7% of patients in home palliative care have a desire to advance death

A study with 43 PADES teams in Catalonia analyzed the desire to advance death in about 1,700 patients. The main reasons are spiritual discomfort, especially related to the lack of meaning and connection, psycho-emotional discomfort and ethical discomfort.

Fotografía del Banco dr Imágenes Enfermeras. Autoría: Ariadna Creus i Àngel García

Researchers from IDIAP Jordi Gol have studied the evolution of the desire to advance death in home care in relation to physical, emotional, spiritual, ethical and socio-family discomfort. Among its main conclusions, it stands out that the desire to anticipate death is a complex and changing phenomenon that can emerge at any time. "The presence of psycho-emotional, spiritual and ethical discomfort, especially in patients without a partner, should make us take a proactive attitude to identify it early", explains Xavier Busquet, the researcher leading the study.

Neither age, gender nor disease influence the desire to anticipate death

In total, 1677 patients were included in the study. Of these, 69% were cancer patients. In a total of 112 patients, almost 7%, a desire to advance death was detected in the initial evaluation. That 7% remained stable in the sample.

The researchers observed that neither age, gender, functional status or disease typology influence the desire to die earlier. In the case of patients who had, among their caregivers, a partner, or in those who presented cognitive impairment, less desire to anticipate death was detected. Also in the PADES teams that have a psychologist and social worker integrated, less desire to advance death was detected.

Regarding the medical diagnosis, in 1 in 5 patients with senescence and in 1 in 4 patients with end-stage renal failure, a desire to anticipate death was detected.

Regarding spiritual discomfort, the lack of meaning and connection were found as activating elements of the desire to advance death. On the contrary, the transcendence, that is, the fear of tomorrow and dying, was a protective element.

For the study authors, the Euthanasia Law should be able to respond to this group of patients, mainly those who reject palliative sedation.

Participating PADES teams: Alt-Empordà, Alt-Maresme (Blanes), Bages, Baix-Camp, Baix-Litoral (Sant Boi), Baix-Penedès (Vendrell), Cerdanya, Cornellà, Delta-Hospitalet Sud, El Prat De Llobregat (Delta del Llobregat), Garraf (Vilanova i La Geltrú), Geriàtric (Sabadell), Gironès i Pla de l’Estany, Gràcia, Horta-Guinardó, Baix Llobregat-Litoral SAP Delta, Les Corts, Mataró, Martorell, Mollet, Nou Barris, Pallars, Pal·liació Cerdanyola, Pal·liació Sabadell, Pius Hospital de Valls, Pla d’Urgell-Garrigues, Reus, Ripollès, Sant Cugat, Sant Feliu de Llobregat, Sant Martí Nord, Santa Coloma de Gramenet, Santa Susanna, Caldes de Montbui, Segrià Sud de Lleida, Selva Marítima (Blanes), Tarragona, Tarragonès, Tortosa, Badalona-Sant Adrià, Igualada-Anoia, Baix Ebre-Montsià, Dreta Eixample, Sants-Montjuic.