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Minority of patients express persistent desire for hastened death

Research at the Institute of Psychiatry at King’s provides new evidence on the prevalence, severity and remission rate of desire for hastened death (DHD) in patients with advanced disease. The research, published in the British Medical Journal Supportive & Palliative Care, shows that patients with persistent DHD are in a small minority, and identifies a number of risk factors associated with severe DHD.

DHD has received particular attention in recent years in ongoing debates over assisted dying for the terminally ill, a practice currently illegal in the UK. In this study, DHD is defined as a passive wish for death, a request for assistance in hastening death or plans to commit suicide. The researchers worked with 300 patients with advanced physical disease receiving palliative care in a large South London Hospice. They were interviewed twice at an interval of 4 weeks in order to track how DHD developed over time. 

Firstly, the study found that the prevalence of DHD was lower than that reported in previous studies and that severe DHD was uncommon. At the first interview, 11% of patients experienced some DHD and 3.7% experienced more severe DHD. 4 weeks later, the total cohort had decreased to 213 patients, of whom 14% experienced some DHD, and 3.3% experienced more severe DHD, suggesting a slight increase in the proportion of patients with DHD. 

Dr Annabel Price at the Institute of Psychiatry says: ‘This is the first study of its kind in the UK and is particularly topical given the ongoing debate around the legalisation of assisted suicide. The results showed that 11% of the patients reported any DHD. More severe or persistent DHD was uncommon in the sample (4%) and for the most part remitted to some extent over the study period.’

Secondly, the study found that persistent DHD was also uncommon, and that most patients remitted to some extent over the study period.  Over a third (35%) of those who reported any DHD at the first interview, no longer did so 4 weeks later and only one participant maintained a strong desire over the time period. These findings suggest that DHD is not stable over time. 

Finally, the study examined risk factors for DHD. The study found a greater association between non-cancer patients and DHD. The researchers also identified the strongest risk factors for DHD which included the presence depression and suicidal thoughts, patients’ physical, emotional and cognitive functioning, as well as the feeling of hopelessness and perceived loss of dignity. They also found the odds of DHD reduced as the level of social support increased. 

Previous research has suggested that a history of depressive illness, lack of religious faith, suicidal thoughts and the experience of approaching death were risk factors for DHD. However, this study found no evidence to support these associations.  

Recognition of these risk particular factors could help inform and identify interventions within palliative care services. 

Professor Matthew Hotopf, the principal investigator for the study at the Institute of Psychiatry says: ‘The provision of effective symptom control and timely detection and intervention for depression coupled with a focus on social support, optimising function and coping, instilling hope and preserving a sense of dignity are likely to contribute to the alleviation of DHD in patients with advanced illness.’

The study was supported by St Christopher’s Hospice. The authors are grateful to the patients and their families who generously gave their time to participate in the study. The authors thank the staff at St Christopher’s for making recruitment possible. 

The researchers were funded by the COMPASS research collaborative and the European Commission’s Sixth Framework Programme, the Medical Research Council (MRC), the National Institute of Health Research (NIHR) Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and Institute of Psychiatry, King’s College London. 

For full paper: http://spcare.bmj.com/content/early/2011/07/04/bmjspcare-2011-000011.full
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