Screening for the Desire to Die in the First Palliative Care Encounter: A Proof-of-Concept Study

Abstract

Context:

There is a lack of consensus about the appropriate moment to assess a potential wish to hasten death (WTHD) in patients with life-threatening illness, despite evidence of its positive appraisal among patients.

Objectives:

To evaluate the practical potential and acceptability of questions about the WTHD in the first palliative care (PC) clinical encounter.

Design:

A proof-of-concept single-arm unmasked trial.

Subjects:

We enrolled 30 advanced cancer patients, 16 inpatients and 14 outpatients in their first PC clinical encounter.

Measurements:

We assessed the WTHD using a semistructured interview guide, the Assessment of the Frequency and Extent of the Desire to Die (AFEDD) embedded in a multidimensional needs assessment carried out during the first PC encounter. Information about practical potential [patients consider the assessment (a) important and (b) helpful] and acceptability [patients (a) understand and (b) are not bothered by the questions] was obtained.

Results:

Thirty-two patients were approached and 30 (94%) agreed to participate. The WTHD was present in two outpatients and eight inpatients. The question to assess WTHD were well understood by 94% of patients and was considered not bothersome by 87% and quite or very helpful by 80%, regardless of whether they had WTHD.

Conclusions:

The results support that clinicians can integrate screening for the WTHD in usual clinical practice within a multidimensional needs assessment. Patient acceptability suggests that this as a part of patient-centered care including in the first PC clinical encounter. Further studies are needed to confirm efficacy and safety in larger and different populations.