Objectives To determine the prevalence, severity and remission of desire for hastened death (DHD) in a UK representative sample of patients with advanced disease receiving palliative care and to examine the associations of desire for death.
Design A cross-sectional survey with 4-week follow-up.
Setting St Christopher's Hospice, Sydenham, South London, which is a large hospice with homecare, outpatient and inpatient facilities serving five London boroughs.
Participants 300 patients newly referred to the hospice for palliative care.
Main outcome measures The Desire for Death Rating Scale (DDRS).
Results At T1 33/300 (11%) reported DHD and 11/300 (3.7%) had more serious or pervasive DHD. Of those who expressed DHD at T1 and were interviewed at both time points, 35% no longer reported these thoughts. Of those who reported no DHD at T1, 8% reported DHD at T2. The majority of those who had more severe DHD at T1 had a reduced DHD score by T2. Factors associated with T1 DHD included presence of non-malignant disease, depression, more severe physical symptoms, hopelessness and perceived loss of dignity.
Conclusions The prevalence of DHD was at the lower end of that seen in previous studies using similar samples. More severe DHD was uncommon and for most part remitted to some extent during the study. The provision of symptom control and timely detection and intervention for depression coupled with a focus on optimising function, instilling hope and preserving dignity are likely to contribute to alleviation of DHD in patients with advanced illness.
- Accepted 7 June 2011.
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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Funding LR is supported by the COMPASS research collaborative and the European Commission's Sixth Framework Programme (contract no. LSHT-CT-2006-037777, EPCRC). WL is a MRC Clinical Training Fellow. AP is supported by St Christopher's Hospice. IJH is a NIHR Senior Investigator. MH is supported by the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King's College London and is a NIHR Senior Investigator.
Competing interests None.
Ethics approval The study was approved by Institute of Psychiatry NHS Research Ethics Committee (06/Q0706/93).
Provenance and peer review Not commissioned; externally peer reviewed.
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