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Complexity of desire for hastened death in terminally ill cancer patients: A cluster analysis

Published online by Cambridge University Press:  01 March 2021

Yutaka Hatano*
Affiliation:
Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
Tatsuya Morita
Affiliation:
Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, Hamamatsu, Japan
Masanori Mori
Affiliation:
Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Japan
Isseki Maeda
Affiliation:
Department of Palliative Care, Senri Chuo Hospital, Osaka, Japan
Shunsuke Oyamada
Affiliation:
Department of Biostatistics, JORTC Data Center, Tokyo, Japan
Akemi Shirado Naito
Affiliation:
Department of Palliative Care, Miyazaki Medical Association Hospital, Miyazaki, Japan
Kiyofumi Oya
Affiliation:
Transitional and Palliative Care, Aso Iizuka Hospital, Fukuoka, Japan
Akihiro Sakashita
Affiliation:
Department of Palliative Medicine, Kobe University School of Medicine, Kobe, Japan
Satoko Ito
Affiliation:
Hospice, The Japan Baptist Hospital, Kyoto, Japan
Yusuke Hiratsuka
Affiliation:
Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan
Satoru Tsuneto
Affiliation:
Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
on behalf of the EASED Investigators
Affiliation:
Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan
*Corresponding
Author for correspondence: Yutaka Hatano, Department of Palliative Care, Daini Kyoritsu Hospital, Kawanishi, Japan. E-mail: yutakahatano1@gmail.com

Abstract

Objectives

The present study aims were (1) to identify the proportion of terminally ill cancer patients with desire for hastened death (DHD) receiving specialized palliative care, (2) to identify the reasons for DHD, and (3) to classify patients with DHD into some interpretable subgroups.

Methods

Advanced cancer patients admitted to 23 inpatients hospices/palliative care units in 2017 were enrolled. Data were prospectively obtained by the primarily responsible physicians. The presence/absence of DHD and reasons for DHD were recorded. A cluster analysis was performed to identify patterns of subgroups in patients with DHD.

Results

Data from 971 patients, whose Richmond Agitation–Sedation Scale score at admission was zero and who died in palliative care units, were analyzed. The average age was 72 years, common primary cancer sites were the gastrointestinal tract (31%) and the liver/biliary ducts/pancreas (19%). A total of 174 patients (18%: 95% confidence interval, 16–20) expressed DHD. Common reasons for DHD were dependency (45%), burden to others (28%), meaninglessness (24%), and inability to engage in pleasant activities (24%). We identified five clusters of patients with DHD: cluster 1 (35%, 61/173): “physical distress,” cluster 2 (21%, 37/173): “dependent and burdensome,” cluster 3 (19%, 33/173): “hopelessness,” cluster 4 (17%, 30/173): “profound fatigue,” and cluster 5 (7%, 12/173): “extensive existential suffering.”

Conclusions

A considerable number of patients expressed DHD and could be categorized into five subgroups. These findings may contribute to the development of therapeutic strategies.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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