Wish to hasten death in Swiss palliative patients
M. Bernard1, C. Gamondi2, F. Strasser3, G. D. Borasio1 (1Lausanne ; 2Bellinzona ; 3St.Gallen)
The wish to hasten death (WTHD) has been the subject of growing interest in recent years, in particular because it is often associated to the debate about allowing or not assisted suicide for people with a life threatening illness.
As part of a study funded by the Swiss National Science Foundation in the context of a national program “End of Life”, we aimed to assess, within Switzerland’s three linguistic regions, (i) the level of WTHD and (ii) to what extent non-physical determinants (quality of life (QOL), psychological and spiritual factors) can be considered as predictors of WTHD.
A cross-sectional study involving face-to-face interviews with palliative patients in a Swiss university hospital was performed. WTHD was measured with the Schedule of Attitudes toward Hastened Death (SAHD, total score: 0-20), spiritual issues were assessed with the Schedule for Meaning in Life Evaluation (SMILE, total score: 0-100) and the Spiritual Subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp, total score: 0-48); psychological distress was assessed with the Hospital Anxiety and Depression Scale (HADS, total score: 0-42); QOL was measured with a visual analogue scale (0-10). One way ANOVA and multivariate analyses were performed.
Between September 2012 and January 2015, 206 patients consented and completed the protocol (51.5% were female and mean age=67.5 ± 10.9). First, results indicated that WTHD was higher in German and French than in Italian patients (respectively 5.2 ± 4.5, 5.6 ±3.5 and 2.6 ± 3.6; F=7.430; p=.001). Second, in the French part, the model explained 10.5% of the WTHD variance and psychological distress appeared as the only significant predictor (β=.475, p=.012); in the German part, the model explained 16.2% of the WTHD variance and psychological distress also appeared as the only significant predictor (β=.424, p=.001); in the Italian part, the model explained 19.4% of the WTHD variance and QOL appeared as the only significant predictor (β=.475, p=.030).
WTHD scores and predictors of WTHD differ by linguistic regions, revealing a particular sensitivity to this issue among the Italian patients, compared to the French and German patients. These results show the importance of considering the cultural background of the patients when addressing this thematic, for both research and clinical areas.