Desire for hastened death: how do professionals in specialized palliative care react?

Area of Science:

• Palliative Care
• Medical Ethics
• Psychology

Background:

• Desires for hastened death (DHD) are common in terminally ill patients.
• Health professionals (HP) often lack preparedness in managing DHD.
• Specialized palliative care health professionals (SPC-HP) frequently encounter DHD.

Purpose of the Study:

• To identify SPC-HP responses to DHD in clinical practice.
• To determine the functions of these responses within patient-SPC-HP interactions.

Main Methods:

• Conducted narrative interviews with 19 SPC-HPs across four German university hospitals.
• Analyzed interview transcripts using the documentary method.
• Compiled an inventory of responses to DHD and reconstructed their functions.

Main Results:

• Identified 12 response categories and 6 corresponding functions.
• Patient-level responses focused on symptom control, exploring reasons, generating perspective, reorientation, and hope.
• Interaction-level responses emphasized relationship building; SPC-HP level responses served self-protection and professional expertise.

Conclusions:

• Responding to DHD requires significant personal and professional development for SPC-HPs.
• Establishing therapeutic relationships is crucial for all SPC-HPs.
• Enhancing skills in relationship building and resilience, potentially through training, is recommended for SPC-HPs.