The Desire to Die in Palliative Care: a Sequential Mixed Methods Study to Develop a Semi-structured Clinical Approach

Overview

Journal BMC Palliat Care

Publisher Biomed Central

Specialty Critical Care

Date 2020 Apr 18

PMID 32299415

Citations 11

Authors

Kerstin Kremeike

Gerrit Frerich

Vanessa Romotzky

Kathleen Bostrom

Thomas Dojan

Maren Galushko

Kija Shah-Hosseini

Saskia Junger

Gary Rodin

Holger Pfaff

Klaus Maria Perrar

Raymond Voltz

Affiliations

Soon will be listed here.

Abstract

Background: Although desire to die of varying intensity and permanence is frequent in patients receiving palliative care, uncertainty exists concerning appropriate therapeutic responses to it. To support health professionals in dealing with patients´ potential desire to die, a training program and a semi-structured clinical approach was developed. This study aimed for a revision of and consensus building on the clinical approach to support proactively addressing desire to die and routine exploration of death and dying distress.

Methods: Within a sequential mixed methods design, we invited 16 palliative patients to participate in semi-structured interviews and 377 (inter-)national experts to attend a two-round Delphi process. Interviews were analyzed using qualitative content analysis and an agreement consensus for the Delphi was determined according to predefined criteria.

Results: 11 (69%) patients from different settings participated in face-to-face interviews. As key issues for conversations on desire to die they pointed out the relationship between professionals and patients, the setting and support from external experts, if required. A set of 149 (40%) experts (132/89% from Germany, 17/11% from 9 other countries) evaluated ten domains of the semi-structured clinical approach. There was immediate consensus on nine domains concerning conversation design, suggestions for (self-)reflection, and further recommended action. The one domain in which consensus was not achieved until the second round was "proactively addressing desire to die".

Conclusions: We have provided the first semi-structured clinical approach to identify and address desire to die and to respond therapeutically - based on evidence, patients' views and consensus among professional experts.

Trial Registration: The study is registered in the German Clinical Trials Register (DRKS00012988; registration date: 27.9.2017) and in the Health Services Research Database (VfD_DEDIPOM_17_003889; registration date: 14.9.2017).

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