的生存威胁时，可以将这种看似对立的立场作为一种应对方式。因此，鼓励卫生专业人员主动与患者就这两种现象进行对话。
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