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Psychooncology. 2018 Dec;27(12):2840-2846. doi: 10.1002/pon.4900. Epub 2018 Oct 16.

The role of perceived dignity and control in the wish to hasten death among advanced cancer patients: A mediation model.

Author information

1
Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
2
School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
3
Faculty of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain.
4
Faculty of Economics and Social Sciences, Universitat Internacional de Catalunya, Barcelona, Spain.
5
Palliative Care Service, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain.

Abstract

OBJECTIVE:

The objective of the study is to test a model in which perceived loss of dignity and control are proposed, along with symptoms of depression and functional impairment, as risk factors for the wish to hasten death (WTHD) in advanced cancer patients.

METHODS:

This was a cross-sectional study of 193 patients in an oncology unit. Outcome measures included perceived control, performance status, symptoms of depression, perceived dignity, and the WTHD. Structural equation modeling was performed.

RESULTS:

Structural equation modeling showed that perceived loss of control (-0.402) and functional impairment (-0.21) were risk factors for perceived loss of dignity. Loss of control (-0.385) and functional impairment (-0.283) were also risk factors for symptoms of depression. Perceived loss of dignity and symptoms of depression were the most proximal determinants of the WTHD, on which they had a direct, positive, and significant effect (0.246 and 0.209, respectively). Therefore, both symptoms of depression and perceived loss of dignity independently predicted the WTHD and mediated the effects of perceived loss of control and functional impairment on this wish.

CONCLUSIONS:

The hypothesized model provides evidence for the impact of the four aforementioned factors on the WTHD. Our results suggest that personalized care plans which are able to enhance the sense of dignity and control among advanced cancer patients could help to reduce the likelihood or intensity of a WTHD.

KEYWORDS:

cancer; control; depression; desire to die; dignity; functional status; mediation model; oncology; self-efficacy; wish to hasten death

PMID:
30251342
DOI:
10.1002/pon.4900
[Indexed for MEDLINE]

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